Diabetes Forecast

Arthritis and Diabetes: Exercise Helps

By Erika Gebel, PhD , ,
woman rubbing back of shoulder


It might come as a surprise to know that exercising achy, arthritic joints actually improves the condition. That's good news for people with diabetes and arthritis, because physical activity is a key part of diabetes management, too.

At last count, about half of people with diabetes also reported having arthritis. While it's not clear whether diabetes directly causes arthritis, it is clear that the combination of these chronic conditions poses special challenges for people who live with both of them. For example, both diabetes and arthritis benefit from exercise, yet they also can make it difficult or painful to exercise. These obstacles are surmountable, though. Research shows there are ways for people with diabetes and arthritis to feel better.

A Joint Aflame
Arthritis is a general term for inflammation of the joints. There are more than 100 specific types of arthritis, but the big three are osteoarthritis, rheumatoid arthritis, and gout.

Osteoarthritis is by far the most common type and results from joint injury or normal wear and tear over a lifetime. The condition occurs when the cartilage that normally cushions the joints gets worn down, causing bones to rub together. The result is pain, stiffness, and swelling in the joints, particularly the knees. The discomfort tends to be worse during and after bouts of activity.

Rheumatoid arthritis is the result of a misfiring immune system that attacks the joints, producing inflammation. Unlike osteoarthritis, rheumatoid arthritis often causes a visible redness near the joint, which may feel warm to the touch. This type of arthritis tends to attack the small joints of the fingers and feet and is worse after periods of inactivity, such as first thing in the morning.

Gout is a metabolic abnormality that leads to too much uric acid in the blood. Uric acid can get into the joints and trigger inflammation, most often in the big toe. "For people in the old days, [gout] was mainly seen as a disease of the wealthy," says Patience White, MD, vice president of public health for the Arthritis Foundation. That's because the condition is linked to a rich diet, particularly excess alcohol, fructose-sweetened drinks, meat, and seafood.

Diabetes Link?
Just because diabetes and arthritis tend to strike the same people, that doesn't mean one condition causes the other. "We're not saying there is any causal relationship between arthritis and diabetes," says Charles Helmick, MD, scientific lead for the arthritis program at the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion. "Maybe there is, but we have no evidence."

What may make the two conditions coincide more often than not is that osteoarthritis and diabetes share some common characteristics. For example, people who are overweight or obese are at risk for type 2 diabetes, plus they are more likely to develop osteoarthritis because of the extra pressure weight puts on the joints. Gout also shares the link with excess weight. Another commonality is older age, which is strongly associated with both type 2 and osteoarthritis.

A 2012 study in Diabetes Care, however, did suggest there may be something else going on. The study found that people with type 2 are more likely to develop severe osteoarthritis than those without the disease, regardless of age or body mass index (BMI), a rough approximation of body fat percentage. Further research is needed to establish whether type 2 can cause arthritis and, if it does, to figure out the underlying relationship between the diseases.

Rheumatoid arthritis and type 1 diabetes have their own similarities. Both diseases result from a wayward immune system that attacks the body instead of protecting it. Researchers have established that the two conditions share some common genes, as do many autoimmune diseases.

Putting Out the Fire
As with diabetes, there is no cure for arthritis, but there are helpful treatments. A variety of arthritis medications are available, including both oral and topical pain relievers. Gout-specific medications help get uric acid levels under control. Immune-suppressant medications can be effective in people with rheumatoid arthritis, preventing damage if initiated early in the course of the disease. In severe cases, a surgical joint replacement may be warranted. "When you've worn the cartilage away, joint replacement is an effective treatment," says White. "But there is the risk of surgery."

Experts agree that for arthritis, as for diabetes, exercise is key. It helps reduce pain and improve blood glucose levels. Yet, for people with both conditions, the diseases may pose barriers to physical activity. "We know that people with diabetes and arthritis exercise remarkably less than those with either condition alone," says White. Adults with both arthritis and diabetes are 30 percent more likely to be sedentary than those with diabetes alone, according to a 2008 study in Morbidity and Mortality Weekly Report.

The Arthritis Foundation (arthritis.org) offers options to help people with painful joints learn to make their bodies work for them, including online self-help tutorials as well as aquatic programs at YMCAs across the country. The American Diabetes Association is partnering with the Arthritis Foundation in developing a program specifically for people with both diabetes and arthritis. White says the evidence-based program includes both strengthening and low-impact cardio exercise, such as walking, swimming, or biking. Stretching is also important, she notes: "Just strengthening doesn't improve your range of motion. You need a good range of motion."

People with diabetes and arthritis often cite concerns about joint pain as reason to avoid physical activity. "The main message we have for people is, if you have diabetes and arthritis, don't get discouraged," says Helmick. "You can be physically active."



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