Inflammatory Arthritis and Diabetes: Managing Both
Inflammation is one link between arthritis and diabetes, but there are other factors involved.
Almost half (47%) of adults with arthritis also have another chronic condition. Of the 52.5 million US adults with arthritis, 16% (7.3 million) have type 2 diabetes, and 47% of adults with diabetes have arthritis. Is there a connection? Does having one condition lead to the other?
Inflammatory arthritis is a general term used for a group of autoimmune diseases in which the immune system attacks a person’s own tissues – the joints but also other organs throughout the body. The resulting joint symptoms include inflammation, pain, stiffness and swelling. The most common forms of inflammatory arthritis are rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) – affecting approximately 4 million people in the US.
Type 1 diabetes is also an autoimmune condition that causes the body to not produce, use, or metabolize the hormone insulin sufficiently. In a healthy person, insulin is produced in the pancreas and helps the body convert sugars to energy. A person with type 1 diabetes does not produce insulin because their immune system attacks and destroys the insulin-producing cells of the pancreas; although the reason why this occurs is unknown, genes and possibly viral infections are thought to be responsible. It is usually diagnosed in children and young adults.
Type 2 diabetes begins with insulin resistance, in which the pancreas gradually loses its ability to produce sufficient amounts of insulin. Technically considered a metabolic disorder, this type of diabetes is associated with older age, obesity, family history and other factors. In adults, nearly all diagnosed cases are type 2 diabetes.
The Relationship Between Arthritis and Diabetes
Type 1 diabetes and inflammatory arthritis are both autoimmune diseases. The classic sign of any autoimmune condition is inflammation, and that may be the link between these two diseases. In diabetes, the immune system attacks the pancreas, whereas in inflammatory arthritides, it attacks the joint tissues.
Another reason so many people with diabetes develop arthritis, and vice versa, could be a matter of shared risk factors and lifestyle behaviors. Non-modifiable risk factors, such as your age, gender and genetic make-up, are primary ingredients for a diagnosis of either arthritis or diabetes. Similarly, modifiable risk factors that include smoking, diet, obesity, and physical activity also affect your likelihood of developing either arthritis or type 2 diabetes.
Cause and Effect
Which comes first: arthritis or diabetes? There have been a number of studies investigating the cause and effect of having a type of inflammatory arthritis and then developing diabetes. As mentioned, inflammation is one link. It is well established that levels of inflammatory cytokines – such as tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukins-1 and -6 – are high in people with rheumatoid arthritis; related studies indicate that these inflammatory molecules are also high in people with type 1 diabetes.
In a study published in 2010 in the Annals of the Rheumatic Diseases, researchers found that the relative risk for diabetes was increased by approximately 50% in patients with RA or PsA compared to people who don’t have these diseases. “With psoriatic arthritis, it’s been known there’s an increased risk of diabetes,” explains study author Daniel Solomon, MD, from the division of rheumatology at Brigham and Women’s Hospital in Boston. “With RA we didn’t really know what to expect because there hasn’t been a rigorous study focusing on this issue.” Dr. Solomon says the risk of getting diabetes increases with age and body mass index, and people with RA are at increased risk for developing these comorbidities. Dr. Solomon speculates that the increased risk of diabetes is due to inflammation and possibly inactivity.
How Can You Manage Both?
Research and experts agree: physical activity is essential. The benefits of exercise include improved physical function and mobility, reduced blood glucose levels, and weight control – all factors that can affect disease progression and lower your risk of complications in diabetes and arthritis. In spite of this, people with both conditions tend to exercise less – even compared to those with either condition alone. In a 2008 article in the Morbidity and Mortality Weekly Report, adults with diabetes and arthritis were nearly three times more likely to be sedentary than those with neither condition. Pain, excess weight, fear of injury, lack of motivation or desire, and time were other barriers to physical activity. However, the Arthritis Foundation has many tools and programs to help you stay active.
Another vital part of disease management is proper medication. In the case of inflammatory arthritides, inhibiting proinflammatory cytokines and reducing joint damage are the primary goals of treatment. These same inflammatory biomarkers are also increased in people with diabetes. A number of studies indicate that biologic agents prescribed for arthritis, such as adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade), also work to reduce your risk of developing either type of diabetes.
Being in control of both arthritis and diabetes is possible through medical management, self-care and consistent physical activity.