Rheumatoid Arthritis Linked To Serious Mood Disorders, Cognitive Impairment

 

According to a new study of autoimmune patients, neuropsychiatric symptoms were found to be common among those with RA.

It makes sense that those who live with a chronic illness or disability may occasionally feel down or depressed about their health status.
But new research shows a stronger-than-expected link between serious neuropsychiatric symptoms and rheumatoid arthritis (RA).
The comprehensive review, published in Autoimmunity Reviews, concluded that not only can RA affect the joints and tendons as well as other organs, but it can also have some effect on the central nervous system, spine, and brain.

This goes far beyond mood swings.
"Neuropsychiatric manifestations — especially mood disorders and headache — are frequently observed in RA,” lead author Dr. Andrei Joaquim from the Department of Neurology at State University of Campinas (UNICAMP) in São Paolo, Brazil said in a statement. “It is of paramount importance for neurologists and rheumatologists to understand the nuances of neurological symptoms in RA patients for a proper diagnosis and an adequate treatment.”
Read More: A Simple Blood Test Could Predict Rheumatoid Arthritis Up to 16 Years in Advance »

Mental Health Side Effects

The researchers concluded that neurological manifestations of RA could include, but are not limited to, peripheral neuropathy (nerve pain,), migraine headaches, “brain fog,” cognitive impairment, depression, anxiety, and even seizures.
Some studies have even shown links between autism spectrum disorders and inflammatory autoimmune conditions like RA. Others have investigated the prevalence of bipolar disorder with the disease.
Many studies and articles have discussed the existence of suicidal thoughts and tendencies in patients with chronic illnesses such as RA. The UNICAMP study focused mainly on headache, depression, anxiety, and cognitive impairment.
The researchers found that headaches were the leading neuropsychiatric condition found in RA patients. However, whether these headaches were from the disease process itself, co-existing health problems, or the medications used in treatment remains unknown.

The study also showed that up to 40 percent of patients acknowledge having, or have been diagnosed with, depression. That is a higher rate than the general population. The researchers found that anywhere from 21 to 70 percent of RA patients experience anxiety.
Read More: Stem Cell Therapy a Possible Treatment for Rheumatoid Arthritis »

Impaired Cognitive Functions

The researchers also concluded that patients with RA appeared to have far higher rates of cognitive dysfunction than the general population.
This was apparent mostly in areas of visual-spatial perception and planning. However, some level of cognitive dysfunction was also observed regarding impaired functional ability, reduced quality of life, and/or poor medication compliance.
The authors of the study did acknowledge that outside factors may have played a role in cognitive dysfunction among RA patients. These include low education, low income, use of oral steroids, and increased cardiovascular disease.
The symptom “brain fog” is also commonly mentioned by rheumatologists and their patients, especially those with RA and fibromyalgia, yet the lack of mental clarity remains a mystery. Researchers have yet to determine if “brain fog” stems from the diseases, the associated fatigue, the pharmaceutical drugs used in treatment, or a culmination of all of these factors.
Perhaps the most interesting part of the review is the involvement of focal/visual disturbances, the mention of stroke and seizure, and the affectation of the spine and central nervous system.

Still the biggest question remains unanswered: What is the cause?
In many cases, it’s uncertain whether the disease is actually causing these conditions, whether the sedentary lifestyle or medications taken are a factor, and whether the patients observed would have had these neuropsychiatric or mood disorders even without a diagnosis of RA.

Symptoms

Signs and symptoms of rheumatoid arthritis may include:

• Tender, warm, swollen joints
• Joint stiffness that is usually worse in the mornings and after inactivity
• Fatigue, fever and weight loss

Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.
As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.
About 40 percent of the people who have rheumatoid arthritis also experience signs and symptoms that don't involve the joints. Rheumatoid arthritis can affect many nonjoint structures, including:

• Skin
• Eyes
• Lungs
• Heart
• Kidneys
• Salivary glands
• Nerve tissue
• Bone marrow
• Blood vessels

Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.

When to see a doctor

Make an appointment with your doctor if you have persistent discomfort and swelling in your joints.

Causes

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  Rheumatoid arthritis vs. osteoarthritis

Rheumatoid arthritis occurs when your immune system attacks the synovium — the lining of the membranes that surround your joints.
The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint.
The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.
Doctors don't know what starts this process, although a genetic component appears likely. While your genes don't actually cause rheumatoid arthritis, they can make you more susceptible to environmental factors — such as infection with certain viruses and bacteria — that may trigger the disease.

Risk factors

Factors that may increase your risk of rheumatoid arthritis include:

• Your sex. Women are more likely than men to develop rheumatoid arthritis.
• Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
• Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
• Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
• Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
• Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.

Complications

Rheumatoid arthritis increases your risk of developing:

• Osteoporosis. Rheumatoid arthritis itself, along with some medications used for treating rheumatoid arthritis, can increase your risk of osteoporosis — a condition that weakens your bones and makes them more prone to fracture.
• Rheumatoid nodules. These firm bumps of tissue most commonly form around pressure points, such as the elbows. However, these nodules can form anywhere in the body, including the lungs.
• Dry eyes and mouth. People who have rheumatoid arthritis are much more likely to experience Sjogren's syndrome, a disorder that decreases the amount of moisture in your eyes and mouth.
• Infections. The disease itself and many of the medications used to combat rheumatoid arthritis can impair the immune system, leading to increased infections.
• Abnormal body composition. The proportion of fat compared to lean mass is often higher in people who have rheumatoid arthritis, even in people who have a normal body mass index (BMI).
• Carpal tunnel syndrome. If rheumatoid arthritis affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers.
• Heart problems. Rheumatoid arthritis can increase your risk of hardened and blocked arteries, as well as inflammation of the sac that encloses your heart.
• Lung disease. People with rheumatoid arthritis have an increased risk of inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.
• Lymphoma. Rheumatoid arthritis increases the risk of lymphoma, a group of blood cancers that develop in the lymph system.