Rheumatoid Arthritis and Diabetes: What's the Link?

Medically Reviewed by David Zelman, MD on May 30, 2024
4 min read

Did you know that if you have rheumatoid arthritis (RA), you’re more likely to also get diabetes? Some reports say that those with RA are 23% more likely than others to end up with type 2 diabetes. Research has also found that people with type 1 diabetes have a higher risk of developing RA.

Scientists have been studying the connection between the two conditions. It can involve your genes as well as lifestyle factors, like having excess weight. Inflammation plays a big role, too.

Research doesn’t indicate that RA directly causes either type of diabetes, or that diabetes causes RA. Instead, diabetes is a comorbidity. That means the two conditions often affect the same person at the same time.

Both RA and type 1 diabetes are autoimmune conditions, in which your body’s defense system mistakenly attacks healthy cells. When you have a chronic autoimmune condition, your immune system overproduces a type of inflammatory protein called cytokines.

Tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) are two cytokines that are found in higher levels in people with RA and in those with both types of diabetes. Your body releases these cytokines to ward off infections and help you heal. But too much of them can cause harmful inflammation.

In RA, your immune system goes after your joints. In type 1 diabetes, it’s your pancreas. That makes it hard for your body to produce the insulin you need to regulate blood sugar.

Research shows that when you have one autoimmune condition, your chances of developing another one go up. The genetic defect that causes the first condition can also cause another type of autoimmune disease. When there’s inflammation in your body, it may affect organs and tissues in more than one area.

What about type 2 diabetes? It’s the most common form, making up 90% of the world’s cases. It’s not considered an autoimmune condition. But obesity, one of the main risk factors for type 2, boosts inflammation. That can lead your cells to become more resistant to insulin.

Other possible links between RA and diabetes include lifestyle habits, socioeconomics, and medications you may take.

One study that looked at 2,535 adults with RA found that nearly 20% of them also had diabetes. Among those who had both conditions, some common risk factors were:

  • Obesity
  • Male gender
  • Older age
  • Lower socioeconomic status
  • Smoking
  • Drinking alcohol

Some anti-inflammatory RA medications also affect your risk for diabetes. They include:

Glucocorticoids.Steroid drugs for RA such as prednisone may lower your insulin resistance. If you’re already at risk for type 2 diabetes, they can increase that risk, especially if you take them for 6 months or more. To lower the chances of this and other side effects, experts recommend taking these drugs only for short periods. If you have diabetes, you’ll need to check your blood sugar more often while you’re on glucocorticoids. You may also need higher doses of your diabetes medication. Talk with your doctor about the safest ways to use glucocorticoids.

Disease-Modifying Antirheumatic Drugs (DMARDs). This class of drugs is designed to reduce some of the harmful effects of inflammation. Some research has shown that the DMARDs hydroxychloroquine (Plaquenil) and abatacept (Orencia) lower your risk for diabetes. But DMARDs also put you at higher risk of infection, as do both diabetes and RA. So you’ll need to be extra careful about protecting yourself from infections and getting treatment if you do get sick.

Other DMARDs used to treat RA include:

Another possible link between the two conditions is inactivity. The joint pain of RA may lead some people to avoid exercise. But a sedentary lifestyle may lead to weight gain, which is a risk factor for type 2 diabetes. Further, exercise can reduce your disability from RA while easing fatigue and improving mood.

Type 2 diabetes doesn’t always cause symptoms, especially at first. The American Diabetes Association recommends that everyone over 45 get screened for diabetes every 3 years. If you have risk factors for diabetes, you should get screened earlier.

Symptoms of diabetes can include:

  • Increased thirst and urination
  • A bigger appetite
  • Unintentional weight loss
  • Fatigue
  • Blurry vision

If you notice these symptoms, tell your doctor. If you develop diabetes, they can start you on treatment early and help you keep the condition under control.

If you have a family history of either type of diabetes, let your doctor know.

Type 1 diabetes is thought to be caused by a combination of your genes and things in your environment. But healthy habits make a big difference in your risk for type 2 diabetes. To lower your risk or reverse the condition, you can:

  • Stay active. Regular exercise helps to reduce inflammation in your body. Aim for at least 30 minutes of physical exercise per day. If you haven’t exercised in a while, start with gentle movements like walking or stretching. Once you build stamina and strength, try weight training. Research shows lifting weight 2-3 times a week can lower your blood sugar levels.
  • Lose excess weight. Obesity is a major risk factor for type 2 diabetes. Dropping even a few pounds can greatly reduce the risk.
  • Eat healthy. Include a variety of fruits and vegetables, lean proteins, and healthy fats like omega-3 fatty acids in your daily diet. This may reduce inflammation while it lowers your blood sugar levels.