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Rheumatoid Arthritis and Diabetes: Understanding the Connection

Posted on November 11, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Sarah Winfrey

The connection between rheumatoid arthritis (RA) and diabetes mellitus — commonly referred to as diabetes — is complex because the two conditions are risk factors for one another. In other words, having one of the conditions seems to raise a person’s chances of developing the other.

People diagnosed with RA may have up to a 50 percent higher risk of developing diabetes than those in the general population. Similarly, people diagnosed with diabetes are also at a higher risk of developing rheumatoid arthritis. However, the probability depends on the type of diabetes they have, along with a few other factors.

The Connection Between RA and Diabetes

Rheumatoid arthritis (and any inflammatory arthritis, including psoriatic arthritis) and diabetes are connected in several different ways.

RA and Type 1 Diabetes

Type 1 diabetes occurs when the pancreas does not create enough insulin, a type of hormone that regulates the body’s blood sugar levels. When you don’t have enough of it, your blood sugar may become too high (a condition known as hyperglycemia).

Connected Autoimmune Conditions

Type 1 diabetes is an autoimmune disease that occurs when the body’s immune system attacks the pancreas. RA is also an autoimmune condition in which the immune system attacks the joints.

If you have been diagnosed with one autoimmune condition, you are statistically more likely than the general population to be diagnosed with another. Thus, being diagnosed with either type 1 diabetes or RA can make it more likely that you will be diagnosed with the other, too.

Genetics

Having certain genes may make it more likely that people will be diagnosed with both RA and type 1 diabetes. These include:

  • TNFAIP3
  • PTPN22
  • CTLA4

If you have had any genetic testing done, you may know whether you have one of these genes. Alternatively, you may be able to request testing to determine whether you are at an increased risk of developing these conditions.

RA and Type 2 Diabetes

In type 2 diabetes, the body may make sufficient insulin, but it does not use or interact with it the way it is supposed to. This is known as insulin resistance and can lead to many other health problems.

Inflammation

Both type 2 diabetes and RA are inflammatory diseases — they are conditions that cause the body to experience an excess of inflammation.

Inflammation in RA is connected to an inflammatory protein called tumor necrosis factor (TNF), the buildup of which eventually causes joint pain and other symptoms. Some studies seem to show that medications directed at lowering this particular protein also lower the risk of developing diabetes.

Your body produces TNF whenever there is an injury or an infection because it is designed to lead the body’s immune system response by recruiting other proteins (cytokines) to help fight and heal from invaders. If the body is producing this protein without reason, however, the result is an overactive and unwarranted autoimmune response, which is seen in both RA and diabetes.

Medications

Some people diagnosed with rheumatoid arthritis are given long-term doses of corticosteroids, like prednisone. Although these are often very effective at slowing the progression of RA and providing relief from symptoms, these medications tell the liver to release more glucose into the blood. They also increase the time it takes for glucose (sugar from the foods we eat) to move into the body’s fat and muscle tissues. This process raises blood sugar levels. Unless the body can adjust and produce enough insulin to deal with that much blood sugar, a person may develop type 2 diabetes.

Inactivity

Many people who have been diagnosed with RA find it difficult to keep their bodies moving. Stiff, swollen joints can make exercise or even routine physical movement painful and challenging. Studies have shown less active people are more likely to develop type 2 diabetes.

Thus, it’s important to keep exercising even after being diagnosed with rheumatoid arthritis. Rheumatologists and specialists like physiotherapists can help those with RA find ways to get moving without exacerbating joint pain or other symptoms.

Preventing and Managing Diabetes With Rheumatoid Arthritis

If you have been diagnosed with rheumatoid arthritis but not diabetes, there are a few things you can do to monitor your condition and try to prevent that diagnosis. There are also ways to continue to care for yourself if you already have both diagnoses.

Know the Signs of Diabetes

Learn the most common symptoms of diabetes, and if you notice any of these in yourself, it’s time to visit your health care team to get tested for diabetes. The earlier you find diabetes, the more likely it is that you won’t suffer severe health consequences from it.

Some symptoms of diabetes include:

  • Wanting to eat more food than you usually do, with possible weight loss although you’re eating more
  • Consistent (and, in some cases, extreme) fatigue
  • Drinking more water and urinating more frequently
  • Vision that is blurry all or some of the time

Regular Screenings

Talk to your doctor about regular screenings for diabetes. Your health care provider may ask you questions or perform tests to help determine if you have developed diabetes. This will help you avoid being one of a significant number of people diagnosed with RA who have undiagnosed diabetes.

Talk to Your Health Care Team About Steroids

Because steroids can boost blood glucose levels, make sure you specifically discuss the potential of developing diabetes before you begin taking them to treat your RA. Ask your doctor any questions you have, including about ways to help decrease your risk of diabetes.

Control Inflammation

Although corticosteroids can help increase the risk of developing diabetes, they can play a key role in keeping inflammation at bay. This is much easier to do before you develop diabetes than it is afterward.

Methotrexate and hydroxychloroquine (Plaquenil) have been shown to control inflammation and lower the chances of developing diabetes for many people. If these medications don’t work for you, another biologic or disease-modifying antirheumatic drug might help, as may a TNF inhibitor, like infliximab (Remicade). Your rheumatologist can help you determine which medications will work best for your situation.

Stay Healthy

One of the best ways to avoid developing type 2 diabetes and manage the condition if you already have it is to take care of your body. For example, you can adopt a variety of lifestyle changes.

Get Consistent Exercise

Aim for at least 150 minutes of exercise a week, if possible. Low-impact activities are best if you’re dealing with RA symptoms, so look for physical activities like water aerobics or biking. A physical therapist can help you come up with a plan if you aren’t sure what to do.

Learn more about rheumatoid arthritis and exercise.

Eat a Healthy Diet

Keeping your blood glucose levels steady will help you avoid and manage diabetes. Eating a diet full of fresh fruits and vegetables and lean protein and opting for healthy fats (like olive oil) and whole grains can help keep your blood sugar stable. A nutritionist or dietitian who specializes in diabetes can help you devise a diet plan tailored to your needs.

Learn more about the anti-inflammatory diet for rheumatoid arthritis.

Lose Weight

Obesity increases the risk of developing type 2 diabetes. Find out your body mass index from your doctor and ask them if you should lose weight to help reduce your risk of diabetes.

Find Your RA Support Team Today

On myRAteam, the social network for people with rheumatoid arthritis, more than 192,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

Are you living with diabetes and RA? Comment below to share your story, or start a conversation on myRAteam.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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