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Patients with arthritis are more likely to develop diabetes compared to the general population. This article outlines the connection between arthritis and diabetes and how to treat these two diseases.

Arthritis is an inflammatory joint disease characterized by joint inflammation, pain and swelling. Studies have shown that 47 percent of patients with arthritis have another chronic condition (known as a comorbidity. The most common comorbidities in patients with arthritis include heart disease, obesity, and diabetes.

In fact, approximately 16 percent of arthritis patients have type 2 diabetes. Conversely, 47 percent of patients with diabetes have arthritis.

For patients with psoriatic arthritis and rheumatoid arthritis, one study found that the risk of diabetes was increased by almost 50 percent. However, while the connection between psoriatic arthritis and diabetes is well-established, the link between rheumatoid arthritis and diabetes is less well-known. With rheumatoid arthritis patients, doctors don’t often know what to expect. However, if you have risk factors for diabetes, then there are is a good chance you will develop the disease. Thus, there is an intricate connection between the two diseases.

There are two different types of diabetes:

  • Type 1: Type 1 diabetes is an autoimmune disease (similar to arthritis) in which the body doesn’t produce or metabolize the hormone insulin properly. The hormone insulin helps metabolize glucose. Thus, a lack of insulin leads to high blood sugar levels. In type 1 diabetes, the immune system attacks and destroys the cells that produce insulin.
  • Type 2: Type 2 diabetes develops because the cells that produce insulin gradually lose their ability to make adequate levels of insulin. People most likely to get type 2 diabetes are older, have more weight, and have a family history of the disease.

So what is the relationship between arthritis and diabetes?

The connection between the two disease is not fully understood. However, researchers have their theories.

Type 1 diabetes

The link between type 1 diabetes and arthritis stems from the fact that they are both autoimmune diseases in which the immune system goes haywire and starts to attack healthy tissue, causing inflammation and the death of cells. The fact that both these diseases are autoimmune diseases could be the reason why patients with either disease are more likely to get the other one.

Inflammation is the main link between the two diseases, as autoimmune diseases are characterized by inflammation. Thus, patients with both types of diseases have high levels of inflammatory molecules called cytokines. These include tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and IL-1 and IL-6.

Type 2 diabetes

Patients with type 2 diabetes are more likely to get the disease if they have certain risk factors. These include older age, genetics and gender, all of which predispose an individual into developing either disease. Additionally, non-modifiable risk factors such as diet, smoking, obesity and physical activity can also increase the risk of developing these diseases.

Management of both arthritis and diabetes

Unfortunately, similar to arthritis, there is no cure for diabetes. However, there are medications that can help manage both these diseases. The primary way to manage a combination of arthritis and diabetes, besides taking the proper medication, is to follow one main piece of advice: engage in physical activity. Research has shown that physical activity and exercise helps improve a variety of domains including:

  • Physical functioning
  • Improved mobility
  • Reduced blood glucose levels
  • Improved weight control
  • Improve range of motion

Conducting physical activity and exercise on a daily basis helps manage both of these conditions by slowing down disease progression, lowering your risk of complication and improving your physical functioning. Unfortunately, despite these significant benefits, patients with simultaneous diabetes and arthritis tend to exercise less than their counterparts who only have one disease. In fact, one study showed that patients who have both diabetes and arthritis are three times more likely to be sedentary and less active compared to patients that have neither condition. This is because patients with both diseases have pain, extra weight that makes it hard to exercise, fear of injury to already fragile joints and a lack of motivation.

If you are not sure how to start exercising or scared to do so because you think it may negatively impact your arthritis, there are several evidence-based programs designed specifically for arthritis patients that include both strengthening exercises (to make the muscles around your joints stronger) and low-impact cardio exercise such as walking, swimming, or biking. Stretching is also very important as that helps improve your range of motion and improves joint functioning. Do not be discouraged by having both diseases, many people with both arthritis and diabetes are able to live active lives through exercise.

The second important part of disease management is medication. In the case of inflammatory or autoimmune diseases, including both type 1 diabetes and certain subtypes of arthritis, there are medications that can inhibit pro-inflammatory molecules and reduce joint damage. These molecules are higher in people with diabetes.  These medications include biologic agents such as adalimumab, etanercept, and infliximab. These work to reduce the risk of developing these types of diabetes.

  • Wasko, Mary Chester M., et al. "Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis." Jama 298.2 (2007): 187-193.
  • Solomon, Daniel H., et al. "Association between disease-modifying antirheumatic drugs and diabetes risk in patients with rheumatoid arthritis and psoriasis." Jama 305.24 (2011): 2525-2531.
  • Coto‐Segura, Pablo, et al. "Psoriasis, psoriatic arthritis and type 2 diabetes mellitus: a systematic review and meta‐analysis." British Journal of Dermatology 169.4 (2013): 783-793.
  • Photo courtesy of SteadyHealth

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