When you live with rheumatoid arthritis (RA), you may have to deal with more than swollen, stiff joints. RA can also be linked to other health issues, including heart disease, lung problems, eye conditions, and skin bumps and rashes, according to the Arthritis Foundation.

In addition, RA may be connected to an increased Risk of Dementia. A research review found that developing RA increases the risk of developing dementia as well.

Other factors may also contribute to this risk. One study found that people with RA who also had heart disease or heart disease risk factors had an increased risk for dementia, compared with those who had RA but no heart-related risk factors.

What Is Dementia?

According to the Alzheimer’s Association, dementia is an umbrella term for Brain changes that can include memory loss as well as changes in your thinking, language, and problem-solving skills that are severe enough to interfere with daily life.

Alzheimer’s is the most common type, but it’s also possible to have vascular dementia, which occurs as the result of microscopic bleeding and blood vessel blockage in the brain, or mixed dementia, which is a combination of types.

Inflammation, RA, and Dementia

While both RA and dementia are partly due to a genetic predisposition, there’s another underlying cause they share: inflammation. “The chronic inflammatory process for rheumatoid arthritis can affect brain inflammation, due to hardening of the arteries,” says Jonathan Greer, MD, a rheumatologist at the Arthritis & Rheumatology Associates of Palm Beach and an assistant clinical professor of medicine at both Nova Southeastern University and the University of Miami. “This causes decreased blood to the brain, which can lead to vascular dementia.”

While the research review cited above questioned whether RA medications, such as disease-modifying antirheumatic drugs (DMARDs), including methotrexate (Trexall), hydroxychloroquine (Plaquenil), and sulfasalazine (Azulfidine), may also lead to an increased risk of dementia, Dr. Greer cautions against reading too much into this. “The underlying inflammation caused by rheumatoid arthritis may not be sufficiently controlled with these drugs, and, therefore, the inflammation itself could lead to the dementia,” Greer says. Indeed, the association was not found with tumor necrosis factor (TNF) agents and biologics, which are sometimes better at controlling inflammation.

No matter which treatment you’re prescribed for RA, “You should not be fearful, and you should never stop these drugs without your doctor’s permission,” Greer emphasizes. If you have any concerns about your treatment, “Work in a collaborative fashion with your doctor to find the best options for you.”

Ways to Improve Brain Health

Much has been made about the benefits of mind-sharpening activities such as crossword puzzles to help protect against dementia and Alzheimer’s disease, but these strategies are only part of the picture. Such benefits have been found mainly in observational studies, meaning they don’t prove cause and effect, according to a study in the International Journal of Geriatric Psychiatry. The evidence suggests that mentally stimulating activities may help delay the onset of dementia but not prevent it.

So if learning a new language, reading books, or being social can only help so much, what else can you do to protect your brain? It turns out, a healthy lifestyle may do far more to help than you may realize. “What is good for your brain health is also good for your heart,” says Donn Dexter, MD, a neurologist and the former education chair for the Mayo Clinic Health System, who is based in Eau Claire, Wisconsin.

While the biggest risk factor for dementia is age, there are other factors you can change. “What I usually focus on with my patients are the things you can control, like physical activity and a healthy diet,” says Dr. Dexter.

Try incorporating these healthy habits to help boost your brain health and your overall RA:

1. Eat a healthy diet. The right nutrients can help both your body and brain function at their best. “Particularly, we recommend the Mediterranean diet,” says Dexter. That means sticking to a diet primarily consisting of vegetables, fruits, beans, seeds, whole grains, and lean protein like fish, and using extra-virgin olive oil as your main source of fat. This diet may be especially beneficial because it is anti-inflammatory, meaning it may help reduce inflammation throughout the body, according to the Arthritis Foundation.
2. Stay active. Evidence shows that regular physical activity helps keep blood flowing to the brain, says Dexter. “The benefits are seen with 150 minutes a week of moderate physical activity.” If joint pain makes it hard for you to exercise, water aerobics may be a great option.
3. Prioritize sleep. Getting enough continuous sleep is important not just for your overall health but also for your brain. “People really tend to underestimate the importance of sleep. Aim for seven and a half to eight hours of good sleep at night, ideally uninterrupted,” Dexter says. A study from 2021 found that in older adults, both short and long sleep disruptions were associated with cognitive decline.
4. Limit alcohol intake. Moderating alcohol use or abstaining altogether is also protective for the brain. “You have to be very careful about excess alcohol. You can enjoy a glass of wine a day, but understand that that means 5 ounces of wine, not more,” Dexter notes.
5. Quit smoking. Smoking damages your lungs and hardens and narrows the arteries, affecting blood flow. According to a longitudinal study, smoking is tied to higher disease activity with RA. Smoking may also lead to a greater risk for dementia, according to a separate longitudinal study.

It’s still beneficial to keep up your social ties and challenge your mind to help it stay sharp. But beyond that, a healthy lifestyle will be the best investment you can make for your brain, your body, and your RA.