It’s Not Just All in Your Head – The Impact of RA on Mental Functioning

It’s Not Just All in Your Head – The Impact of RA on Mental Functioning

A quick read of the experiences of RA patients will reveal not only a common set of physical symptoms, but also an expression of changes in mental states and moods over time. These mental symptoms include mood swings, lack of interest in social interaction, depression, and what I like to call “brain fog” or more scientifically, cognitive dysfunction. The best way I’ve devised to describe this feeling for someone who doesn’t have RA is to think about how their brain feels while they have a bad case of influenza. Such dysfunction is associated with many autoimmune disorders.1

The connection between mood and RA has been known for some time. In fact, as far back as 1970, scientists reported a correlation between joint symptoms and mood in RA patients.2 And these results were repeated numerous times in the scientific literature.3

For many with RA, mood changes associated with RA are more difficult to cope with than the physical symptoms. It’s quite frustrating when your brain just won’t “get up and work right.” Yet, the American College of Rheumatology (ACR) does not include mood/emotional changes in its diagnostic criteria for RA. This is the case in spite of the fact that the risk of depression in RA patients is much greater than general populations.4

Cognitive impairment of any sort is not “just in your head” as many friends, family members, and even doctors believe. I argue that there may be biochemical processes involved with RA that bring about these symptoms. A complex set of biochemical processes are involved with RA. Part of these processes includes the overproduction of inflammatory chemicals called cytokines. According to some researchers, cytokines play a role in the brain of sick patients in determining mood.5 RA related inflammatory cytokines include interleukin-1, interleukin-6, and tumor necrosis factor-alpha (TNF). These cytokines are the target of many biological medicines for RA such as Humira, Enbrel and others. These cytokines are also related to depression.6 7  One group of scientists demonstrated the connection between cytokines and mental changes in RA patients. They stated,

“The ‘cytokine hypothesis of depression’ implies that proinflammatory cytokines, acting as neuromodulators, represent the key factor in the (central) mediation of the behavioural, neuroendocrine and neurochemical features of depressive disorders. Several medical illnesses, which are characterised by chronic inflammatory responses, e.g. rheumatoid arthritis, have been reported to be accompanied by depression.” 8

For me, the link between RA and mental symptoms is clear. There are times when my brain shuts down, I can’t think clearly, I’m depressed, and I just don’t want to be around people. And those times tend to be when RA symptoms are at their greatest.

In addition to cognitive dysfunction caused by the biochemical processes of RA, the medications we take to control the disease may also contribute to mental well being. Almost all of the disease modifying (DMARD), biologicals, corticosteroids, and pain medications list side effects linked to mental functioning. These side effects include dizziness, drowsiness, headache, mood changes, anxiety, and a litany other related issues. Like with any side effect, one must consider the tradeoffs. If I don’t take the RA meds, I’m more prone to permanent tissue damage. If I take the meds, I have to learn to manage the brain fog. With most patients, getting the disease process under control takes priority over side effects.

RA patients must be careful to not blame every mental issue on RA or their treatments. I’ve learned to be able to tell when mood swings and brain fog are associated with RA. My general practitioner told me that my ongoing tiredness might point to something other than just depression. It was during that time that other symptoms of RA became apparent ultimately leading to a referral to a rheumatologist, diagnosis, and treatment. I wish that all doctors had this level of insight because I hate reading about RA patients being dismissed because their symptoms are only “in their head.”

I hope that scientists and doctors continue to investigate the connections between autoimmune diseases and cognitive functioning. Perhaps it will even be used as an indicator of disease activity someday. Most importantly, I wish that all those suffering from RA would not feel guilty about changes in their mental state. Get on a good RA treatment regimen, don’t be afraid to take medications for depression or anxiety, talk to others about how you’re feeling, and speak to your doctor about any noticeable changes mood that impacts daily functioning.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. http://www.ncbi.nlm.nih.gov/pubmed/23622338
  2. http://www.psychosomaticmedicine.org/cgi/reprint/32/3/309.pdf
  3. http://cat.inist.fr/?aModele=afficheN&cpsidt=13998231
  4. http://web.a.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=16831624&AN=93445810&h=LkVSdYcorDB6yVg2gip1VozJMcWbwd3FaMpZzl53IHrLnnfX1bh5Te5DawYxYI6uO45R6ZuUVupVM3ExzEvOvQ%3d%3d&crl=c
  5. http://ajp.psychiatryonline.org/article.aspx?articleID=174101&resultClick=3
  6. http://www.biopsychiatry.com/cytokinesdep.html
  7. http://www.biopsychiatry.com/antidepressants-cytokines.htm
  8. http://www.ncbi.nlm.nih.gov/pubmed/15694227

Comments

View Comments (92)
  • Nell
    4 months ago

    I have been diagnosed with RA recently (after a few months of finger pain) and I’ve been on medication now for a a couple of months. I genuinely think my outlook and perspective in life has changed for better. I have been a lot happier in general. I think that is because I am not taking everything as granted anymore. I have started eating healthier, exercise more and spend more time with my friends. Maybe it is too early for me to have mental and cognitive symptoms but so far, I can’t complain.

  • merhohexate77
    4 months ago

    I can’t believe I logged in as misspelled Methotrexate! I am 77
    Diagnosed about 4 months ago
    Started with prednisone from my PMP who referred me to a tele-health Rheumatologist who started me on Methotrexate. I’ve been an RN for forty plus years, still work weekends. I remember all the little kids and teens on this drug for cancer in the 70’s at LA Children’s Hospital. Last week I took about my fifth week of once a week 4 pills on Tuesday and spent the next day slower and dumber than ever!
    Fatigue? Weakness? Now symptoms of the cure AND the disease!
    Ugh. I’m not happy with this reality!
    Do the fatigue and brain fog side effects of methotrexate get better..ever?

  • MareV
    1 month ago

    I started with. methotrexate about 5 years ago @6 tablets per week. I didn’t like the history of Methotrexate first being used for Cancer, but decided to take it. My overall pain has decreased on a daily basis, except for my knees which hurt EVERY DAY. My Dr. switched me to Methotrexate INjections and has increased the dosage amount, but there are days when I feel really bad. I did get used to the effects of the medicine and don’t notice them the next day as I first did. I was diagnosed when I was 65.

  • AuntieRA
    4 months ago

    Thank you for this article–it’s a reminder to me that I have to note this and discuss with both my rheumatologist and my general practitioner. No pun intended, but it is something I forget to discuss with them. I realize age can also influence it, but I am also still fairly young…thank you again.

  • HeidiKat
    5 months ago

    Great article! Thanks for the information. I’m well-educated, and I remember when I was “smart”. Now, I have a hard time with something as simple as word recall. You’re so right. I cognitively struggle most when my pain and fatigue are high.

    I have adrenal insufficiency and an adenoma on my pituitary gland. Thank you for explaining these connections. I’m not crazy after all, lol

  • Andrew Lumpe, PhD moderator author
    5 months ago

    Thanks for the kind words! There could be many reasons, including just the aging process, to explain a decrease in cognitive functioning. But it’s clear that RA can certainly contribute. Andrew, RheumatoidArthritis.net Team

  • Nina Winterbottom moderator
    5 months ago

    I’m so glad this article was helpful and made you feel understood, @HeidiKat! It takes such an emotional toll to deal with the cognitive effects. Stay strong and we’re thinking of you! – Nina, RheumatoidArthritis.net Team

  • deeacof
    5 months ago

    I am experiencing short term memory loss. This loss preceded RA symptoms. Could the two be connected?

  • Monica Y. Sengupta moderator
    5 months ago

    We cannot give medical advice (for your protection) but highly advise you speak with your physician about this symptom and anything related to it.

    Many community members experience what we call “brain fog” as a side effect of RA and the medications we take. I thought you might be interested in a couple of articles about it: https://rheumatoidarthritis.net/living/pain-and-um-i-forgot/

    https://rheumatoidarthritis.net/living/all-about-the-brain-fog-all-trouble/ (this article I wrote myself!)

    All the best, Monica

  • tryingharder
    5 months ago

    Hi thankyou for letting in the group, I’ll try not to bore you, but it’s nice to find a group of others like myself (rheu. .., anyway, I find that I get very angry at myself dropping things losing strength while try to complete a task, cursing at myself, very disheartening, I’m trying to lessen the expectations of myself, knowing that this disease is stealing from me. Thanks, any pointers or suggestions? I try and exercise, ride my bicycle to ease stress, but usually go to far and end up in bed most of the next day????

  • HeidiKat
    5 months ago

    I completely understand! I always think, “I used to be able to do these things. I used to be smart, I used to be strong…” There is nothing easy about a any decline in ability

  • Richard Faust moderator
    5 months ago

    Thanks for writing tryingharder and glad that you find the site and community helpful. Know that you are not alone in getting frustrated with the struggle to complete tasks or in pushing to hard and then paying the price. Thought you might be interested in this article from one of our contributors who is an occupational therapist on pacing: https://rheumatoidarthritis.net/living/shifting-gears-a-guide-to-pacing/. In addition, the emotional and psychological impact of dealing with a chronic condition like RA is very real and important. This article from our editorial team looks at managing these issues: https://rheumatoidarthritis.net/living-with-ra/managing-emotional-problems-and-stress/. Wishing you the best and know you are always welcome here for information or just a little extra support. Best, Richard (RheumatoidArthritis.net Team)

  • tryingharder
    4 months ago

    Andrew and Richard, Thankyou for your knowledge and insight, you really are saving me right now, from a scetchy bit of depression, scetchy in the part that my depression isn’t full on, thank God, some day’s I at least have the scruples to thank God for all that I really do have and try not to wallow in my self pity. sometimes this disease plays tricks on my mind, but reading your articles really helps knowing im not alone, God bless you all!

  • Andrew Lumpe, PhD moderator author
    5 months ago

    As a follow up to this article I wrote a few years back, here’s some new research on RA and mood disorders…

    http://www.rheumatologynetwork.com/rheumatoid-arthritis/mood-disorders-and-rheumatoid-arthritis-updates-eular-2018?rememberme=1&elq_mid=2156&elq_cid=1829629

    In the first study, Fragoulis and colleagues found a strong association between RA and depression and anxiety.1 In the second study, Bechman and fellow researchers in the UK uncovered a link between psychological and functional status that predicts flares in RA.2

    1. Fragoulis GE, Cavanagh J, Derakhshan MH, et al. Depression and anxiety in an early rheumatoid arthritis inception cohort: associations with epidemiological, socioeconomic and disease features. Presented at: EULAR 2018; June 13-16, 2018; Amsterdam, The Netherlands. Abstract OP0350.

    2. Bechman K, Sin FE, Ibrahim F, et al. Psychological and functional states predict disease flare following TNF inhibitor tapering in patients with rheumatoid arthritis: a post-hoc analysis of data from the Optimizing TNF Tapering in RA (OPTTIRA) cohort. Presented at: EULAR 2018; June 13-16, 2018; Amsterdam, The Netherlands. Abstract THU0115.

  • 2wacky
    5 months ago

    For one whose depression has been successfully treated with antidepressants, prior to RA diagnosis, is a change in dosage of antidepressants a common practice?

  • Andrew Lumpe, PhD moderator author
    5 months ago

    That’s a good question for which I don’t have an answer as we can’t give medical advice here. Perhaps others can chime in with their experience?

  • Nancyj99
    5 months ago

    Thank you so much for this story, it brought tears to my eyes, because I thought there was something wrong with me. I did not associate it with my ra or the drugs that I take to keep my ra at Bay!
    I’ve cancelled family get-togethers and always feel guilty doing so. I also have IBS which keeps me close to home some days.
    I don’t want to be alone some days but I don’t want to be with people either it’s so frustrating! Sometimes I force myself to go anyways and ignore the panic attacks brought on by leaving the house. And most times after spending time with my mom or other family members it does help. I can’t say that always follow this advice but, try to get out and be around people, people who love you and understand you!
    Nancy J

  • Andrew Lumpe, PhD moderator author
    5 months ago

    Hi Nancy, glad you liked the article. There can be many reasons for mood disorders but it’s clear RA and its meds can contribute. Glad you’re learning to cope and make adjustments. Andrew

  • 2wacky
    5 months ago

    No surprise that RA and mood changes have a high correlation. While pain has an impact, I find the profound fatigue that comes with early stages of an RA diagnosis is the most significant.

    Mind fog is a good term for a process we share with RA. However, the fatigue and the frustration of not being motivated or able to do normal activities is what I find is dragging me down. And once down, it is hard to get back up to my personal normal. At first, this element made me angry. That gave way to worsening depression. Acknowledging that makes me angry again. This is my first 24 hours on Enbrel so I hope I can get off of this seesaw.

  • Andrew Lumpe, PhD moderator author
    5 months ago

    Sure hope Enbrel helps you can quickly. My rheumy always says that the first sign a RA med is working is that you start getting some energy back. Andrew

  • 2wacky
    5 months ago

    Thanks for the comment. Still waiting for the giddy up and go to come back. More frustrating is the lack of endurance when I find motivation to move. On the bright side, I seem to find the motivation to move a little more frequently.

  • ladyliliebelle
    6 months ago

    Does anyone have hair loss with RA and dry skin?

  • Nancyj99
    5 months ago

    Yes I have trouble with both. I found that eating peanut butter everyday will help promote new hair growth. It takes a while so you have to be persistent.

    The only problem is I’m still losing hair and the new growth is never the length of my other hair LOL so my hair looks frizzy because of all the new growth.

  • Monica Y. Sengupta moderator
    5 months ago

    That’s so interesting! I’m glad this is working for you! I’ve never heard of peanut butter for hair growth so I’m very intrigued. Thanks for sharing! ~Monica

  • cogen
    6 months ago

    Thank you for posting this. Omg im not crazy thank you.
    Have been diagnosed with RA for roughly 5 yrs thought i could do this naturally and with no meds. Last 6 months has been hell fingers twisting severe pain but most of all feeling like i have chronic fatigue and periods were im lucky if i remember my own name. I finally caved and went to pcp today told me fingers are definitely twisting and with such elevated pain its time for a RA dr and meds but that the brain fog and fatigue were in my head. I couldnt believe that because no way would anyone want to feel like this.
    So thank you for validating im not crazy

  • Alesandra Bevilacqua moderator
    6 months ago

    Hey, cogen! I’m glad to hear this article was affirming to you. You are certainly not alone. Thanks for sharing with us. Thinking of you today! – Alesandra (RheumatoidArthritis.net Team)

  • starscream
    6 months ago

    As for mental side effects of meds: I discovered one med causes paranoia only after accusing a colleague of stealing our work and taking all the credit. The colleague had not done this at all! I checked my meds for side effects after the colleague countered that I was acting paranoid and aggressive. Prednisone had made me so aggressive I no longer ever take it. And that keyed me into checking up cortisone, which sure enough causes paranoia! I explained everything to my colleague along with an extended and often repeated apology. But the damage in our collaboration is done.

  • Monica Y. Sengupta moderator
    6 months ago

    Oh no!! I am so sorry to hear this, starscream! I’ve definitely experienced conversations like this as well, especially due to Prednisone!

    I wish people tried to understand more what we are going through, but some just won’t. It’s an awkward situation, for sure, when it’s in a work environment.

    Thank you so much for sharing!! ~Monica

  • starscream
    6 months ago

    Please post an article about overcoming brain fog and treatment options. I don’t believe we need to live with it. I refuse to accept that this cannot be handled. Some days I’m fine, no fog at all, others I am lost to the world. I seem to have settled into the fine mode for quite a few months now taking a certain combo of meds and eating rules mostly told to me by friends. But I would love to hear medical advice on this. It seems rheumatoidarthritis.net has posts on a daily basis as if brainfog is how our lives will be forever and I don’t see that as necessarily true. I don’t see that reassuring people that brainfog is normal (and maybe in funny in some of the FB posts) is helping. We need to know actions to take. I wrote a list for myself to read when in brain fog: tasks to do, meds to take, anything to guide me out of it towards when my brain in clear again. The biggest reassurance is not that it is normal and part of RA, but that it will be over and I will have smart days again between flares.

  • Monica Y. Sengupta moderator
    6 months ago

    Thanks for the feedback, starscream!! I am not sure if this is a helpful article but I just wrote one on how brain fog affects me and how I try to deal with it — unfortunately, for me personally, I still can’t kick it but I can sort of (sort of!) control it! I wish more people acknowledge brain fog…It’s real, it’s there and we can’t ignore it!!

    https://rheumatoidarthritis.net/living/all-about-the-brain-fog-all-trouble/

    Like you, I also make lists and post reminders because when my brain fog hits I can forget everything!

    Please let me know if this article is helpful or not. I’ll pass along this topic idea to the other contributors and see if someone can address it in an upcoming article!

    Thanks again! ~Monica

  • anitarelief
    6 months ago

    That certainly is a positive way to look at the brain fog. We have to give ourselves a break and be a little easier on ourselves, especially when we flare up. I know I get so angry because I am physically unable to do what I want to do, thus getting mad at myself/disease. The ups and downs of the Prednisone are horrible as well, but it does help with the swelling. PLENTY of other side effects but sure does bring down inflammation and pain.

  • starscream
    6 months ago

    I felt brain fog on no meds too…

  • Debwhite
    6 months ago

    Hi my name is Debbie , i just joined and already i have learned so many things i am going to try to implement in my daily life.So thank you all for sharing .It took years to diagnose my RA and begin real treatments im not in remission yet but trying a new infusion Orencia . Remicade was working great for 4 months felt like new person but then to many infections sooo now we will try this im hopeful .Appreciate any info you might share about Orencia .Again thanks for input.
    God bless

  • Andrew Lumpe, PhD moderator author
    6 months ago

    Hi Debbie,
    Glad you found this community. It’s important to have connections to quality information and people who are also dealing with RA. Unfortunately, you’re not alone with it taking a while to receive a diagnosis. RA can sneak up on you sometimes. Your experience with changing meds is also not uncommon. Everyone responds differently to different medications. I do hope that Orencia does the trick for you. Below is a link to some information about Orencia.

    https://rheumatoidarthritis.net/treatment/orencia-reviews-how-well-does-it-work/

  • southerngirl72
    7 months ago

    I am so glad I read this. I have been struggling with various cognitive sx off & on for the last couple of months. I have also had an exacerbation of joint pain & swelling. I knew there must be a connection!

  • Andrew Lumpe, PhD moderator author
    7 months ago

    Glad you found the article interesting. There may be many reasons for lack of cognitive functioning and RA could certainly be one of them. Hope you get some relief soon.
    Andrew, Patient Advocate

  • stephgavaladon
    7 months ago

    I’m feeling the same way. I hate every minute of this! Depression is part for sure!! Your not alone!

  • pattieh
    8 months ago

    How can depression NOT be part of RA? I was diagnosed 6 months ago, im in pain, I’m tied, prednisone has made me fatter and ruined my skin, methotrexate is making my hair fall out. I can’t do the things I used to enjoy. I hate this and I want my life back!! Yeah, depression is part of RA!!!

  • Monica Y. Sengupta moderator
    7 months ago

    Thanks for sharing, pattieh! I wish more doctors would make the connection between mental health and these horrible autoimmune conditions. Please reach out if you ever need to talk!

  • mcadwell
    8 months ago

    I had a partially eidetic memory…until I became sick at age 33 (I’m 51 now). Suddenly, on top of pain, fatigue, and other comorbidities, I suddenly couldn’t remember things like my personal phone number, names of friends and family, and even how to get home (I’d just drive around town until something I saw clicked and I could figure out where I was…then I could finish driving home). Yes, it was that serious.

    I’ve found that some foods I eat cause more brain problems than others (i.e. food allergy to pectin – pectin containing foods cause more brain fog). Weather changes too, as does overdoing things (which is ongoing because, apparently, I can’t seem to figure out when I can and when I can’t continue doing things, until it’s too late).

    I’ve started seeing a therapist so hopefully that will help with the depression. Time will tell.

  • CaseyH moderator
    8 months ago

    Hi mcadwell, thanks for sharing. I’m sorry to hear about your ongoing battle, and the struggles you have had with your memory. However, I really appreciate what you wrote about learning how food and other “triggers” like the weather affect your memory. These are not only great tips for others, but also demonstrate that you know your body well and are listening to the things its telling you. That’s really great to hear! As you mentioned, this is an ongoing, evolving journey, but I’m glad to read that you’re finding additional support through a therapist. That is such a healthy and positive decision to make. Please keep us posted on everything, and know that we’re here for you whenever you need! -Casey, RheumatoidArthritis.net Team

  • MareV
    1 month ago

    Casey….I am responding to your thoughts on food and weather aggravating your RA. I went for a foot massage today, because I have been having body aches and severe knee pain. It felt so good when the massuse massaged my feet and my knees but afterwards, my knees felt worse and I experienced sharp pain shooting down my leg. Has anyone experienced bad symptoms after getting a massage?

  • Cammy55
    9 months ago

    Thank you Andrew for this article. I was recently diagnosed with RA and Sjogren’s. I have been dealing with a lot of fatigue and brain fog a lot. I had gone back to school for my RN (I am an LPN) and I struggled. Couldn’t understand why I couldn’t remember things that I know I knew or when I needed to complete a task I would just stand there and look and struggle to remember what I needed to do. I didn’t know that this could be related to my RA. I have talked with my physician and I am now on Methotrexate but some days I still struggle. I work in dialysis have for the past 17 years, have done tasks repeatedly but I seem to zone out, like I can’t figure out what I am supposed to do. I have to walk away or leave the floor and go back, sometimes this works but I have to push myself. Your article helped me to realize that I’m not going crazy and to look for options to help deal with the fog and fatigue.

  • CaseyH moderator
    8 months ago

    Hi Cammy55, I’m so sorry to hear about your recent diagnoses, and your accompanying struggles with fatigue and memory. However, it is so impressive that you have been able to go back to school and fight through some of these issues like a champion. That initiative shows just how strong you are. I also really liked how you mentioned that although these struggles do come up while performing your work, you know when you need to walk away and give yourself time to recoup. That shows that you are listening to your body and what it needs. So great! Also, as you mentioned, you are certainly not going crazy! This is such a real and common experience that many of our community members report struggling with! I’m glad this article was helpful for you, and has got you thinking about other ways you may be able to manage your fatigue and brain fog. Please keep us posted on your journey, and let us know if there’s anything we can do to help! -Casey, RheumatoidArthritis.net Team

  • Indigo2
    9 months ago

    Thank you for this article & discussion.

  • CaseyH moderator
    8 months ago

    So glad this resonated with you, Indigo2! -Casey, RheumatoidArthritis.net Team

  • kingkatekong
    10 months ago

    I have had an RA diagnosis for less than a year and in that time I have had to quit two jobs (sadly, I was only a few months into a new job when I first got diagnosed), have been to urgent care twice because I thought I was dying from fatigue–not understanding this is a symptom of RA, have had mildly successful hand surgery, and in roughly 9 months I have had anywhere from 6-8 weeks of being completely incapable of functioning because of fatigue–brain fog specifically. I’m currently unemployed and desperately want to go back to work, but I don’t know how to reconcile my next episode of fatigue with a new employer–i can muscle through pain (and pain, if severe enough, can be treated with medication), but as my rheumatologist keeps telling me, there is nothing to treat the fatigue. arggghhhhh!!!

  • CaseyH moderator
    8 months ago

    Hi kingkatekong, sorry for the delayed response, but I just stumbled across your comment! I’m sorry to hear about your recent diagnosis and your need to leave two of your jobs. How frustrating and upsetting! I’m glad that you’ve had a somewhat successful surgery, however, I’m sorry your RA-related symptoms have led to hospital visits and such a long period of being out of commission. Your concern about communicating with a potential new employer about your RA are very valid, and something many of our members report struggling with. I’ve found two articles that you may be interested in on this topic, if you want to check them out! The first is on community thoughts on this issue that I thought you may connect with, https://rheumatoidarthritis.net/living/community-thoughts-strategies-work/ and the second is on workplace accomodations, https://rheumatoidarthritis.net/living/ra-and-workplace-accommodations/ Wishing you the best, friend! -Casey, RheumatoidArthritis.net Team

  • starscream
    6 months ago

    I don’t agree that there is no way to address the fatigue. There must be something. I have some days with no fatigue and others with terrible brain fog (which is beyond tiredness). I’ve been recommended by my dr to sleep ten hours a night, which helps, and I mean sleep not lying in bed in pain hoping to sleep. Also certain vitamins seem to help which were recommended by a friend with RA who was recommended them by her dr. I can’t say this is a cure, but I don’t see why we are expected just to accept brain fog.

  • kristin
    12 months ago

    Besides the pain…this is one of the most frustrating parts of having r.a.
    I have R.A, Type1 diabetes and to make my brain worse…A.D.D! Talk about a brainless mess! We know what the R A does… Horrible Fog! But then I get a low or high blood sugar on top of it.. there goes another part of my brain for a while until I can get sugars level and then throw my inability to concentrate at all with ADD and I am just basically out of the game plan! Having a family with 2 kids and everyone looking to me for answers becomes a joke at times! Sometimes It takes everything in me just to figure out where all my stuff is to get dressed for the day let alone tell them where their stuff is! 9 out of 10 times it makes me late for everything too! It’s becoming a not so funny joke! I used to multitask like no other and now, I’m lucky to find my shoes! Once I get out of the house and get to where I’m going.. I have to apologize for being late, and pray that someone ..anyone will maybe understand even just a little? Usually no luck there! I try so hard not to feel bad. I know I tried my best with the obstacles I have. I know if I looked differently. Maybe Godforbid using a walker or in a wheelchair, people maybe a bit more understanding, but once again I Pat myself on the back and say to myself…. You did the best you can! Who cares what others think. I know in my heart that I am strong.. that many wouldn’t even get out the door, so yayyyy for me! Late and non matching socks or shoes and all!

  • CaseyH moderator
    8 months ago

    Hi Kristin, I just wanted to let you know that I so admire your outlook and attitude. You definitely should congratulate yourself! You deserve it! You words are so perfectly descriptive, and I feel like I can truly envision what a day in the life for you is like when these things are occurring. I especially felt your comment about sometimes being overwhelmed with your own fog, that the thought of sorting out issues for your kids and family are just the icing on the cake. It’s very apparent how strong you are, and I hope you never doubt this for a second! Please keep us posted on everything, we’re wishing you the best and hope you’ll keep sharing your awesome attitude with us! -Casey, RheumatoidArthritis.net Team

  • rockcandi
    8 months ago

    You should pat yourself on the back Kristin, bc there are many who if in your situation, wouldn’t try at all! Keep your head up and don’t apologize for having diseases you’d never choose to have! You’ve inspired me for sure.

  • bc55
    2 years ago

    Wow – I thought I was losing my mind. I am so depressed that I’m losing weight and have no appetite. I used to have mega energy, but can’t seem to find the energy for doing anything it seems. I decline invites, don’t want to go out, et cetera. I am seeing a psychologist this week, however, and I praying that I can get out of the depression and fatigue and sadness I’ve found myself in. This is no way to live, and if this is the way it’s going to be forever, I don’t want to play.

  • Cammy55
    9 months ago

    I just recently got diagnosed with RA. I had always told my PCP about my fatigue and joint pain but due to other issues it was associated with that however thankfully he sent me to a Rheumatologist and some things became clear of why I was having these symptoms. I was attending college for my RN however I couldn’t continue I couldn’t concentrate, seemed like I was always in a fog and the fatigue, it was so hard to push myself to continue. Napping helps a bit however I’m an LPN in dialysis and work 36 hours a week and it’s so difficult some days, the fatigue, pain and just general blah feeling. Coworkers don’t understand because I work and push myself they think I’m fine but I’m not. I cry a lot at home when I’m alone. I just don’t know how much longer I can push myself to work when all I want to do is stay home and try to get by.

  • Jules58
    2 weeks ago

    Hi Cammy ! From a different perspective you know how your body is changing and your struggling to do everyday things. Then trying to rap your mind around going to work when you’re screaming inside because of pain. I know what that’s like. You could apply for SSI and work on getting your RA under control. Always remember if you get better you can go back to work. It will be 1 year on the 17th since I left my employment with the same company for 19 years due to my RA. I am searching for a treatment so I can revisit working in the future. Somedays that’s a dream as I wear my pj’s til noon and feel like I did a big stroke of business just making the bed and emptied the dishwasher. My feelings on therapy or psychiatrists is this, “pain makes me sad” can someone help take my pain away! I know & I care♡

  • Indigo2
    9 months ago

    I would suggest seeing a “psychiatrist” who specializes in Depression.
    It sounds like you are really depressed & the quicker you find treatment the sooner you will start to feel better. Take care.

  • Indigo2
    9 months ago

    I might add that there are “suicide prevention” hot lines in many cities & call if you feel really terrible, they will listen & direct you to help. aside: I use to work in Social Services

  • Lauren Tucker moderator
    2 years ago

    bc55,
    So sorry to hear you are experiencing this as well as having these emotions. You are not alone in your RA and there are many others in the community that are here to support you.
    We commend you on reaching out and getting some support from a psychologist.
    Please know when you do have these thoughts of depression and sadness we are here to support you but we always encourage you to seek support through a local support person or team in your area. The arthritis foundation does have support people locally that can be of assistance. See their link here: http://www.arthritis.org/

    We are glad to have you here and please check back with us at anytime.

    Gentle Hugs,
    Lauren (RheumatoidArthritis.net Team)

  • mxvkan
    9 months ago

    Thank you Lauren!
    Yes, depression but there is help!!!

  • gammabrit
    3 years ago

    Feel like i am goingg crazy or maybe have dementia, on top of the RA and Fibromyalgia. Neurologist tested me for rare PML virus, as a result of all RA meds. Negative but still have abnormal spots on brain. Anyone else have MRI? Lumbar puncture or PET Scan? I feel it cant be just brain fog. It has progressed..first couldn’t balance my checkbook and still cant. Now, it sometimes takes me 3 hours to get dressed. I feel trapped. I get so confused that i just cry. So much anxiety. Is this fog or something Else? I feel so alone

  • Jillian S moderator
    3 years ago

    Gammabrit,
    Thank you for reaching out to us- you have come to the right place! I understand that what you are going through is very scary. Have you discussed these these specific instances of not being able to balance your checkbook and taking a long time to get dressed with your doctor? I know that sometimes doctors can make us feel rushed but it is important to share these concerning experiences so that you both can best figure out the best way to approach them.

    Even though you feel trapped and confused, I want you to know that you are never alone. Our community is ALWAYS here to listen and support you.
    I thought you might be able to relate to this article written by one of our moderators with RA about anxiety: https://rheumatoidarthritis.net/living/anxiety/

    Many of our community members find it extremely helpful to talk about how RA affects their life in a support group or with a professional. If you are interested, feel free to contact the Arthritis Foundation http://www.arthritis.org/, which is an extremely helpful resource for conquering RA.

    Please let us know if you have any more questions, comments or concerns.
    We are here for you.
    Warm regards,
    Jillian (Rheumatoidarthritis.net Team)

  • Elizabeth Bramley
    4 years ago

    Hi, Andrew,

    Thank you for writing this. I’ve had RA for 13 years, and one of the most frustrating (and depressing) things about it is the effect so much mental and physical fatigue has had on my cognitive functioning. I used to run a research lab for a pharmaceutical company; now many days I struggle to put together a grocery list. But one thing I have found that has helped–given me several hours of improved mental and physical energy here and there–is phentermine. It’s a stimulant, widely prescribed for weight loss. You can’t take it all the time because you develop a tolerance to it, but I’ve found I can take it two or three times a week. It doesn’t affect my appetite or make me jittery; it just lets me feel, mentally, like the old me, at least for a few hours. I was wondering if you had any experience with phentermine or had heard of anyone else who had.

  • Jen
    4 years ago

    Hi Andrew, thanks so much for the information! Towards the end of your article you said that you’ve learned how to distinguish mental/mood issues from when its related to RA vs. something else. Can you expand on this a little bit or point me to another article that does? Thanks for your time!

  • Jen
    4 years ago

    Hi again, can’t seem to reply to your message so I’m replying to mine 🙂 Thanks for your response! I appreciate the time you’ve spent on your articles and replying to questions…they have helped me a lot!

  • Andrew Lumpe, PhD moderator author
    4 years ago

    Hi Jen, glad you liked the article. For me, the mental struggles from RA seem to accompany a flaring of joints and increase in fatigue. It can also happen when I push myself too much.

  • Loreen Hackett
    4 years ago

    Living with RA and any other autoimmune disease(s) is frustrating, to say the least, and it makes perfect sense depression and brain fog go hand in hand with it all. Having this stuff IS depressing – the pain, the loss, the ongoing search for personal strength, etc. Any doctor worth his salt should acknowledge this. The ‘trick’ is for you yourself to know there is no ‘fault’ in these feelings. Chemical reactions in the brain leading to emotion would seem to be a ‘no brainer’ when they are already off kilter in attempting to fight with an immune system gone haywire. I’ve been labeled as a ‘walking total immune dysfunction’, having about a dozen varying immune disorders – RA, RSD, Anklosing, ITP, Sjogrens, and some very rare bone marrow issue just to name a few. I am hoping that research continues – I read tons of this stuff – focusing on the involvement of cytokines and leukocytes, as they seem to be some nasty little culprits that keep getting connected with malfunctioning immune system, thereby effecting all sorts of brain activity. Very informative and promising article – thank you.

  • Andrew Lumpe, PhD moderator author
    4 years ago

    Loreen, thanks for the kind words about the article! These biochemical processes are very complicated and all connected.

  • Carolyn Haney
    4 years ago

    Thank you for this information about depression and brain fog. I have been on an emotional roller coaster for about four months now, it is especially hard for me to put on a happy face and pretend all is right with the world during these emotional breakdowns. I’m wondering what kind of impact losing my best friend and three family members all within the last four months has on my fibromyalgia and RA? If I’m not crying, I’m angry and so depressed. I’ve noticed I’m in more pain and I have trouble remembering what I did two days ago.

  • carol white
    4 years ago

    Wow– I mean WOW! I had no idea about the brain fog, and that has been suddenly happening over the past 2 months. At first I thought it was mildly amusing (at work: “answering” my mouse, when the phone rings…), but then it started to upset me to the point that I called my doc and acupuncturist for help (at times I can barely remember entire days). I was told to take the B-vits and AA also — which has helped. I’m dealing with GERD also, and I’m assuming this has a relation to the brain fog also. (Ref. Hermix’s comments). Up until this very moment of reading your article and the comments, I thought some form of dementia was setting in. You have no idea how relieved I feel at this moment… well actually, you– and many others– do! Thank you!

  • Andrew Lumpe, PhD moderator author
    4 years ago

    Glad you liked the article Carol. I’m sure some of our brain fog is related to aging and other things. But RA seems to contribute.

  • Hermix
    4 years ago

    Thanks very much for posting this article.
    Brainfog is definitely an inflammation related symptom. Unfortunately I have another chronic disease (ulcerative colitis) and I know from the past when it flared up I also had a malfunctioning brain, exactly the same way I have it now with RA when it’s active. Doctors don’t think it’s a relevant complaint, though for me as an academic it’s devastating for my professional career. Because of this I can’t work for more than 50%, which causes a lot of financial troubles, apart from the frustration. I used to have an infallible memory and nowadays I often feel like I’m an elderly person suffering from dementia.
    I would like to point out, though I really appreciate your article (there can’t be enough attention for this problem), that it’s important to make a distinction between cognitive and mood disorders, since a different kind of neurological processes and neurotransmitters are involved in them. Depression and cognitive disorders often go together but not always. Even though my situation is miserable I’m generally in a good mood (just not when I’m agitated) but my brain still doesn’t function properly. I think one of the main reasons I can keep up the good spirit is that I fully accept that I have to rest a lot and also because of my ability to enjoy little things, like the flowers and birds in my garden or a nice conversation with a neighbor or something.
    Considering self treatment I therefore focus on improving my cognitive functioning. Recently I started with orthomolecular supplements and must say that especially adding B-vitamins and certain amino acids has improved my brain function and my energy level as well. Also my sleep duration and quality have improved, which I’m very happy about. It didn’t cure me (yet) but now I have more often a day without afternoon nap and still feeling reasonably feeling well to the end of it.
    I hope that doctors in the future will start paying more attention to the well being of their patients, and not so much focus on medical definitions.

  • starscream
    6 months ago

    I agree, as a person whose profession needs my brain to function, that the brain fog is a serious problem separate from depression. I also find vitamin B helps but I also take Mg and D as recommended by a friend and I take claritin daily which seems to help. I also sleep ten hours a night. Then when it is time to work, I test myself for brain fog (an online IQ test is an easy quick assessment) before starting something. If my brain fog is bad I all in sick and sleep (and will catch up the work over the weekend). If it is so-so then I do tasks that don’t require brilliance (writing up reports, editting, etc), and if my brain is clear, then I do the serious technical thinking that is needed for the rest of my job. Overall my job performance is quite high since the RA dx 4 years ago but my weekends are gone.

  • Andrew Lumpe, PhD moderator author
    4 years ago

    Thanks for reading and commenting. Sorry you’re battling two autoimmune diseases and that it’s impacting your work :(. You make a good point about differences between cognitive and mood disorders. They tend to be comorbid.

  • Loretta Tweed
    4 years ago

    I am so glad to have found my way here. I don’t feel so alone.
    Thank-you everyone…:)…

  • Andrew Lumpe, PhD moderator author
    4 years ago

    Loretta, your comment made my day and reinforces why this site and others like it are so important for RA patients. Glad you found us!

  • Dana Sebek
    5 years ago

    Andrew, thank you for this article. I am a chemo nurse studying for my NP and have been studying a lot of cellular processes for RA. I was diagnosed in 2010. Since I’m in grad school, my brain fog is not there, thank heavens. Its interesting that a lot of these pathways are similar in breast cancer, which is what I work in. Chemo of course causes chemo brain, so I find the parallel interesting. There’s so much about RA that needs to be told! I’ve suffered from Depression too for most of my life. Not a week goes by that suicide comes to the forefront. There it is. I have wonderful doctors, but pills can only do so much. Therapy is long and grueling. Anyway, once an NP, my options are endless and it will be interesting to see where I end up. In Rheum, in cancer, in celiac??? maybe even in psych. So many diseases that need people who have the disease treating them. I hate every minute of every disease I have, but know that my experiences are hopefully helping others. I look forward to your future posts. Found you on facebook. dana

  • Loretta Tweed
    4 years ago

    Loved your post! Thank-you so very much!…~hugs~ <3

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Dana, Thanks for reading the article and so sorry you suffer so much. But it sounds like you have been able to focus on your medical career and hopefully you can have a positive impact on many for years to come.

  • Cayenna
    5 years ago

    I have struggled with depression my entire life. Looking back, I have had symptoms of my various conditions (RA, fibro, and narcolepsy) for about the same length of time. No matter what I did, I could never get rid of the depression and anxiety that plagued me.
    After realizing I had RA about 6 years ago, and getting treatment, it started easing in a way it never had before…. As I got treatment for the fibro and narcolepsy, it continued to get better. Now, despite the pain and stress of being an (almost) single mom and working, my depression has been in remission for almost two years. I realized a while ago that there was a connection for me, but this article made my day!!!!

  • Indigo2
    9 months ago

    You rock! Keep on keeping on!

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Cayenna, you made my day by telling about how good things have gotten for you! Glad the article resonated with you.

  • Rena McDaniel
    5 years ago

    Thank you for this article. I suffered for 2 years being told “It was all in my head” because my Felty’Syndrome was triggered after a car accident. I can’t tell you the pain this caused me!

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Rena, so sorry for that. Glad you liked the article.

  • Mary
    5 years ago

    Thank you for this article. The information you present is helpful but has both positive and negative interpretations. Yes, there have been years of literature pointing to depression and RA, cognitive difficulties and RA. The historical literature also describes hysteria, catastrophizing, an RA personality, and other mental processes that are simply not based in fact. The literature about depression and RA is over-simplified. There is a legitimate grief response to a catastrophic loss when RA hits hard that is likely NOT clinical depression. So, when you cite historical literature please be very careful to be aware of the mythology that has been built around RA and cognitive processes. From a personal perspective, I agree with you. I have severe, aggressive, and erosive RA. When I was first diagnosed, the drop in my cognitive functioning was astounding. I couldn’t put sentences together, my writing was full of mistakes, my speech was slow, and memory was poor. I am convinced there was an undefined pathophysiological process occurring my brain related to RA. Perhaps inflammation, perhaps cytokines. The danger in labeling RA people with cognitive dysfunction is that we may be labeled as less than competent and seen as poor handicapped people. Now that I have regained about 90% of my cognitive functioning, I do not appreciate when people speak to me like I’m a 3 year old. Lene Anderson has posted about this phenomena as well. I am a highly educated, articulate woman who worked with people with disabilities all of my professional career. It is astounding to me to be treated, from time-to-time, as if I don’t have a functioning mind. The benefit of addressing cognitive functioning and RA is that there can be a period of time, either brief or extended, where cognitive functioning is affected by RA. More CREDIBLE research on this intriguing phenomena is certainly warranted. Thanks again, Andrew.

  • starscream
    6 months ago

    Mary, what treatment plan did you use that improved your cognitive process by 90%?!!! People here are saying their doctors don’t do anything about their brain fog. There are many posts constantly acting like brain fog is just what we are stuck with! I won’t believe it. It must be curable. It is a higher priority for me as a tech professional than joint pain and becoming physically handicapped. I miss work for brain fog and I am only in my forties. So please, how did you regain 90% of your cognitive functioning?

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Thanks for the reading and the comments Mary. That’s disconcerting that people have treated you with such disrespect! I did write a post about the grieving processes involved with chronic diseases like RA…
    http://rheumatoidarthritis.net/living/grieving-part-living-chronic-disease-like-ra/.

    I’ve known Lene Andersen for sometime now and respect her deeply as she’s a tireless advocate for RA.

  • Cheryl Buhr
    5 years ago

    I found this interesting. I am reluctant to take anything for the depression and anxiety. Still hoping that once I get my RA under control and manageable the depression and anxiety will subside.

  • Carolyn Haney
    4 years ago

    Cheryl, I suffered with anxiety to the point that I was blacking out. The doctor I was seeing told me I was having seizures but he was wrong, I went to another dr that really listened to me and after many tests told me I was having severe anxiety attacks and put me on Xanax and they stopped immediately and I’ve never had another black out spell. This all happened years before I was diagnosed with Fibromyalgia and RA, please don’t let it get out of hand. I was one of those people who had trouble swallowing an asprin!

  • Loretta Tweed
    4 years ago

    I am on an Antidepressant. It has helped me…

  • Connie Rifenburg
    5 years ago

    Cheryl, can I ask you why you are reluctant to take anything for depression and anxiety, but are willing to take meds (I am assuming) to treat your RA?

    The drugs that treat the depression and anxiety are no worse or better than those that we must take to bring our RA under control. I know I resisted taking any narcotic for pain for many years after I was diagnosed but during a 2 yr flare, I was finally told by my RH dr. that it was better for me to take oxycodone, then it was for me to take increasing amounts of the darvoset due to the tylonol in it and it’s affect on my liver. I was shocked to find that I could take one oxycodone 2/day and have better, longer relief, than taking darvoset every 4 hrs and still having break thru pain. I have been on that same dose of oxy for 2 years now and haven’t felt the need or desire to take more. (that’s what I was afraid of..would I keep needing more) In my case. NO. I also take Prozac in the day and Klonpin at night (for restless legs). I don’t fight taking these anti-anxiety meds for the same reason I take the prednisone and the Orencia, and the Lyrica, & even the stomach meds (which help protect my stomach from so many other pills). I want the quality of my life to be the best it can be.

    If you are in a flare, you are under stress, there is no other way to feel during a flare. Why not concentrate on allowing yourself to fight other symptoms of RA rather than trying to keep yourself from being depressed or having any anxiety attacks because you’d rather not take those kinds of pills.

    I guess what I’m saying is: be open to trying different cocktails of meds that together, can make your life so much more manageable. I know it can be scary especially if you were like me and rarely if ever, took even an aspirin for most of my life. Suddenly, my life is ruled by the number of pills I take and how they interact and how they either help or need to be changed. It’s just a part of the whole picture of RA (and it’s associated other illness). Medications are a way of life with RA and with the right combinations, we can sometimes find the good in even while taking all these expensive drugs. Best of luck to you.

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Glad you liked the article. I do find I’m in a better frame of mind when RA is under control.

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