Can Rheumatoid Arthritis Affect My Brain?

An exceedingly rare complication of prolonged, untreated RA is an inflammation of the arteries in the brain. People who experience this problem can present with symptoms similar to a stroke, such as weakness or numbness of their arms or legs. This condition can be treated with medications such as corticosteroids.

Fatigue, malaise, and depression are also commonly associated with RA. Effective treatment of RA frequently helps people feel as if they have more of their normal energy. Antidepressants may be necessary to treat depression, or they may be prescribed to help manage chronic pain.

Many of the medications used to treat arthritis have central nervous system (CNS) side effects. Corticosteroids (such as prednisone and Medrol) frequently cause nervousness, mood disturbances, and insomnia. Psychosis can also occur, although this severe side effect is usually seen only with doses of corticosteroids that are higher than those typically prescribed for RA.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may also cause CNS side effects, albeit more subtle symptoms than those mentioned previously. Headache may be a CNS-related side effect of NSAIDs, for example. This outcome is somewhat ironic, because many of these medications are touted as headache remedies! Difficulty concentrating can also be a side effect of NSAIDs, but is often missed if the doctor and patient aren't on the lookout for it. These side effects may be more common in older people as well as with older drugs such as indomethacin.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Medications that relieve joint pain and stiffness by reducing inflammation. Examples include aspirin and ibuprofen.

Aspirin and other salicylates (such as salsalate and choline magnesium trisalicylate) frequently cause problems with tinnitus.

Tinnitus is usually described as “ringing in the ears,” but some people have much more colorful auditory experiences. For example, some people may find that tinnitus is like the sensation that there is a radio playing in the next room, for example, or it may sound like people are talking somewhere in a low murmur. Salicylates do not cause visual hallucinations, but difficulty hearing and occasionally dizziness can occur with these medications. Many older people already have some degree of tinnitus and hearing loss and aren't bothered by these medications. In other patients, the problems are additive such that a person who was mildly hard of hearing can return to the doctor's office quite deaf after taking salicylates! The doctor may monitor your blood salicylate levels if he or she suspects this kind of problem, but often it is faster and easier to just decrease the medication dosage or stop the medication temporarily. Once the salicylate level drops, the side effects of tinnitus, hearing loss, or dizziness should resolve promptly.

If you think you are having one of these side effects, speak to your doctor or pharmacist. Changing to a different medication or reducing the dose can often make a big difference.