Cognitive dysfunction in systemic autoimmune rheumatic diseases: a new focus for future research and a need for greater support?

This editorial refers to the article ‘Self-reported cognitive dysfunction and memory impairment in systemic autoimmune rheumatic diseases (SARDs): a mixed methods analysis of the INSPIRE cohort’ by Avni Varshney et al. 2025; 64:6213-6223. Systemic autoimmune rheumatic diseases (SARDs) are an umbrella term including inflammatory arthritis, SLE, SS, idiopathic inflammatory myopathy (IIM) and systemic vasculitis. All SARDs can impact health-related quality of life and psychological well-being; respondents from the 2025 Rare Autoimmune Rheumatic Disease Alliance patient survey (n = 1300), reported difficulties with mental health (73%), ability to complete everyday tasks (86%) and working effectively (66%) [1]. Cognitive dysfunction is a specific symptom that has been particularly highlighted in patients with SLE [2] but also occurs in at least a third or more of people with other SARDs, including SSc, SS and ANCA associated vasculitis [3, 4]. Often known colloquially as ‘brain fog’, this term can underestimate the profound impact on psychological well-being and daily functioning, including work, relationships, and self-management. In a recent issue of Rheumatology, Varshney et al. describe a mixed-methods study aiming to explore the extent and impact of cognitive impairment in people across SARDS, through an international online patient survey focused on self-report of memory difficulties (n = 1853), and qualitative interviews [5]. This study is part of the INSPIRE (Investigating Neuropsychiatric Symptom Prevalence and Impact in Rheumatology Patient Experiences) research project [6].