Diabetes, Aching Joints, and Arthritis

If you’re managing diabetes and achy joints simultaneously, learn more about the pharmaceuticals and non-medicinal therapies available to help keep your joints in the best possible shape.

“There's definitely a connection,” says Timothy Kaniecki, MD, a rheumatologist and an assistant professor at Johns Hopkins University School of Medicine. “The most obvious with type two diabetes and osteoarthritis is the metabolic syndrome that comes with type 2 diabetes, specifically weight. Increased weight, BMI, has an increased risk for osteoarthritis, particularly in our weight-bearing joints.”

• Psoriatic arthritis, which stems from an overactive immune system causing inflammation and joint problems, may also increase the risk of developing type 2 diabetes and related conditions, such as metabolic syndrome.

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• Gout, which is common in type 2 diabetes, can cause sudden attacks of swelling and pain in any joint, often at the base of the big toe.

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• Ankylosing spondylitis, a form of inflammatory arthritis which primarily affects the spine, is associated with increased risk of developing type 1 diabetes.

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• Lupus is not strictly an arthritis type,

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   but this autoimmune disease, which can also cause joint pain, is associated with type 1 diabetes risk

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   and has worse outcomes when it co-occurs with type 2 diabetes.

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In addition to the types of arthritis already discussed, there are other joint pain conditions that are either directly caused by or highly related to diabetes, including:

• Frozen shoulder causes limited movement and pain in the shoulder.

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• Diabetic hand syndrome broadly refers to a number of hand disorders that are linked to diabetes, which can cause different types of stiffness, pain, and skin issues in various parts of the hand.

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• Diabetic amyotrophy affects the hips and legs, and symptoms include muscle weakness and nerve-related pain.

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   Diabetic amyotrophy is more common in type 2 diabetes and will sometimes occur despite low or improving A1C levels.

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• Charcot foot is just one of several conditions affecting the ankles and feet, which are typically caused by diabetes-related-neuropathy.

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• DISH (diffuse idiopathic skeletal hyperostosis), a hardening of the ligaments and tendons near the spine, is associated with both diabetes and gout.

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• Bursitis is defined by inflamed bursae, the fluid-filled sacs that help cushion the joints.

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For people with diabetes and arthritis, there are a number of treatment components. If you have both conditions, you may choose to work with multiple specialists to find approaches that work for both conditions.

Blood Sugar Control

Kaniecki notes that in general, diabetes control is good all around. He says that better diabetes control might decrease risk for some complications like frozen shoulder as well as decrease risk for infection. He adds that people who have their diabetes controlled lose weight in general, which then leads to less stress on joints and less of an inflammatory response.

Medications

Some possible medications used in arthritis treatment include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful in the treatment of osteoarthritis and can help relieve pain and improve joint function.

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   Andrew I. Spitzer, MD, an orthopedic surgeon at Cedars-Sinai Medical Center in Los Angeles, notes that caution may be warranted for people with diabetes who have kidney problems or cardiovascular disease associated with diabetes.

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• Analgesics such as acetaminophen,

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   should be avoided if you have severe liver problems.

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• Steroids reduce inflammation and are an important treatment for inflammatory arthritis types. But both oral and injectable steroids can lead directly to higher blood sugars, so people with diabetes should be cautious.

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• An injectable extended-release steroid named triamcinolone acetonide (Zilretta), which has been designed to reduce side effects, is approved to treat osteoarthritis pain in the knee. Dr. Spitzer says this drug releases slowly, “at low concentrations in the joint,” leading to significantly lower blood sugar spikes in people with diabetes.

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• Other injection treatments, such as hyaluronic acid and prolotherapy, can help with joint pain but are not appropriate for all types of arthritis,

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   though Spitzer says their impact may be somewhat limited.

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• Disease-modifying antirheumatic drugs (DMARDs), including biologics, can treat the root cause of ankylosing spondylitis, psoriatic arthritis, or rheumatoid arthritis

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  and may benefit blood sugar, too.

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   Kaniecki says immunosuppressive medications should be taken with caution, however, since people with “poorly controlled diabetes are at higher risk for infection.”
• Duloxetine, an antidepressant, may be beneficial in helping with pain relief in knee osteoarthritis,

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   though it may increase blood sugar levels.

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Of the above choices, Kaniecki highlights steroids as the trickiest option for people with diabetes. “They help reduce inflammation and can help control symptoms quickly,” but he tries to use them sparingly. He says it can often come down to a conversation with the patient about how steroids will impact blood sugar if they should be used. It’s important to discuss adjunct therapy options with your healthcare team to make sure they’re performed safely and don’t negatively impact your diabetes management.

Non-Medicinal Therapies

Options include:

• Physical or occupational therapy can help address the aches and pains of day-to-day living with joint disease.

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• Acupuncture involves using small needles and may help with arthritis pain, such as in osteoarthritis.

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• Exercise can strengthen muscles to better support the joints, and burn calories that help you lose weight.

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• Massage could help improve physical functioning in people with osteoarthritis.

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• Tai chi or yoga incorporate aspects of deep breathing and meditation to help center and relax you.

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Kaniecki says that people with diabetes, particularly who also have neuropathy, should get regular foot examinations to monitor for complications and infection, since infection can affect arthritis medication use and overall health.

Weight Loss

• Diabetes and arthritis frequently occur together. Nearly half of adults with diabetes also have chronic joint conditions, and high blood sugar can directly contribute to inflammation, nerve damage, and joint tissue breakdown.
• Osteoarthritis is especially common in people with type 2 diabetes, due to excess weight and chronic inflammation.
• Rheumatoid arthritis is especially common in people with type 1 diabetes, as the two autoimmune conditions may share genetic factors.
• Better diabetes control supports joint health. Keeping your blood sugar and weight in a healthy range, along with tailored medications and physical activity, can reduce pain, limit complications, and improve function across many forms of arthritis.