In 2004, I was in one of the worst flares of my life, the pain so intense and omnipresent it cast a shadow over everything. For the first time in a long time, I had problems focusing. Where I once was able to relate a conversation in detail, now I couldn't remember what someone said half an hour ago. Where I once could have a vigorous debate lasting an entire evening, now I couldn't follow someone's argument from point A to point B.
Cognitive problems are the dirty little secret of RA. Many of us have problems with short-term memory, logic and focus, but no one talks about it. Admitting that your brain is not sharp as it used to be is really scary.
A study by Shin et.al. found that 31 percent of people with RA experienced cognitive problems such as short-term memory, verbal fluency and logic memory. This was more likely to occur in people who had low income, no low education, took oral steroids and had a higher risk of cardiovascular disease. Unfortunately, the study did not suggest any causes for this, which can leave many of us worrying about losing our minds.
I am not a scientist and I have not done studies on numerous people who live with RA. All I have is my own experience and I have some ideas about what happens with RA and your mind.
During that big flare mentioned above, I met with a social worker. After about half an hour, I wasn't able to focus any longer. I cried when I told her, feeling humiliated and devastated at this loss of ability to pay attention. "Of course you can’t focus," she said. "Pain takes up a lot of room in your head." And then I cried again, but this time with relief.
No one had ever told me that before. All these years later, that simple statement remains one of the most precious gifts I have ever received. It was an explanation that gave me an exact reason why my previously sharp mind had turned into a fog. And it was a validation of just how profoundly impact of pain can be. Pain does take up a lot of room in your head. It makes it hard to concentrate on anything but the screaming coming from your body. Just as you would not be able to focus on a conversation if a loud fire alarm was blaring in the room, paying attention to the intricacies of a discussion is impossible when you're in pain.
Getting your RA and your pain under control are important first steps in dealing with cognitive problems. Even if you don’t go into remission, any suppression of your disease will help you be more mentally sharp. As well, effective pain management can be a huge help in helping you get your brain back. Your ability to focus will improve when that fire alarm is no longer blaring next to your ear.
Fatigue in general affects cognitive performance, sometimes profoundly so. The more tired you are, the worse you perform. RA comes with a healthy dollop of chronic fatigue. When your body is under attack, it makes you tired. So does inflammation and pain. The Johns Hopkins Rheumatoid Arthritis page states that "people with rheumatoid arthritis often need over 10 hours of sleep a night, or eight hours a night and a two-hour nap during the day." Our society is not made for that kind of sleep pattern and between the demands of your day and the demands of RA, many people are tired all the time. This will have an impact on your ability to focus and remember.