Dr. Ahmed
When the immune system malfunctions and attacks the body, autoimmune diseases like type 1 diabetes and rheumatoid arthritis (RA) develop.
When a person has type 1 diabetes, the pancreas, which produces insulin, is attacked. The tissue that lines bones and allows for free joint movement is attacked by the immune system in rheumatoid arthritis (RA). You run a higher risk of developing another autoimmune disease if you already have one.
Although anyone can develop rheumatoid arthritis, those who have a family background of the disease or other autoimmune disorders, such as type 1 diabetes, are more likely to do so.
Diabetes and arthritis are related to each other’s risk factors; Arthritis affects 47% of adults with Type 2 and Type 1 diabetes.
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Rheumatoid Arthritis and Inflammation:
Both type 1 diabetes and rheumatoid arthritis are autoimmune diseases in which your body’s defense mechanism unintentionally targets healthy cells.
Your immune system overproduces cytokines, which are a particular class of inflammatory proteins when you have a chronic autoimmune disease.
RA patients and those with both types of diabetes have higher levels of the cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6).
These cytokines are released by your body to fight off infections and promote healing. However, an excess of them can lead to harmful inflammation.
Your immune system attacks your joints if you have RA. It’s your pancreas if you have type 1 diabetes. Because of this, it is challenging for your body to produce the insulin required to control blood sugar.
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Metabolic disturbances:
Diabetes may have a direct impact on the arthritic disease process. Reactive oxygen species (ROS) are molecules that promote the production of pro-inflammatory cytokines, and high blood sugar contributes to their development (substances that are secreted by certain immune cells).
Additionally, it causes the development of substances known as advanced glycation end products (AGEs) [ref], which accumulate in joints and harm them. AGE production increases in long-term RA and results in cardiovascular diseases.
Typical risk factors
Lifestyle choices, socioeconomic factors, and medications you may take are additional factors that may be connected between RA and diabetes.
Some common risk factors among those with both conditions were:
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Disease-Modifying Antirheumatic Drugs (DMARDs).
This class of drugs is intended to mitigate some of the negative effects of inflammation. Some studies have found that the DMARDs hydroxychloroquine (Plaquenil) and abatacept (Orencia) reduce your risk of developing diabetes.
However, DMARDs, like diabetes and RA, increase your risk of infection. As a result, you’ll need to be extra cautious about avoiding infections and seeking treatment if you do become ill.
Among the other DMARDs used to treat RA are:
- Certolizumab pegol (Cimzia)
- Etanercept (Enbrel)
- Golimumab (Simponi, Simponi Aria)
- Methotrexate
- TNF-inhibitors (Adalimumab) [ref]
Inactivity is another possible link between the two conditions. Some people may avoid exercise due to the joint pain caused by RA.
A sedentary lifestyle, on the other hand, may result in weight gain, which is a risk factor for diabetes. Furthermore, physical activity reduces your RA disability while also relieving fatigue and improving your mood.
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Diabetes and DMARDs’ effects
Certain RA medications may have an impact on diabetes. Prednisone and other steroids are probably the worst offenders.
These frequently cause blood sugar levels to rise, sometimes even as a result of an injection of steroids into a joint.
Increased steroid dosages may necessitate other medication or more insulin to maintain blood sugar control. When steroids are stopped or tapered off, the opposite can occur.
Diabetes patients should be vigilant for infections and should treat any fever or localized symptoms of infection (such as a cough with phlegm, discolored nasal discharge, fever, skin rashes, or burning in the urinary system) as soon as they appear by contacting a healthcare provider right away.
This is because many DMARD drugs, particularly biological agents, can raise the risk of infection [Ref].
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Some Rheumatoid Arthritis Medicines also Affect Blood Sugar
Discuss with your doctor any potential effects on your blood sugar from your RA medication. Prednisone (Prednisone Intensol, Rayos), prednisolone (Millipred, Orapred, Pediapred, Prelone, Veripred 20), and methylprednisolone (Medrol) are corticosteroids that can have the side effect of raising blood sugar levels.
To minimize side effects, corticosteroids are commonly recommended for the briefest time at the lowest possible dose.
Other RA medications, on the other hand, may reduce the risk of developing diabetes or insulin resistance [Ref]. They consist of:
- Plaquenil (hydroxychloroquine), which alters the course of RA
- Actemra (tocilizumab), which inhibits the inflammatory protein IL-6
- Abatacept (Orencia) is a drug that blocks T-cell costimulation.
It can be very beneficial to work with your doctor to manage your RA because you may also be assisting in keeping your blood sugar levels under control.
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Steps you can take to control both Diabetes and Rheumatoid Arthritis
Weight management, diet, and exercise are the three pillars of managing diabetes and rheumatoid arthritis.
Weight management.
Losing weight is the first line of treatment for both conditions. Increased joint stress and insulin resistance are both consequences of being overweight.
The burden on arthritic knees increases by 13 pounds for every 2 pounds of additional body weight. Reduced pressure on the lower extremities will help to reduce pain in the hips, knees, and feet.
Blood sugar levels can be significantly lowered by losing just 5 to 10 percent of body weight.
Certain diabetes medications can help you lose tons. These include:
However, it should be noted that these medicines can be used only by people with type 2 diabetes. Except for Farxiga which got a temporary EMA approval for obese patients with type 1 diabetes, other medicines are not indicated for treating type 1 diabetes.
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Eat healthily.
To assist your body in maintaining steady blood glucose levels, eat frequently and consistently. Talk to your doctor about making informed food choices.
Consume whole-grain carbohydrates, non-starchy vegetables, protein, and healthy fats at each meal.
Exercise regularly.
Last but not least, engage in regular exercise—at least 150 minutes of aerobic activity 6 days a week.
Low-impact exercises like biking and water aerobics can be beneficial. Include a few days per week of strengthening, flexibility, and balance-enhancing exercises.
Just be careful not to push yourself too hard during exercise. You can lower your risk of injury by exercising with a qualified trainer or physical therapist.
