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 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. Brain fog is associated with many autoimmune disorders. But be careful, there are many pseudoscience websites and “experts” out there who try to peddle remedies for brain fog.
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.[i] And these results were repeated numerous times in the scientific literature. [ii]
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 “nearly a third of patients with an inflammatory disease may develop depression.” [iii]
Cognitive impairment of any sort is not “just in your head” as many friends, family members, and even doctors believe. I argue that there are a set of biochemical processes involved with RA that bring about these symptoms. As mentioned in an earlier post, there are a set of biochemical processes involved with RA. Part of these processes includes the overproduction of inflammatory chemicals called cytokines. According to some researchers,
“Cytokines and their receptors are expressed in the brain. They interact closely with neurohormones and neurotransmitters….In animal models, they affect behaviors such as food intake, temperature regulation, and social exploration.”[iv]
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. They are also related to depression. [v] [vi] One group of scientists demonstrated the connection between cytokines and mental changes in RA patients.
“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.” [vii] (emphasis mine)
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. I’ve learned to be able to tell when mood swings and brain fog are associated with RA. I still remember my general practitioner telling me that my ongoing tiredness may point to something other than just depression. It’s during that time that other symptoms of RA became apparent ultimately leading to a referral to a rheumatologist 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.”
The TNF cytokine blocker called Cimzia that I take has had a huge impact on my mental capacity. The first positive outcome of this drug treatment was a dramatic increase in energy and mental clarity…brain fog disappeared. Physical symptom improvements came later and were more spread over time.
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 cytokine blocker treatment, don’t be afraid to take other medications for depression, talk to others, and speak to your doctor.