The Sneaky Condition That Can Follow PsA
If you have psoriatic arthritis (PsA), an autoimmune disorder that causes painful swelling of joints among other symptoms, your doctor has likely already told you how you have an increased risk of developing other health conditions, including high blood pressure (HBP), Crohn’s disease, and certain cancers. So the last thing you probably want to hear is that you’ll need to add type 2 diabetes—a condition where the body is resistant insulin—to that list. But recent research indicates there is a likely and even substantial connection. Learn more to protect your health.
The Link Between PsA and Diabetes Is Strong
People with PsA have about a 40% higher risk of developing type 2 diabetes compared with the general population, according to a study from researchers at the University of Toronto in Canada. Here’s where it gets really concerning: The average American already has a 40% chance of developing diabetes, according to the Centers for Disease Control and Prevention (CDC). When you combine those risk factors together, you’re looking at higher than 50-50 odds. So, yeah, this is definitely an issue to take seriously.
The More Active Your PsA, the Higher Your Diabetes Risk
One of the biggest factors that appears to drive diabetes risk in people with PsA is what doctors call “disease activity”—the level of psoriatic-arthritis symptoms you experience, like swollen joints in your hands and feet. If you have more active joint disease and elevated inflammatory markers in your blood work, you’re particularly vulnerable to developing diabetes, the Toronto researchers also found. Previous studies have also found links between rheumatoid arthritis (RA) and diabetes, but the association between PsA and diabetes appears to be even stronger.
Inflammation Drives Both Conditions
PsA and diabetes are both inflammatory conditions, with the body attacking its own cells or tissues. “Any kind of chronic disease process associated with inflammation is associated with increased risk for cardiovascular disease and type 2 diabetes,” explains Kathleen Wyne, M.D., an endocrinologist at the Ohio State University Wexner Medical Center in Columbus. While short-term inflammation helps heal your body, chronic inflammation damages healthy cells, tissues, and organs. Diabetes and PsA share other risk factors, too, including obesity and a family history of metabolic syndrome (high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels).
Diabetes Is No Joke
So, why should you be concerned about developing type 2 diabetes? For starters, the condition comes with a host of short-term and long-term medical complications, including damage to your eyes, impaired kidney function that may require dialysis, and a nerve disease called diabetic neuropathy whose symptoms include pain, weakness, and numbness in the hands and feet. People with diabetes are also at increased risk of heart attack and stroke. Finally, diabetes can also cause joint pain and stiffness—something you already have too much of when you have PsA.
Every Person With PsA Needs to Know the Signs of Diabetes
If you have PsA, get familiar with the common signs of diabetes, including increased hunger and/or thirst, frequent urination, unexplained weight loss, blurred vision, and fatigue. “All too often, these symptoms are ignored,” says Marina Charitou, M.D., an endocrinologist with Stony Brook Hospital in New York. “Many people think it’s normal to go to the bathroom more often as they get older, for example. We think about 20% of people with diabetes don’t even know they have it.” If you’re experiencing such symptoms, call your doctor, pronto.
If You’re Recently Diagnosed With PsA, Request a Diabetes Test, Too
Ask your doctor to be screened for diabetes when you’re first diagnosis with PsA, and every three years after. It’s easier than ever to get tested. “We no longer require a fasting glucose-tolerance test,” says Dr. Charitou. That test requires fasting for 8 to 12 hours beforehand, then having blood drawn before and two hours after drinking a sugary liquid. “We [now] test for diabetes using the A1C test, a simple blood test that measures your average blood sugar levels over the past three months. Many doctors can do this test instantly with a finger prick” [without fasting].
Losing Even a Little Weight Helps Both Conditions A Lot
Lower your risk of diabetes—or get control of it if you’ve already been diagnosed—by dropping a few pounds. “Losing just 5% to 10% of your body weight has been shown to decrease your risk of diabetes by 60%,” says Dr. Charitou. The USDA’s ChooseMyPlate program is a great guide. It comes with an app to help you make healthier eating choices. Bonus: The Arthritis Foundation reports that many PsA drugs work better if you maintain a healthy weight, so weight loss can improve PsA symptoms. In fact, pretty much everything you do to prevent, or control, diabetes helps manage your PsA, too.
Gentle Workouts Can Be Powerful
Exercise lowers blood glucose levels and boosts your body's sensitivity to insulin, countering insulin resistance from diabetes. Plus, it helps ease PsA symptoms by improving range of motion and reducing pain and stiffness. The catch-22? Swollen joints from PsA can make exercise challenging or even painful. Still, “any amount of exercise will help,” says Joseph Henske, M.D., director of the diabetes program at the University of Arkansas for Medical Sciences in Little Rock. “Gentle forms of activity like walking, yoga, and pool exercises are good options.” Aim for 30 to 45 minutes of moderate activity four to five times a week.
Still Smoking? Do Everything You Can to Quit
Smokers are 30% to 40% more likely to develop diabetes than nonsmokers, according to the CDC, and three times more likely to develop PsA, according to a 2011 study from Harvard investigators. Smokers also tend to have worse symptoms of PsA, possibly due to increased inflammation, and appear to get less benefit from their medications, perhaps because smoking interferes with the body’s ability to absorb the drugs. Quitting will help you get both conditions under control and improve your symptoms. Ask your doctor for resources to help you quit smoking for good, or check out this CDC toolbox.
Stress Management Isn’t Optional
Stress contributes to chronic high blood sugar in diabetes; it can also trigger and worsen PsA symptoms. Exercise is a great stress reducer, an added benefit if you’ve already added a power walk or downward dogs into your schedule. Other ways to lower stress: Incorporate meditation and mindfulness, chatting with friends, and cutting back on caffeine and alcohol. “Getting better sleep also reduces stress, so aim for a consistent seven to eight hours of sleep each night,” says Dr. Henske. If you follow these screening and lifestyle steps, you can take control of both your psoriatic arthritis and your diabetes risk.
Risk of Diabetes: The Lancet Diabetes and Endocrinology (2014). “Trends in lifetime risk and years of life lost due to diabetes in the USA, 1985–2011: a modelling study.” thelancet.com/journals/landia/article/PIIS2213-8587(14)70161-5/fulltext
Complications of Diabetes (1.): Harvard Health Publishing. “Type 2 diabetes mellitus.”
Complications of Diabetes (2.): Clinical Diabetes (2001). “Diabetes and Your Joints.” clinical.diabetesjournals.org/content/19/3/136
PsA and Diabetes (1.): Rheumatology (2019). “Risk of type 2 diabetes and cardiovascular disease in an incident cohort of people with psoriatic arthritis: a population-based cohort study.” academic.oup.com/rheumatology/article/58/1/144/5091588
PsA and Diabetes (2.): Journal of Rheumatology (2017). “The Risk of Developing Diabetes Mellitus in Patients with Psoriatic Arthritis: A Cohort Study.” jrheum.org/content/early/2017/01/26/jrheum.160861
A1C Testing for Diabetes: Centers for Disease Control and Prevention (2018). “All About Your A1C.” cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html
Excess Weight and PsA Drug Efficacy: Arthritis Foundation (2019). “How Fat Affects PsA.”
Smoking, PsA, and Diabetes (1.): Centers for Disease Control and Prevention (2018). “Smoking and Diabetes.” cdc.gov/tobacco/campaign/tips/diseases/diabetes.html
Smoking, PsA, and Diabetes (2.): Arthritis Foundation (2015). “Smoking Increases the Risk of Psoriatic Arthritis.” blog.arthritis.org/psoriatic-arthritis/smoking-psoriatic-arthritis/
Smoking, PsA, and Diabetes (3.): Centers for Disease Control and Prevention (2019). “Quitting Resources.” cdc.gov/tobacco/campaign/tips/quit-smoking/quitting-resources.html
Smoking, PsA, and Diabetes (4.): Annals of Rheumatic Disease (2012). “Smoking and the Risk of Incident Psoriatic Arthritis in US Women.” ncbi.nlm.nih.gov/pubmed/22067198
Stress and Inflammation: Frontiers in Human Neuroscience (2017). “Inflammation: The Common Pathway of Stress-Related Diseases.” ncbi.nlm.nih.gov/pmc/articles/PMC5476783/