Neuropsychiatric manifestations in rheumatoid arthritis (2022)

Table of Contents
Autoimmunity Reviews Abstract Introduction Section snippets Methods Brain involvement Conclusions Take-home messages References (96) Semin Arthritis Rheum J Hand Surg Spine J Autoimmun Rev Rev Neurol (Paris) Joint Bone Spine Autoimmun Rev BMC Infect Dis Prog Neuropsychopharmacol Biol Psychiatry Int J Rheum Dis Clin Psychol Rev Gen Hosp Psychiatry Lancet Autoimmun Rev Am J Med Autoimmun Rev Lancet Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis J Rheumatol Rheumatoid arthritis of the craniovertebral junction Neurosurgery Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS) BMC Psychiatry Anti tumor necrosis factor therapy is associated with less frequent mood and anxiety disorders in patients with rheumatoid arthritis Psychiatry Clin Neurosci Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications J Abnorm Psychol Are behaviour and motor performances of rheumatoid arthritis patients influenced by subclinical cognitive impairments? A clinical and neuroimaging study Clin Exp Rheumatol Cognitive impairment in rheumatoid arthritis Methods Find Exp Clin Pharmacol Vasculitis associated with rheumatoid arthritis: a case–control study Rheumatology (Oxford) An unusual central nervous system involvement in rheumatoid arthritis: combination of pachymeningitis and cerebral vasculitis Rheumatol Int Beyond the joints: neurological involvement in rheumatoid arthritis Clin Rheumatol Peripheral nerve entrapment syndromes: diagnosis and management Br J Hosp Med Radiological evaluation of cervical spine involvement in rheumatoid arthritis Neurosurg Focus Cardiovascular risk in rheumatoid arthritis: pathogenesis, diagnosis, and management J Clin Rheumatol Cardiovascular death in rheumatoid arthritis: a population-based study Arthritis Rheum Overt psychopathology in rheumatoid arthritis. A fifteen-year follow-up study Scand J Rheumatol Psychological aspects of rheumatoid arthritis Psychol Med Psychological well being in rheumatoid arthritis: a review of the literature Musculoskeletal Care Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis Psychosom Med Predicting depression in rheumatoid arthritis: the signal importance of pain extent and fatigue, and comorbidity Arthritis Care Res Poststroke depression: a review Can J Psychiatry Risk of developing depressive disorders following rheumatoid arthritis: a nationwide population-based study PLoS One The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis Rheumatology Suicides in persons suffering from rheumatoid arthritis Rheumatology Concurrent psychiatric disorders are associated with significantly poorer quality of life in patients with rheumatoid arthritis Scand J Rheumatol Major depressive episodes are associated with poor concordance with therapy in rheumatoid arthritis patients: the impact on disease outcomes Clin Exp Rheumatol Corticosteroid-related central nervous system side effects J Pharmacol Pharmacother Depression in rheumatoid arthritis J Rheumatol The psychosocial impact of systemic lupus erythematosus and rheumatoid arthritis Arthritis Rheum Cognitive impairment in persons with rheumatoid arthritis Arthritis Care Res (Hoboken) Tocilizumab treatment safety in rheumatoid arthritis in a patient with multiple sclerosis: a case report BMC Res Notes A biochemical perspective of methotrexate neurotoxicity with insight on nonfolate rescue modalities J Investig Med Cited by (40) Recommended articles (6) FAQs Videos
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Autoimmunity Reviews

Volume 14, Issue 12,

December 2015

, Pages 1116-1122

Abstract

Rheumatoid arthritis (RA) is a chronic disease characterized by persistent synovitis, systemic inflammation, and the presence of autoantibodies. Neuropsychiatric manifestations are quite common in RA, including depression, cognitive dysfunction, behavior changes, spinal cord compression and peripheral nerve involvement. Potential causes include systemic inflammatory process, neural compression due to bone and joint destruction, side effects of medications and copying difficulties due to the chronicity of the disease. A high level of suspicious is required for an adequate diagnosis and treatment. In this review, we will discuss topographically the main neuropsychiatric manifestations described in RA patients, in an attempt to help in the management of these complex and multifaceted disease.

Introduction

Rheumatoid arthritis (RA) is a chronic disease characterized by persistent synovitis, systemic inflammation, and autoantibodies (particularly to rheumatoid factor and citrullinated peptide) [1]. Extra-articular features are observed in up to 40% of patients and are associated with increased morbimortality [2], [3]. The estimate incidence of neurological symptoms in rheumatic diseases is about 11%, but in RA it can reach up to 70% when mood disorders are included [4], [5], [6], [7], [8]. Extra-articular manifestations are associated with disease severity, disease duration, presence of autoantibodies and comorbidities (e.g. smoking) [9], [10]. With earlier diagnosis and more aggressive treatment many extra-articular manifestations such as rheumatoid nodules, have been declining [11], [12], [13]. However little is known about neuropsychiatric manifestations. In a recent study, rheumatoid vasculitis has been shown to remain a serious complication of RA and associated with significant mortality [10].

Some of the reasons for a higher incidence of neurological symptoms in RA patients compared with the normal population are:

1)

RA disease by itself, with inflammation, autoantibodies, pain, fatigue and disability leading to psychiatric diseases [4], [6].

2)

The systemic inflammatory processes involving all organs and systems, which can involve the neural tissue (e.g. pachimeningitis or vasculitis) [14].

3)

Joint and bone destruction leading to neural compression (e.g. cervical myelopathy symptoms caused by destruction of the atlanto-axial joints and subsequent atlantoaxial subluxation) or the presence of rheumatoid nodules compressing peripheral nerves [3], [15], [16], [17].

4)

Potential side effects of the medication used to obtain disease control, such as corticosteroids, disease modifying drugs (DMARDS) and biological agents (BA) [17].

5)

Accelerated atherosclerosis associated with systemic inflammation and autoantibodies [18], [19].

Clinical presentation of neurological symptoms may vary from a sudden and emergent vertebrobasilar stroke to a slowly and insidious process of peripheral neuropathy. The intensity of the symptoms is influenced by the degree of the inflammatory process, the size of the vessel involved, medication and comorbidities [1], [2].

To better understand and treat neurological diseases in patients with RA it is important to identify the primary cause of the symptoms, which may not be an easy task [13].

In this review, we discussed the most common neurological manifestations during the course of RA as well as their most probably etiology, in an attempt to help physicians in the management of these complex and multifaceted disease. The clinical manifestations are presented topographically, according to the main involved site.

Section snippets

Methods

We performed a review in the MedLine Database (National Library of Medicine), without time restriction. The following search strategy was used: (“Rheumatoid arthritis” AND “Neurological” OR “Neural” OR “Central Nervous System” OR “Spinal Cord” OR “Peripheral nerves” OR “Cognitive impairment” OR “Vasculitis” OR “Seizure” OR “Depression” OR “Anxiety” OR “Stoke”).

Abstracts were then reviewed and we included articles in English language discussing about the incidence, prevalence, diagnosis and

Brain involvement

The exact incidence of brain involvement in RA is not known but is probably low compared with spine and peripheral nerve involvement.

Conclusions

Neurological and psychiatric manifestations in RA patients are common. Brain symptoms may occur due to vasculitis, inflammatory meningitis, opportunistic infections, atherosclerosis and side effects of RA medication.

Cervical spine instabilities, especially AAS, are one of the most common causes of myelopathy in RA patients. Peripheral neuropathy can occur by nerve entrapment or secondary to other causes, such as side effects of medication or vasculitis.

It is of paramount importance for

Take-home messages

RA can course with neuropsychiatric symptoms caused by neural compression secondary to damage on joints and bones, the diffuse and systemic inflammatory process and also for side effects of the drugs used for disease control.

Brain involvement can be secondary to vasculitis or inflammatory meningitis, as well as opportunistic infections and side effects of RA medication for disease control. Depression and cognitive dysfunction are quite common, potential related to the disease itself and its

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    • Autoimmune central nervous system (CNS) affection comprises an expanding group of potentially treatable disorders that should be included in the differential diagnosis of any type of encephalitis or myelitis.

      The extent of CNS involvement in systemic immunopathic disorders such as lupus erythematosus, rheumatoid arthritis (RA), or sarcoidosis has been recognized since long. However, the identification of underlying pathogenic mechanisms has led to the development of revolutionary antibody (Ab)-based therapies improving the prognosis of this group of patients.

      Further advances in autoimmune involvement of the nervous system have led to the identification of new clinical syndromes, associated with antineuronal Abs that have transformed the diagnostic and therapeutic approach to these disorders. Starting with auto-Abs to the acetylcholine receptor for myasthenia gravis and against intracellular antineuronal nuclear Ab 1 (ANNA-1) (Hu) antigen, there is still a continuous expansion of the number of cell surface, synaptic, and intracellular molecules, which expose antigenic epitopes for autoimmune neurological disorders. Numerous of these Abs were associated with an extraneural malignancy, causing “paraneoplastic neurological syndromes,” while others occur as primary autoimmune diseases. Furthermore, identification of several Abs targeting glial antigens, such as aquaporin-4 (AQP4), has enabled the classification of these disorders as distinct clinical entities.

      The particular focus of this chapter is on autoimmune disorders associated with encephalitis or myelitis, subdivided into two groups: (1) systemic diseases with CNS manifestations and (2) Ab-associated disorders of the CNS.

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      Central nervous system (CNS) involvement is quite unusual in patients with rheumatoid arthritis (RA), although cerebral vasculitis, rheumatoid nodules and meningitis have all been reported, and patients with RA may also have CNS comorbidities such as stroke and neuro-degenerative and demyelinating syndromes. It has been found that biological drugs, especially anti-tumour necrosis factor-alpha (anti-TNF-α) drugs, slightly increase the risk of developing demyelinating diseases, and they are consequently discouraged in patients with multiple sclerosis and related disorders. Furthermore, the risk of opportunistic CNS infections is increased in immunosuppressed patients.

      To review the current literature concerning CNS involvement in patients with RA (including RA-related forms and comorbidities) and the incidence of new-onset CNS diseases in patients with RA undergoing biological treatment (anti-TNF or non-anti-TNF drugs), the Medline database was searched using the key words ‘rheumatoid arthritis’, ‘central nervous system’, ‘anti-TNF’, ‘abatacept’, ‘tocilizumab’, ‘rituximab’ and ‘anakinra’. Abstracts not in English were excluded.

      We selected 76 articles published between 1989 and 2017, which were divided into four groups on the basis of whether CNS involvement was RA-related or not and according to the type of biological agent used (TNF inhibitors or other agents). The RA-related diseases included aseptic meningitis, vasculitis and cerebral rheumatoid nodules, which benefit from immunosuppressive treatments. CNS comorbidities included stroke, seizures, dementia and neuropsychiatric disorders, which have been frequently described in biological agent-naïve patients with RA, and other rarely reported neurological diseases, such as extra-pyramidal syndromes and demyelinating disorders. CNS comorbidities are relatively frequent among patients with RA and may be related to systemic inflammation or concomitant medications. The use of anti-TNF drugs is associated with the risk of developing demyelinating diseases, and CNS infections have been described in patients treated with anti-TNF and non-anti-TNF agents. Non-anti-TNF drugs may be preferred in the case of demyelinating diseases, cerebral vasculitis or neurolupus.

      Patients with RA may suffer from CNS involvement as a manifestation of RA or as a comorbidity. The treatment of such medical conditions should be guided on the basis of their etiopathogenesis: steroids and immunosuppressants are useful in the case of RA-related CNS diseases but are often detrimental in other situations. Similarly, the choice of biological agents in patients with RA with CNS complications should be guided by a correct diagnosis in order to prevent further complications.

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      Central nervous system (CNS) manifestations are often observed in autoimmune rheumatic diseases, and are associated with higher mortality and worse quality of life [1–4].

      To evaluate olfactory function in systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and healthy controls over a 2-year period, and to determine the association of olfactory dysfunction with age, disease activity, disease damage, treatment, anxiety and depression symptoms and limbic structures volumes.

      Consecutive SLE and SSc patients were enrolled in this study. Clinical, laboratory disease activity and damage were assessed according to diseases specific guidelines. Olfactory functions were evaluated using the Sniffin' Sticks test (TDI). Volumetric magnetic resonance imaging (MRI) was obtained in a 3T Phillips scanner. Amygdalae and hippocampi volumes were analyzed using FreeSurfer® software.

      We included 143 SLE, 57 SSc and 166 healthy volunteers. Olfactory dysfunction was observed in 78 (54.5%) SLE, 35 (59.3%) SSc patients and in 24 (14.45%) controls (p<0.001) at study entry. SLE and SSc patients had significantly lower mean in all three phases (TDI) of the olfactory assessment when compared with healthy volunteers. In SLE, the presence of olfactory dysfunction was associated with older age, disease activity, higher anxiety and depression symptoms score, smaller left hippocampus volume, smaller left and right amygdalae volume and the presence of anti-ribosomal P (anti-P) antibodies. In SSc the presence of olfactory impairment was associated with older age, disease activity, smaller left and right hippocampi volumes and smaller right amygdala volume. Olfactory function was repeated after a 2-year period in 90 SLE, 35 SSc and 62 controls and was stable in all three groups.

      Both SLE and SSc patients with longstanding disease had significant reduction in all stages of TDI that maintained stable over a 2-year period. Olfactory dysfunction was associated with age, inflammation and hippocampi and amygdalae volumes. In SLE, additional association with anti-P, anxiety and depression symptoms was observed.

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      Burden of disease in treated rheumatoid arthritis patients: Going beyond the joint

      Seminars in Arthritis and Rheumatism, Volume 43, Issue 4, 2014, pp. 479-488

      The disease burden in rheumatoid arthritis (RA) extends beyond the joint. This article evaluates the physical and psychosocial extra-articular burden of treated RA and relationships among diverse disease manifestations.

      MEDLINE searches identified papers published in English from January 2003 to December 2012 that evaluated systemic complications and psychosocial aspects associated with RA. Preference was given to studies with randomized cohorts and large (>100) sample sizes. Of 378 articles identified in the initial search, 118 were selected for inclusion.

      RA is associated with multiple comorbidities and psychosocial impairments, including cardiovascular disease, osteoporosis, interstitial lung disease, infection, malignancies, fatigue, depression, cognitive dysfunction, reduced work performance, work disability, and decreased health-related quality of life. The etiology of the extra-articular burden may reflect the systemic inflammation and immune system alteration associated with RA, metabolic imbalances and side effects related to treatment, or the influence of comorbidities. Strategies that may help to reduce the extra-articular disease burden include personalized medicine and the potential introduction of treatments with new mechanisms of action.

      Despite improvements in treating joint disease, the extra-articular burden in RA remains substantial, encompassing multiple comorbidities and psychosocial impairments.

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    Copyright © 2015 Elsevier B.V. All rights reserved.

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    FAQs

    How does rheumatoid arthritis affect you mentally? ›

    RA patients are more prone to have anxiety, depression and cognitive impairment compared to the general healthy population. Those mental health conditions contribute to less responsiveness to treatment and higher disease activity in RA mainly due to fatigue and bodily pain.

    Can rheumatoid arthritis cause neurological problems? ›

    Rheumatoid arthritis (RA) is associated with various nonarticular manifestations, including a range of neurologic abnormalities, such as cervical spine instability, compressive neuropathy (eg, of the median nerve at the wrist, which results in carpal tunnel syndrome [CTS]), and an often subclinical sensory or ...

    Does rheumatoid arthritis affect the mind? ›

    A lot of people with rheumatoid arthritis (RA) report having trouble with memory, attention, and mental focus. They forget names and appointments, struggle to find the right words and have trouble making and carrying out plans.

    Does rheumatoid arthritis cause depression and anxiety? ›

    People with all types of arthritis are at high risk of depression and anxiety. If you have been diagnosed with rheumatoid arthritis and are feeling depressed or are worried about developing depression, it's important to talk to your doctor.

    What are the psychological effects of arthritis? ›

    Many adults with arthritis have anxiety and depression. Learn how arthritis and mental health are connected. Learn about programs that can improve mood and well-being, and ease arthritis symptoms. About 1 in 5 US adults with arthritis has symptoms of anxiety or depression.

    What is psychiatric arthritis? ›

    Psoriatic arthritis is a type of arthritis that affects some people with the skin condition psoriasis. It typically causes affected joints to become swollen, stiff and painful. Like psoriasis, psoriatic arthritis is a long-term condition that can get progressively worse.

    What are neurological problems? ›

    Neurological disorders are medically defined as disorders that affect the brain as well as the nerves found throughout the human body and the spinal cord. Structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves can result in a range of symptoms.

    How does rheumatoid arthritis cause brain fog? ›

    Remember, RA causes your body's immune system to attack the lining between your joints, which causes inflammation and swelling. That swelling can alter the way the nerves in your brain communicate. Inflammation in the brain, with or without other RA-related neurologic changes, can lead to brain fog.

    Does rheumatoid arthritis cause lesions on the brain? ›

    Inflammatory central nervous system lesions are infrequent in RA. Cerebral rheumatoid vasculitis is an uncommon and serious complication of RA. Most reported cases have led to the death of the patient especially when cerebral vasculitis was associated with systemic rheumatoid vasculitis (Table1).

    Can rheumatoid arthritis cause psychosis? ›

    Psychosis and its Association with Rheumatoid Arthritis

    The disease onset for rheumatoid arthritis is less as compared to schizophrenia and bipolar disorder [75]. The incidence of rheumatoid arthritis lowers/raises the risk of bipolar disorder and schizophrenia [76,77].

    Can stress and anxiety cause rheumatoid arthritis? ›

    Rheumatoid arthritis (RA) is a chronic inflammatory joint condition and an autoimmune disease that can be caused by stress, according to research. Stress triggers rheumatoid arthritis by setting off the immune system's inflammatory response in which cytokines are released.

    Can rheumatoid arthritis be psychosomatic? ›

    The patients investigated in the two disease groups represent an unselected population with regard to psychological abnormalities (from two internistic rheumatism outpatient clinics); the results can thus be considered to be representative and permit the following conclusions to be drawn: RA is not a psychosomatic ...

    What are the symptoms of arthritis in the head? ›

    Unlike a normal headache, a neck arthritis headache typically begins with pain in your neck. From there, the pain will move up the back of your head until it reaches the top. In addition, the pain will usually be worse on one side of your head, and you won't have pain in your temple region.

    How inflammation affects the brain? ›

    Neurological effects of systemic inflammation

    Systemic inflammation can lead to immune responses in the brain that show up in many ways. People may experience cognitive symptoms such as memory lapses or confusion. Other common symptoms, known as “sickness behavior,” may include: Depression.

    Can arthritis cause confusion? ›

    Rheumatoid arthritis (RA) is an autoimmune disorder that not only attacks your joints, but can lead to brain fog. Cognitive issues can develop when proteins called cytokines increase inflammation in your brain.

    What are 3 symptoms of rheumatoid arthritis? ›

    Signs and symptoms of RA include:
    • Pain or aching in more than one joint.
    • Stiffness in more than one joint.
    • Tenderness and swelling in more than one joint.
    • The same symptoms on both sides of the body (such as in both hands or both knees)
    • Weight loss.
    • Fever.
    • Fatigue or tiredness.
    • Weakness.

    Is anxiety a symptom of rheumatoid arthritis? ›

    Background. Symptoms of anxiety and depression are more prevalent in rheumatoid arthritis (RA) patients than in the general population [1, 2]. Studies have shown that 26–46% of RA patients have anxiety symptoms, and 14.8–34.2% have depression symptoms [1].

    Does rheumatoid arthritis cause low mood? ›

    Rheumatoid arthritis can take a toll on your mental health. The disease is known for causing pain, stiff joints, and fatigue, but it can also lead to depression. In fact, if you have RA, you're two to four times as likely to have depression as someone who doesn't have it.

    Does rheumatoid arthritis make you angry? ›

    The causes of mood swings for people with rheumatoid arthritis are similar to the causes of depression. The chronic inflammation, pain, fatigue, and other symptoms can make it harder for you to withstand stress, so you may react more intensely to certain stressors or situations.

    How does rheumatoid arthritis affect your social life? ›

    Rheumatoid arthritis can at times put a strain on social relationships. Pain and loss of independence can make people feel frustrated, angry, and depressed, which can in turn affect other members of the family.

    Can rheumatoid arthritis cause psychosis? ›

    Psychosis and its Association with Rheumatoid Arthritis

    The disease onset for rheumatoid arthritis is less as compared to schizophrenia and bipolar disorder [75]. The incidence of rheumatoid arthritis lowers/raises the risk of bipolar disorder and schizophrenia [76,77].

    How do people cope with rheumatoid arthritis? ›

    You can take steps to keep it from stopping you.
    1. Tell your doctor how you feel. They may want to change your medications or their doses. ...
    2. Take a breathing break. ...
    3. Keep doing things you enjoy. ...
    4. Use heat, cold, and massage. ...
    5. Notice your emotions. ...
    6. Join a support group. ...
    7. Exercise. ...
    8. Eat a balanced diet.
    16 Oct 2020

    Can rheumatoid arthritis cause personality changes? ›

    A study published in July 2018 in Arthritis Care & Research found that people who have rheumatoid arthritis (RA) are more likely to experience depression, anxiety, and bipolar disorder in their lifetimes than those who have not been diagnosed with the autoimmune disease.

    Does rheumatoid arthritis cause forgetfulness? ›

    Rheumatoid arthritis and brain fog

    Rheumatoid arthritis (RA) is best known for causing painful, swollen joints. But many people with RA say they also have to deal with symptoms like forgetfulness, trouble concentrating, and difficulty thinking clearly.

    Does RA cause bipolar disorder? ›

    This study revealed that patients with RA were at a higher risk of subsequent bipolar disorder.

    What problems can rheumatoid arthritis cause? ›

    Rheumatoid arthritis increases your risk of developing:
    • Osteoporosis. ...
    • Rheumatoid nodules. ...
    • Dry eyes and mouth. ...
    • Infections. ...
    • Abnormal body composition. ...
    • Carpal tunnel syndrome. ...
    • Heart problems. ...
    • Lung disease.
    18 May 2021

    What should you not do if you have rheumatoid arthritis? ›

    1. Not Seeing a Rheumatologist. Your regular doctor may have diagnosed your RA. ...
    2. Too Much Couch Time. You need rest, just not too much. ...
    3. Canceling Doctor Appointments. When you feel good, do you stop seeing your doctor? ...
    4. Not Taking All Your Medications. ...
    5. Skipping Medication When You Feel Good. ...
    6. Overlooking Your Mood.
    20 Jan 2022

    Can you lead a normal life with rheumatoid arthritis? ›

    Rheumatoid arthritis can be life changing. You may need long-term treatment to control the symptoms and joint damage. Depending on how much pain and stiffness you feel and how much joint damage you have, simple daily tasks may become difficult or take longer to do.

    Can rheumatoid arthritis cause schizophrenia? ›

    Disease-specific familial risks were similar to what has been shown in previous studies. A family history of RA was associated with a tripled risk for RA (HR = 3.4, 95% CI = 3.2–3.6), and a family history of schizophrenia was associated with an 8-fold risk of schizophrenia (HR = 8.2, 95% CI = 7.6–8.8).

    Can rheumatoid arthritis cause panic attacks? ›

    One study found a 16% lifetime prevalence rate of anxiety disorders in individuals with RA,24 and in an analysis of survey data, an estimated 11.2% of patients with arthritis reported panic attacks and 5.6% reported receiving a diagnosis of generalized anxiety disorder, though this latter study did not delineate ...

    What is autoimmune encephalopathy? ›

    Autoimmune encephalitis is a collection of related conditions in which the body's immune system attacks the brain, causing inflammation. The immune system produces substances called antibodies that mistakenly attack brain cells.

    How do people live normally with RA? ›

    Dealing with RA can be stressful, but there are many ways to lower your stress level:
    1. Talk with your doctor or nurse. ...
    2. Take time to rest during the day. ...
    3. Try to relax. ...
    4. Learn special techniques like yoga and meditation. ...
    5. Reach out for support from friends, family, and co-workers.
    6. Join a class or support group.
    6 Nov 2020

    What is the latest treatment for rheumatoid arthritis? ›

    New Treatments for Rheumatoid Arthritis - Latest FDA Approvals
    DrugDrug Class
    abatacept (Orencia)selective T cell costimulation modulator
    adalimumab (Humira)tumor necrosis factor (TNF) blocker
    anakinra (Kineret)interleukin-1 receptor antagonist
    infliximab (Remicade)tumor necrosis factor (TNF) blocker
    12 more rows
    11 May 2022

    Is rheumatoid arthritis a critical illness? ›

    While rheumatoid arthritis is not considered life-threatening, if you die from something linked to your condition, your life cover will payout. A life insurance policy will pay out a cash lump sum to your family if you pass away for almost any reason.

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