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Diabetes and Arthritis: What You Need to Know and Tips to Prevent It

Learn more about the link between diabetes, osteoarthritis and rheumatoid arthritis.

Asian couple on couch. Man has sore knee If you suffer from OA, assistive devices such as braces, canes or shoe inserts can help alleviate painful symptoms.(Photo: 123rf)

Arthritis, a condition that causes joint pain or disease, is the leading cause of workplace disability in America. There are more than 100 different types of arthritis and related conditions that affect more than 54 million adults and 300,000 children.1 While anyone can have arthritis, it is most common among women and occurs more frequently as people age.

OA or RA?

Two types of arthritis—osteoarthritis (OA) and rheumatoid arthritis (RA)—are associated with diabetes.

OA is a ‘wear and tear’ disease that occurs when the rubbery cartilage or cushioning surface on the ends of bones wears away, causing pain, swelling and problem moving the joint. Over time, the joint can break down, inciting an inflammatory process that further degenerates the cartilage and causes additional pain as bone rubs against bone.

Like type 1 diabetes, RA is an autoimmune disease. In RA, the immune system, rather than protect the body, malfunctions and attacks the synovial membrane that produces a fluid that lubricates the joints. If unchecked, this can damage cartilage and bones, causing joints to become unstable, deformed, painful and to lose mobility. Since it is a systemic disease, it can target several joints at once, as well as damage the cardiovascular and respiratory systems. 3

In a recent Danish study4, diabetes is associated with a greater risk of having OA and RA. The study involved about 100,000 participants, of which 9,238 (8%) had diabetes. Of the subgroup of people with diabetes, 33% were more likely to suffer from OA than their diabetes-free counterparts, while the odds of having RA (70% higher) were considerably greater among individuals with diabetes. People with diabetes tended to be older, were more often male, had higher BMI, and were most likely to have osteoarthritis.

The authors speculate that the strong association between RA and diabetes is likely the result of chronic inflammation or steroid treatment that can lead to type 2 diabetes, rather than the link that exists between the autoimmune diseases, type 1 diabetes and RA. They point out that the exclusion of people younger than 40 meant that the majority of those included in the study probably had type 2 diabetes.

Osteoarthritis (OA) and Type 2 Diabetes

In both OA and type 2 diabetes, excess weight may be to blame. While extra pounds put pressure on lower joints, additional fat tissue also burdens the pancreas, which must increase insulin production to deal with excess sugar, eventually reducing the organ’s effectiveness.

As heart and blood vessels work overtime to pump blood through a larger body mass, they are also dealing with inflammatory chemicals being churned out by fat cells. 5

The best fix for both conditions is to lose weight, according to Katarzyna Gilek-Seibert, MD, a rheumatologist at Roger Williams Medical Center in Providence, Rhode Island and adjunct professor at Brown University.

“Losing weight—even a small percentage—and keeping sugars low can help,” she says. “Losing 10 pounds can cut the progression of joint disease by about 50%.”

Dr. Gilek-Seibert is an enthusiastic supporter of exercise, not only to increase patient well-being, but to reduce inflammatory pathways.

“OA is definitely linked to lifestyle,” she adds. Anti-inflammatory diets, such as the Mediterranean style diet, “can help patients reduce inflammation and get to a healthy weight in conjunction with physical activity and a non-sedentary lifestyle.”

Signs of inflammation include pain, swelling, loss of function, red appearance and the area feeling warmer than surrounding skin.

Managing Joint Symptoms

When the joint symptoms of osteoarthritis are mild or moderate, they can be managed by:

  • physical therapy
  • hot and cold therapies
  • regular physical activity
  • maintaining a healthy weight
  • strengthening the muscles around the joint for added support
  • using assistive devices (braces, canes, shoe inserts, etc)
  • taking over-the-counter (OTC) pain relievers or anti-inflammatory medicines
  • avoiding excessively repetitive movements

In the case of severe symptoms, surgery may be needed to repair damaged joints. 5

Rheumatoid Arthritis (RA) and Diabetes

Both RA and type 1 diabetes are autoimmune and inflammatory diseases. In type 1, the body attacks the pancreas where insulin is produced; in RA, the body attacks the synovial tissue lining the joints.

Genetics may lead some people to have more than one autoimmune disease at a time, and certain environmental factors, such as smoking, can trigger a disease. 6

“With type 1 diabetes, where there is an increased level of inflammation, eventually a high level of glucose may penetrate the joints and cause hardening,” Dr. Gilek-Seibert explains.

Although there is no direct link between type 2 diabetes and RA, “some research shows that RA can increase the risk of type 2 diabetes by 50%, but that is at the research level,” says Dr. Gilek-Seibert. “If you have diabetes, however, there is about a 20% risk of having type 2 and RA.”

 

The question is which comes first, type 2 diabetes or RA? On one hand, the chronic inflammation of RA, which can promote insulin resistance (where cells no longer respond to insulin), can raise the risk of developing type 2 diabetes. On the other, chronic inflammation stemming from type 2 diabetes can lead to RA, where  the inflammation may trigger people who have a genetic risk for RA to develop the joint disease earlier than they might have otherwise.  6, 7

“People with prediabetes, who have higher levels of glucose and insulin resistance can also be vulnerable to developing inflammatory RA,” says Dr. Gilek-Seibert.

Other factors can promote RA, including steroid use, lack of exercise due to pain and stiffness of the disease, and subsequent weight gain. “Adipose tissue can cause inflammation that can predispose a person to inflammation in the joints,” Dr. Gilek-Seibert explains. 

RA Drugs and Diabetes

With autoimmune and inflammatory types of arthritis (psoriatic arthritis, juvenile idiopathic arathritis, lupus and ankylosing spondylitis are other types of inflammatory arthritis), early diagnosis and aggressive treatment is critical. 

Slowing disease activity can help minimize or even prevent permanent joint damage. The goal of treatment is to reduce pain, preserve joint function, mobility and quality of life.8

Certain medications for RA can raise glucose and promote diabetes. “When it comes to RA, steroids can worsen the state of diabetes,” says Dr. Gilek-Seibert. “The goal is to try to use steroids at lowest possible doses and for the shortest time possible.”

Other drugs can protect against diabetes. These include some types of disease-modifying anti-rheumatic drugs (DMARDs) which not only relieve symptoms but slow progression of joint damage. Hydroxychloroquine has been shown to lower glucose levels and insulin resistance in people with diabetes. 9

Doctors often prescribe DMARDs along with nonsteroidal anti-inflammatory drugs (NSAIDS) or low-dose corticosteroids, to lower swelling and pain.

Patients with more serious disease may need medications called biologic response modifiers or “biologic agents.” These can block immune system chemical signals that lead to inflammation and joint or tissue damage. Most often, patients take these drugs with methotrexate, as the mix of medicines is more helpful.

“Biologic agents are very useful in not only helping to control RA generation and damage, but in controlling other signs of inflammation in other organs. They also help us to use more nonsteroidal drugs,” explains Dr. Gilek-Seibert. “People who struggle with high sugar have these options.”

In the end, she said that the most important advice for people with arthritis and diabetes is to follow the advice of their endocrinologist and rheumatologist.  “And to keep their A1Cs within the norm.”
 

Updated on: April 3, 2019
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