Brain fog or fibro fog is one of the lesser talked about symptoms of Fibromyalgia (FM) and Rheumatoid Arthritis (RA). Until recently the cognitive impairment that is brain fog have been ignored. Most clinicians have focused on the pain management. However, for the millions who suffer with brain fog the symptoms can be more debilitating than the pain.
Brain fog can range from mild to severe. The symptoms can be different on different days and may include short-term memory loss, difficulty finding words, difficulty concentrating, difficulty retaining information, the feeling of being spaced out, slurring speech or you can wake up and be fine the next day.
I was diagnosed with Fibromyalgia (FM) back in 2006. Back then all they talked about was the pain. Many doctor’s didn’t even believe in FM including my family doctor at the time. Fibro fog wasn’t a thing. If you mentioned any of these symptoms they would consider them as part of depression or another psychiatric disorder.
I was put on topomax from my neurologist for chronic migraines and was told by a psychiatrist that he doesn’t like that medication because “it makes people stupid” (his exact words). A side effect of topomax is word finding problems. So until recently I thought it was the topamax because I’ve been taking it almost as long as I’ve had FM. I guess the fibro just makes it worse and I have a double whammy now with rheumatoid arthritis.
There have been many small studies, but, for a person dealing with brain fog, they didn’t have any answers just reiterating what we already know: that pain, lack of good sleep, stress, side effects of medication, and over exerting yourself can all contribute to brain fog.
Some scientists including Mark Swain, MD, a professor at the University of Calgary in Canada, think that inflammation is the main culprit. They have proved that chronic inflammation in the body (as a result of cytokines like tumor necrosis factor (TNF)) can change the way the brain nerve networks start talking to each other differently. This can aggravate many of the symptoms including brain fog.
Swedish researchers came to the same conclusion after following 1500 patients for 2 decades.
Andrew Schrepf Ph.D., research investigator at Michigan Medicine’s Chronic Pain and Fatigue Research Center and colleagues wanted to see how the peripheral inflammation affects the structure and connectivity of the brain.
“Even though it has been assumed for a long time that the inflammation we see in blood is impacting the brain, up until this study we didn’t know precisely where and how those changes in the brain were actually happening.”Andrew Schrepf Ph.D.
They used functional MRI and structural MRI to scan the brains of 54 participants aged 43 – 66 at the beginning of the study and 6 months later.
“In a graph theoretical analysis across the whole brain network, and correlating that with levels of inflammation, we saw a lot of convergence across methods and time points for the amount of connectivity in the inferior parietal lobule and medial prefrontal cortex,”
“They showed us that the brain doesn’t operate in isolation.”Chelsea Kaplan, Ph.D., an anesthesiology research fellow at Michigan Medicine
“[The findings] also demonstrated how inflammation we measure in the periphery may be actually altering functional connections in the brain and playing a role in some of the cognitive symptoms we see in rheumatoid arthritis.”Chelsea Kaplan, Ph.D.
“By relating these advanced neuroimaging measures back to the patient experience, we provide evidence that the future targeting of central inflammatory pathways may greatly enhance the quality of life of patients with rheumatoid arthritis.”Study co-author, author Neil Basu, Ph.D., University of Aberdeen, UK
“This intriguing data supports the idea that rheumatoid arthritis inflammation targets the brain and not just the joints.”Neil Basu, Ph.D.
There are two online support groups one for Fibromyalgia, MyFibroTeam, and the other for Rheumatoid Arthritis (RA), MyRATeam. They are part of a larger group, MyHealthTeams, with a presence in eight countries with millions of members. They not only have peer support through the online network, but they have referrals to doctors and all articles written are fact checked by the appropriate parties. With a million members the most talked about subject is brain/fibro fog.
We are finally seeing some good studies and research being done. BUT There are so many support groups that talk about the struggle with brain fog. Just within MyHealthTeams alone there are hundreds of thousands of sufferers. Why do most of the research studies have less than 100 people? Why does it take 20 years to follow patients to conclude that it’s chronic inflammation in the body that provokes brain fog?
If you look up Fibromyalgia symptoms on the Mayo Clinic website they list fibro fog as a symptom. If you look up Rheumatoid Arthritis on the Mayo Clinic website no where do they list brain fog as a symptom.
The studies I’ve briefly talked about are a start but, more has to be done. Just telling your patients to get more sleep, exercise more, and stay away from stressful situations are not going to cut it.
For more information and to read further studies see the links below.
Until next time,
Fibrofog and fibromyalgia: a narrative review and implications for clinical practice – PubMed (nih.gov)
RA’s Effect on Your Brain (arthritis.org)https://www.arthritis.org/diseases/more-about/ra-effect-on-the-brain
Fibro Fog and ME/CFS Brain Fog Overview (verywellhealth.com)https://www.verywellhealth.com/brain-fibro-fog-causes-symptoms-possible-treatment-716014
Rheumatoid arthritis: How chronic inflammation affects the brain (medicalnewstoday.com)https://www.medicalnewstoday.com/articles/322207
Brain Fog and Rheumatoid Arthritis | myRAteamhttps://www.myrateam.com/resources/brain-fog-and-ra
Cognitive Impairment in Rheumatoid Arthritis: A Systematic Review – PubMed (nih.gov)https://pubmed.ncbi.nlm.nih.gov/28371512/