Several years ago I wrote a post about brain fog caused by the biochemical processes of rheumatoid arthritis. The inflammatory chemicals, including cytokines, produced during an autoimmune response can impact nervous system functioning and cause brain fog – or more accurately, cognitive dysfunction. The best way to describe this for someone who doesn’t have RA is to think about how their brain feels while they have a bad case of influenza.
Lately I’ve been wondering about cognitive dysfunction caused by the vast array of medications used to treat RA. This wondering is grounded in the fact that for the past few months I’ve just not felt sharp in thinking and the timing of that goes along with some changes in medication and dosing. I was also reminded of a colleague years ago who was battling multiple sclerosis, another autoimmune disease, and how the medications he was taking caused changes in his cognitive functioning to the point where he could no longer perform his job effectively resulting in his taking disability leave. At the time I didn’t understand what was going on with him but now I have empathy.
I spent a little time exploring the side effects of various medications used to treat RA and its symptoms. Below is a list of side effects related to brain functioning. This confirms what I hypothesized…these drugs can impact cognitive functioning. I suspect that part of my recent “fogginess” is a combination of the biochemical processes of RA coupled with the side effects of my treatment regimen. 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. I’m done writing this post now as I can’t focus any more attention to complex tasks!
Disease Modifying (DMARDs)
Methotrexate[i]
- dizziness
- drowsiness
- headache
- confusion
Plaquenil (hydroxycholoroquine)[ii]
- Blurred vision or eye problems
- Headache
Arava (lefunomide)[iii]
- Headache
Imuran (azathioprine)[iv]
- Lightheadedness or fainting
Biologicals
Enbrel[v]
- Blurred vision or sudden change in vision
- Lightheadedness, fainting, seizure, or trouble thinking
- Depression, or mood or behavior changes
- Mild headache or dizziness
Humira[vi]
- Changes in vision or eye pain
- Headache
Orencia[vii]
- Dizziness, drowsiness, or lightheadedness.
- Headache
Rituxan[viii]
- Changes in vision
- Confusion
- Dizziness, lightheadedness, or drowsiness
- Problems with coordination or speech
- Anxiety
- Trouble sleeping
Anti-Inflammatory
Prednisone[ix]
- Nervousness
- Trouble sleeping
- Confusion, depression, or mood changes
- Seeing or hearing unusual things
Pain Killers
Tramadol[x]
- Lightheadedness, dizziness, or fainting
- Severe sleepiness or unusual drowsiness
- Feeling nervous, anxious, shaky, or unusually happy
- Feeling of constant movement of self or surroundings
- Headache
- Trouble sleeping
Tylenol 3 (with codeine)[xi]
- Hallucinations or unusual thoughts
- Lightheadedness
- Sleepiness
Vicodin (hydrocodone)
- Drowsiness
- Feeling faint
- Dizzy
- Confused
- Feeling unhappy or unwell
- Head pain
- Nervousness
- Sluggishness
- Mood changes
- Anxious
- False sense of well-being
Sleep Aides
Ambien (zolpidem)[xii]
- Lightheadedness
- Seeing, hearing, or feeling things that are not really there
- Unusual or disturbing thoughts or behavior
- Confusion, blurred vision, or problems with balance
- Dizziness
- Headache
- Memory loss
Lunesta (eszopiclone)[xiii]
- Abnormal thinking and behavior
- Anxiety, aggressiveness, confusion, depression, or dizziness
- Headache
- Memory loss
Elavil (amitriptyline)[xiv]
- confusion, agitation, hallucinations
- Changes in vision such as trouble focusing
- Drowsiness or dizziness
- Seeing, hearing, or feeling things that are not there
Creative Commons Photo Credit: http://commons.wikimedia.org/wiki/File:50mgtramadolhclakyma.jpg
Reblogged this on aceso and commented:
Brain Fog: So that’s what happened to my memory!
For me, it’s probably a combination of RA itself, RA meds, and age!
Yeah that’s true… its often hard to separate the medication side -effects from the disease symptoms from normal aging!
Very informative, what about Remicade’s side effects? I really dont know what to attribute my brain fog/horrible memory to, if it’s undisguised ADD or just fuzzy headed trying to remember everything for work, and managing my 3 kids, husband, dog and oh yeah RA? It would be nice to know there is some scientific reason behind my inability to remember things besides just being nuts!
Tanya, Thanks for the comment. You’re not nuts! The only Remicade side effect related to brain function was headache. I wrote an earlier post describing how RA itself can impact cognitive functioning.
Thanks Andrew for letting me know about remicade (and the reassurance I am not crazy). my blog, Moms Small Victories, deals with my RA and how I try to focus on the things I can accomplish versus all those things I can’t. Hope you will pay me a visit. Thanks
Nice post!! Good information!! Clear and concise! I have rationalized the fogginess by concluding that all that “thinking” that I’m missing is over rated anyway! But you have inspired me to look for possible similar type of info for Remicade. This is helpful information. Thank you!
Hi Fran, Thanks for the comment. The only Remicade side effect related to brain function was headache.