Managing Brain Fog With Rheumatoid Arthritis
Rheumatic ConditionsRheumatoid Arthritis

Coping With Brain Fog When You Have Rheumatoid Arthritis

Coping With Brain Fog When You Have Rheumatoid Arthritis
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Published on February 24, 2026
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While rheumatoid arthritis (RA) is not commonly thought to affect the brain, research shows that many people with the condition have some level of cognitive impairment.

“Brain fog is a pretty common symptom that a lot of my patients complain about,” says Nilanjana Bose, MD, a rheumatologist practicing in Houston. Cognitive functions in people with RA are often reduced and the impairment is worse in those with active disease compared with people in remission.

Learn what causes brain fog, what it feels like, and how you can minimize your cognitive symptoms.

What Does RA Brain Fog Feel Like?

People describe brain fog as a hazy feeling or cobwebs in their brain. It’s a nonscientific term that’s used to describe a range of cognitive symptoms, including trouble thinking clearly, focusing, remembering, and making decisions. It’s often associated with fatigue, a common symptom of RA.

When researchers study brain fog, they assess cognitive deficits in attention, working memory, processing speed, and executive function skills.

Causes of Cognitive Impairment in RA

The leading theory behind brain fog in RA, and in many chronic conditions, is inflammation. Chronic inflammation, specifically the activity of cytokines like tumor necrosis factor (TNF), is known to affect neural activity in the brain — the way brain neurons communicate with each other.

One study of people with RA found that those who had cognitive impairment had more inflammatory activity over the course of their illness than those without cognitive impairment. When RA is well controlled, meaning inflammation is kept at bay, symptoms like fatigue and brain fog tend to improve as well.

While the disease itself can cause inflammation, there are other conditions — some common in people with RA — that may also cause brain fog, as well as certain medications.

“Attributing the symptoms of brain fog to RA should be a diagnosis of exclusion as other possible causes should be investigated,” says Dallas-based rheumatologist Scott Zashin, MD. These include:

  • Cardiovascular Disease Narrowed arteries from atherosclerosis can lead to reduced blood flow to the brain and this condition has been linked to cognitive decline.

     Likewise, major events like stroke and heart attack may also contribute to cognitive impairment.
  • Fatigue Poor sleep or other chronic conditions can cause mental fatigue, which contributes to brain fog. “In my mind, low energy and brain fog are intertwined,” says Dr. Bose.
  • Pain Chronic pain is a known contributor to brain fog. Some researchers have theorized that pain processing uses up mental resources, so your brain can’t carry out other functions as easily.

  • Depression The prevalence of depression in rheumatoid arthritis has been shown to be two to three times higher than in the general population.

  • Menopause has been associated with brain fog, and treatments like hormone therapy may help relieve symptoms.
  • Medications Long-term use of certain medications, such as methotrexate and steroids, may contribute to cognitive impairment, while some medications that control the overall inflammation may help preserve cognitive impairment or decline. Speak to your healthcare provider about which medications are right for you.

  • Obesity is known to increase inflammation, and obesity can also contribute to sleep apnea, which can cause fatigue.

  • Thyroid Disease An underactive thyroid can cause symptoms similar to brain fog. RA patients are at risk for thyroid disease, so it’s important to have your healthcare team review your entire history if you’re experiencing any memory impairment.

Treating Brain Fog in RA

It’s not easy to treat brain fog, often because it’s hard to determine the exact cause. But the first thing you can do is make sure that your RA is being treated aggressively, so that your RA is in remission or at the lowest disease state possible. Reducing inflammation is the most effective thing you can do, says Bose. That may mean increasing or changing medications if yours are not effective enough.

Your doctor should also check you for other conditions that may be causing brain fog. They can order screening or diagnostic tests for any of the conditions mentioned above. They should also check if any of your medications may be contributing to the RA.

Lifestyle Measures That May Help

While there’s limited research on how effective lifestyle measures are, several approaches are generally recommended to reduce inflammation or fatigue, both of which contribute to brain fog.

Nutritional Issues If you’re deficient in certain nutrients, it can exacerbate fatigue and brain fog, so it’s a good idea to check your levels of vitamin B12, vitamin D, and iron. Also, your doctor can check your electrolyte levels, which may contribute to brain fog, says Zashin. A few supplements are known to have anti-inflammatory properties, like fish oil, which is high in omega‐3 fatty acids.

 Check with your providers to see if these are appropriate for your condition.

Adequate Sleep When you’re sleep deprived, it affects your ability to focus and make decisions, and can also make symptoms like pain and depression worse. “Sleep is an issue in 90 percent of my patients with RA,” says Bose.

The first step is to treat any conditions that may affect sleep, like sleep apnea, depression, pain, or night sweats from menopause. It’s also helpful to follow good sleep habits, like reducing screen time, dimming bright lights at night, and avoiding alcohol at night and caffeine after noon.

Healthy Diet An anti-inflammatory diet, such as the Mediterranean diet, is recommended for anyone with inflammatory conditions. These diets are usually rich in fruits, vegetables, whole grains, and lean protein.

Regular Physical Activity Exercise can reduce inflammation.

 It also has a positive effect on your energy and mood, and can ease pain and stiffness.

Stress Management Stress can lead to a number of risks for brain fog including poor sleep, increased pain, and mood disorders. Consider some stress-reducing techniques such as deep breathing, meditation, and yoga.

The Takeaway

  • Effective management of rheumatoid arthritis (RA) through medication can reduce inflammation, which may, in turn, alleviate symptoms like brain fog and fatigue.
  • Identifying and treating other underlying conditions, such as cardiovascular issues, sleep problems, or nutrient deficiencies, can address cognitive impairments associated with RA.
  • Lifestyle changes, including a balanced diet like the Mediterranean diet, regular physical activity, and stress management techniques, may provide additional relief from cognitive symptoms.
  • If you experience persistent or worsening brain fog, it's essential to consult with a healthcare professional to ensure comprehensive treatment and rule out other serious health concerns.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Bauer ME. Accelerated Immunosenescence in Rheumatoid Arthritis: Impact on Clinical Progression. Immunity & Ageing. 2020.
  2. Mena-Vázquez N et al. Impact of Inflammation on Cognitive Function in Patients with Highly Inflammatory Rheumatoid Arthritis. RMD Open. 2024.
  3. Liang J et al. Associations Between Atherosclerosis and Subsequent Cognitive Decline: A Prospective Cohort Study. Journal of the American Heart Association. November 4, 2024.
  4. Dass R et al. Understanding the Experience and Impacts of Brain Fog in Chronic Pain: A Scoping Review. Canadian Journal of Pain. 2023.
  5. Ionescu CE et al. Depression in Rheumatoid Arthritis: A Narrative Review-Diagnostic Challenges, Pathogenic Mechanisms and Effects. Medicina (Kaunas). November 13, 2022.
  6. Fazel SD et al. Impact of Disease-Modifying Antirheumatic Drugs on Cognitive Function in Older Adults with Rheumatoid Arthritis. Drugs and Aging. April 2025.
  7. Shen YC et al. The Impact of Obesity in Cognitive and Memory Dysfunction in Obstructive Sleep Apnea Syndrome. International Journal of Obesity (London). February 2019.
  8. Liu YJ et al. Association Between Rheumatoid Arthritis and Thyroid Dysfunction: A Meta-Analysis and Systematic Review. Frontiers in Endocrinology (Lausanne). October 13, 2022.
  9. Qidwai M et al. Cognitive Implications of Rheumatoid Arthritis: A Call for Comprehensive Care and Research Focus. Immunity, Inflammation and Disease. 2023.
  10. Khalafi M et al. Influence of Different Modes of Exercise Training on Inflammatory Markers in Older Adults With and Without Chronic Diseases: A Systematic Review and Meta-Analysis. Cytokine. September 2023.
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Beth Biggee

Beth Biggee, MD

Medical Reviewer
Member of American College of Lifestyle Medicine, Castle Connolly Top Doctor

Beth Biggee, MD, is owner and practitioner of Lifestyle and Integrative Rheumatology, a holistic direct specialty care practice in North Andover, Massachusetts. She offers whole-person autoimmune care, lifestyle medicine, and holistic integrative consults.

She has over 20 years of experience in rheumatology and holds board certifications in rheumatology and integrative and lifestyle medicine. Dr. Biggee brings a human-centered approach to wellness rather than focusing solely on diseases.

Biggee graduated cum laude with a bachelor's degree from Canisius College, and graduated magna cum laude and as valedictorian from SUNY Health Science Center at Syracuse Medical School. She completed her internship and residency in internal medicine at Yale New Haven Hospital, her fellowship in rheumatology at Tufts–New England Medical Center, and her training in integrative rheumatology at the University of Arizona Andrew Weil Center for Integrative Medicine.

Following her training, she attained board certification in rheumatology and internal medicine through the American Board of Internal Medicine, board certification in integrative medicine through the American Board of Physician Specialties, and accreditation as a certified lifestyle medicine physician through the American College of Lifestyle Medicine. She is certified in Helms auricular acupuncture and is currently completing coursework in the Aloha Ayurveda integrative medicine course for physicians.

In prior roles, Biggee was medical director and integrative rheumatologist at Rheumission, a virtual integrative rheumatology practice, and she also provided healthcare wellness consulting for Synergy Wellness Center in Hudson, Massachusetts. Biggee taught as an assistant clinical professor of medicine at Mary Imogene Bassett Hospital (an affiliate of Columbia University). She was also clinical associate of medicine at Tufts University School of Medicine and taught Introduction to Clinical Medicine for medical students at Tufts. She was preceptor for the Lawrence General Hospital Family Medicine Residency.

Biggee has published work in the Annals of the Rheumatic Diseases, Arthritis & Rheumatology, Current Opinion in Rheumatology, Medicine and Health Rhode Island, and the Field Guide to Internal Medicine.

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Laurie Tarkan

Laurie Tarkan

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Laurie Tarkan has an extensive background in health journalism, and has written regularly for The New York Times. She is a frequent contributor to a host of magazines and health websites. Laurie is an accomplished editor and provides writing, editing, and website content for nonprofit organizations and for-profit healthcare companies.

Laurie is also the author of several health books, including My Mother's Breast: Daughters Face Their Mothers’ Cancer, and Perfect Hormone Balance for Fertility: The Ultimate Guide to Getting Pregnant.

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