The Diabetes-Arthritis Connection
What do diabetes and arthritis have in common? Plenty
By Denise Lynn Mann and Donna Rae Siegfried
New research shows that people with diagnosed diabetes are nearly twice as likely to have arthritis, indicating a diabetes-arthritis connection. If you have both conditions, you probably take different treatments for them. You probably see different doctors for them. But the lifestyle changes you make for one may be good for the other. Eating smaller portions of healthy foods and walking daily, for instance, are important parts of treating diabetes; rheumatoid arthritis benefits from the same activities.
Diabetes occurs when the body does not produce or use the hormone insulin sufficiently. Insulin shuttles glucose from foods into cells so it can be converted into energy. Without insulin, glucose remains in your blood (raising blood glucose levels), your cells create less energy and you feel fatigued.
What starts off as a hormonal problem can evolve into joint problems, in addition to the widely known cardiovascular problems.
Diabetes causes musculoskeletal changes that lead to symptoms such as joint pain and stiffness; swelling; nodules under the skin, particularly in the fingers; tight, thickened skin; trigger finger; carpal tunnel syndrome; painful shoulders; and severely affected feet. After having had diabetes for several years, joint damage – called diabetic arthropathy – can occur.
Though they both share connections with diabetes, rheumatoid arthritis (RA) and osteoarthritis (OA) are related to the disease in different ways. Having arthritis does not mean you’ll develop diabetes, or vice versa, but taking good care of your health in response to one condition might mean staving off or minimizing the other.
Autoimmunity and type 1 diabetes
Type 1 diabetes is an autoimmune disease, as is rheumatoid arthritis. In people who have type 1 diabetes, the body attacks the pancreas, the organ where insulin is made, just as RA attacks the synovial tissue lining the joints. Inflammation is the common culprit.
Levels of inflammatory markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6), which often are high in people with rheumatoid arthritis, also are increased in those with type 1 diabetes. A study of people who had type 1 diabetes for longer than five years shows an increase in tumor necrosis factor-alpha (TNF-a), another inflammatory marker often elevated in people with inflammatory forms of arthritis. Inhibiting TNF-a with drugs such as adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) is the goal of treating arthritis and related conditions.
As scientists learn more about the roots of inflammation, some treatments for inflammatory arthritis may wind up helping to control other inflammation-related conditions. Researchers already are testing the possibilities.
Reducing inflammation with Remicade improved insulin sensitivity in people who had inflammatory diseases and were insulin resistant, according to a small study published in the journal Annals of the Rheumatic Diseases. And in a study of 70 people who had type 2 diabetes, the arthritis drug anakinra (Kineret) brought down the glucose level, improved function of the pancreas and decreased levels of CRP and IL-6.
Osteoarthritis and type 2 diabetes
Go above your ideal weight, and your lower-body joints feel the burden. As the scale creeps upward, your organs become burdened, too. The pancreas increasingly produces more insulin to deal with excess sugar, eventually becoming exhausted and ineffective. The heart and blood vessels become stressed as they strain to pump blood through a larger body mass and deal with the inflammatory chemicals being churned out by fat cells.
“Type 2 diabetes is [largely] a disease of people who are overweight or obese, and overweight and obesity are big risk factors for knee and hip OA,” says David Felson, MD, a professor of medicine and epidemiology at Boston University School of Medicine.
The first-line fix for both conditions? Lose weight, which, Dr. Felson says, will improve each one. Modest weight loss will alleviate pressure from the lower extremities, helping to ease pain in the hips, knees and feet. Losing just 15 pounds can cut knee pain in half. And losing just 5 percent to 10 percent of body weight will reduce blood sugar significantly and can enable some people to taper off insulin and other medications.
Taking good care
Eat regularly and consistently to help your body maintain steady blood glucose levels. Doing so keeps the body from releasing too much insulin, which is known to make weight loss (and fat loss) difficult. Try to eat the same amount of food during meals or snacks at the same times every day, and, of course, choose your foods wisely. Consume some protein and healthy fats, along with whole-grain carbohydrates and nonstarchy vegetables, at each meal, and keep portions small: Eating too much at once causes blood sugar to spike.
Then, make sure you engage in about 30 minutes of physical activity on as many days of the week as possible to help keep your weight down, your joints lubed and your blood sugar normal, not to mention to decrease your risk of heart disease – a top health risk associated with both arthritis and diabetes.
