Stiffness, swelling, and pain may be the hallmark symptoms of inflammatory arthritis such as rheumatoid arthritis, but many people with RA, psoriatic arthritis, ankylosing spondylitis, and other types of inflammatory arthritis don’t expect to encounter the forgetfulness and trouble thinking that often accompany these diseases.
With autoimmune diseases like these, your immune system starts attacking your own body. Normally people with RA and PsA feel that inflammation assault in their joints, where your body’s cells attack your own tissue, but the constant inflammation can affect other parts of the body too.
Experts haven’t pinned down the exact link between arthritis and cognition problems, but they suspect that proteins released by the immune system called cytokines might be a factor, says Ashira Blazer, MD, a rheumatologist at NYU Langone Health in New York City. When immune flares release cytokines, they send signals in your brain that get in the way of its normal functioning — and you feel that as arthritis brain fog.
On top of all that, the chronic pain of these diseases makes your entire nervous system extra sensitive, says John Davis III, MD, a rheumatologist with Mayo Clinic in Rochester, Minnesota. Especially when your arthritis is extra active, it can cause a domino effect that affects your whole body. “Inflammation levels may be high, and that may contribute to pain, fatigue, and sleep disturbance — and that might contribute to the fog,” says Dr. Davis.
As your arthritis flares up, you can have trouble concentrating. You forget about important meetings. You lose your train of thought. You can’t find the words you’re looking for.
As if that weren’t frustrating enough, the reactions from other people can make it even worse. “The looks people can give you are awful,” says RA patient Vicki from San Antonio, Texas.
The cognitive effects of inflammatory arthritis are challenging, but with the right strategies, you can cut through the brain fog and help sharpen your thinking.
A little planning goes a long way in fighting arthritis brain fog. “Sticky notes and reminders in your phone can be important,” says Dr. Blazer. The key is to write *everything* down when it comes to grocery lists, meeting times, and To-Do list items. You’ll thank yourself later.
Less arthritis pain means usually means less brain fog, so asking for help with chores or taking breaks between tasks can ease all your symptoms. As great as your homemade chocolate chip cookies for the baseball barbeque might be, no one will begrudge you for picking some up from the bakery instead, or for having your partner make your grocery run for the ingredients instead you schlepping to the store. “Make the whole thing more manageable while not overdoing it to the point of a flare,” suggests Dr. Davis.
Arthritis can snowball at night. If pain and anxiety keep you awake, you won’t get the restful sleep your body needs, and that in turn can make you groggier the next day. Cue the arthritis brain fog. Getting extra rest with eight to 10 hours of sleep can help, says Dr. Blazer, but if you’re someone who deals with arthritis painsomnia, that’s easier said than done.
One of the best ways to prep your body for sleep is to stick to the same schedule every day. Try to go to bed and wake up at the same time every day — including weekends —recommends Dr. Davis. “That way you’ll have a regular rhythm about when the body gets sleepy,” he says.
If you generally need a nap during the day, give that a designated time, too.
You might need to switch your habits while you train your body into its new bedtime routines. Reading and watching TV in bed seem relaxing, but they could actually work against you, says Dr. Blazer.
“That trains your brain to be wakeful in the place where you should be sleeping,” she says. Curl up with a book in the living room instead, she suggests. That way, your body knows it’s time for brain fog-soothing sleep the moment you crawl under the covers.
Most of the time, your recommended medication will help brain fog by easing the rest of your arthritis symptoms. But every now and then, steroid-based drugs like prednisone might cause side effects like brain fog, anxiety, and sleeplessness, says Dr. Blazer.
Don’t ever stop taking a medication without checking with your doctor, or avoid one because of the slight risk of unpleasant side effects, but do keep in mind that finding the right arthritis drug might take some trial and error. If you suspect your medication is having a negative side effect, talk to your doctor about your options.
Your arthritis medications aren’t the only drugs that could be exacerbating brain fog. Inflammatory arthritis increases risk of heart problems, so you might be watching your cholesterol in addition to your joints. Brain fog can also be a side effect of cholesterol-lowering statins. Make sure your doctors are aware of all the medications you take as you discuss whether a change in your treatment may be necessary.
Attending parties can be double trouble for arthritis brain fog. Socializing can drain you, leaving you at a loss for words when you want them most. At times like that, be a listener while you wait for the brain fog to clear.
“I have learned to stay within my own energy envelope, accept what is going on, and rest until it goes away,” says Maisie, a rheumatoid arthritis patient from Tacoma, Washington. Don’t be shy about excusing yourself to sit down or go home on the early side. (Here are tips for surviving special events like weddings when you have arthritis .)
When you have a chronic condition, it’s normal to have anxiety about the future: What will your condition be like tomorrow? This weekend? Ten years from now? Using mindfulness to focus on the present can help. You can note the worrying thoughts as they come in, then let them go without dwelling on them.
“Being able to direct attention to the moment and not taking on stressors that haven’t presented yet can be a good way to compartmentalize and improve your mood,” says Dr. Blazer.
The idea of exercise can be intimidating when you’re worried about joint pain and other arthritis symptoms, but physical activity has a slew of benefits for inflammatory arthritis. Exercise can decrease inflammation, tire you out for a good night’s sleep, and strengthen the muscles supporting your joints. You’ll feel better from the inside out.
“It improves sense of health and wellness, and that can lead to advanced self-efficacy,” Dr. Davis says. “It gives the feeling that they can control the situation.” Stick with low-impact workouts like swimming and cycling, and start slow so you don’t overwork yourself.
You could kill two birds with one stone by using yoga as your workout. “It’s meditation and mindfulness rolled into exercise,” says Dr. Blazer.
When you’re at a loss for words or are having trouble concentrating, it’s easy to let frustration get the best of you. Instead of getting worked up over your arthritis brain fog, give yourself permission to stumble. “Sometimes it just takes a deep breath and starting over,” says Dr. Blazer.
Cognitive problems sometimes have a pattern, so you might be able to plan ahead. For some people, arthritis brain fog might be worst in the morning, when your joints are still warming up; for others, your fuzzy mind might peak as you deal with ongoing stress throughout the day. If you can pin down a brain fog pattern, you could have success scheduling concentration-heavy tasks during the times when you expect your thinking to be the clearest, says Dr. Blazer.