There’s research that suggests a connection between rheumatoid arthritis (RA) and diabetes. But the nature of that connection or even whether it’s actually real is unclear. "There are tantalizing links between the two diseases,” says Daniel Solomon, MD, MPH, an associate professor of medicine at Harvard Medical School and a rheumatologist at Brigham and Women's Hospital in Boston. But "at this point they are mainly speculative."
WebMD asked Solomon and Androniki Bili, MD, MPH, to explore the possible connection between RA and diabetes. Bili is an associate rheumatologist at Geisinger Health System in Danville, Pa. Here is what they had to say and how it might affect the way you manage RA.
Nancy Hardin, age 71, of Dyersburg, Tenn., was diagnosed with rheumatoid arthritis (RA) 11 years ago. A few months after her diagnosis, she quit her teaching job at a local high school because she could barely walk. Then she started taking the biologic drug Remicade and became nearly symptom-free. Nevertheless, she decided that going back to the classroom would wear her out. She did, though, become a volunteer translator for local Spanish-speaking immigrants and a member of the Tennessee Council...
There are a number of theories about the connection between diabetes and rheumatoid arthritis. RA is an autoimmune disease. The immune system defends the body from invading organisms and substances that can cause damage. With RA, the body’s immune system attacks its own joints. The result of that attack is an ongoing inflammation, which is a hallmark of RA. Some research suggests that inflammation may also play a role in the onset of diabetes.
Solomon tells WebMD that there are links between inflammation and insulin resistance. "We know there is an increased risk of insulin resistance among people with RA," he says. Insulin is produced in the pancreas and helps the body use glucose, or blood sugar, for energy. In people with insulin resistance, the body’s cells don’t respond to insulin in the correct way. That increases the risk of developing type 2 diabetes.
But inflammation is not the only potential link between RA and diabetes. Certain drugs that are used to treat RA, namely steroids, may actually increase the risk of diabetes. "We need to be very aware of RA patients' glucose levels, especially if they are on corticosteroids,” says Solomon. “This drug is a risk factor for hyperglycemia or high blood sugar levels."
The effects of RA may also increase the risk of diabetes. People with RA may lead sedentary lives due to pain and RA-related disabilities. When people are physically inactive, they are more likely to be overweight. Being overweight or obese is a known risk factor for diabetes. And according to the CDC, the inactivity caused by arthritis interferes with management of both RA and diabetes.
RA/Diabetes Connection: Can the Risk Be Lowered?
”If a patient has any modifiable risk factors for diabetes such as obesity,” Solomon says, “I want to be as proactive as possible." This means encouraging the patient to eat a healthful diet and get regular exercise. Doing so will help lose weight and reduce the risk of diabetes.
And treating RA may also play a role in reducing the risk of diabetes. While steroids can increase diabetes risk, other rheumatoid arthritis medications may actually help lower the risk. For example, studies show that the antimalarial drug hydroxychloroquine is associated with a decreased risk of diabetes among people with RA.