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Diabetes and Psoriatic Arthritis: What’s the Connection?

Posted on November 04, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Anastasia Climan, RDN, CDN

People living with psoriatic arthritis (PsA) may have a much higher risk of type 2 diabetes than the general population, research has found. Although the overall prevalence of type 2 diabetes is between 2.4 percent to 14.8 percent, that rate can be as high as 20.2 percent in people with PsA.

Research into the connection is still ongoing, but here’s what’s currently known about diabetes as it relates to psoriatic arthritis.

What Is Diabetes?

Diabetes is a chronic condition characterized by high blood sugar levels in the body. There are two types of diabetes: type 1 diabetes and type 2 diabetes. PsA is associated with type 2 diabetes.

Normally, the pancreas releases insulin (the hormone that helps our cells use sugar for energy). Type 2 diabetes occurs when the body becomes insensitive or resistant to insulin’s effects. When the body can’t use insulin properly, more sugar is left in the blood. Over time, high blood sugar can lead to many health problems, including cardiovascular disease (heart disease), kidney disease, poor circulation, and nerve damage.

What Causes Diabetes in Psoriatic Arthritis?

Diabetes and psoriatic arthritis are both chronic diseases. The exact causes of the relationship are unknown, but researchers suspect there are several possible reasons for the higher rates of diabetes seen in people with psoriatic arthritis.

Physical Inactivity

A common risk factor for both diabetes and psoriatic arthritis is obesity or high body mass index. Unfortunately, when you’re trying to stay active, joint pain and stiffness from psoriatic arthritis can present a challenge. Decreased physical activity due to joint damage and pain can further contribute to issues with weight management, increasing the potential risk of diabetes.

Inflammation

Inflammation in the body may promote insulin resistance even when those with psoriatic arthritis keep their weight at a healthy level.

Some studies suggest that people with psoriatic arthritis have elevated levels of a protein that contributes to inflammation in the body, called tumor necrosis factor or TNF-alpha. Increased TNF-alpha may impair the function of insulin receptors. When insulin receptors in the body don’t work as well, the body may develop insulin resistance.

Increased inflammation can also lead to more severe PsA. One member of MyPsoriasisTeam put it simply: “Get that diabetes under control because diabetes causes inflammation, and inflammation makes psoriasis worse.”

Decreased Insulin Sensitivity

People with PsA tend to have lower levels of certain biomarkers that normally enhance insulin sensitivity (help your body control blood sugar levels). Lower levels of these biomarkers in PsA may increase the risk of diabetes.

Genetic Risk Factors

Some research suggests that diabetes and psoriatic arthritis may share genes that make a person more susceptible to either or both conditions.

Treatments for PsA

Some of the treatments prescribed for PsA may be beneficial for people with diabetes, and others could make blood sugar issues worse. For example, when systemic corticosteroids are taken for long periods of time, they exacerbate insulin resistance. More research is needed to determine whether other medications such as Otezla (apremilast) and TNF-alpha inhibitors affect blood sugar control in a positive or neutral manner.

Managing Psoriatic Arthritis and Diabetes

Knowing that psoriatic arthritis places you at higher risk for diabetes is a great incentive to keep up with your primary care appointments to screen for blood sugar concerns. Other approaches may also help you decrease your risk or better control the impact of your conditions on your quality of life.

Avoid PsA Triggers

Staying away from trigger foods that promote inflammation, including sugar, alcohol, and saturated fats, is a primary guideline for both psoriasis and diabetes.

Maintain Healthy Habits

Focusing on healthy lifestyle habits is not only good for your psoriasis but could also lower your risk of diabetes or other common comorbidities (conditions that occur at the same time). Fortunately, the lifestyle changes that doctors recommend for diabetes prevention and treatment — including maintaining a body weight recommended by your doctor and keeping stress to a minimum — can be beneficial for those with autoimmune diseases like psoriatic arthritis.

Losing excess body fat, cutting back on refined sugars, increasing your fiber intake, getting more exercise, and improving your sleep habits can all help to bring blood sugars back into the normal range for people with type 2 diabetes.

If psoriatic arthritis limits your ability or motivation to exercise, consider meeting with a physical therapist or occupational therapist to find solutions that let you take advantage of the positive effects of physical activity, including better blood glucose levels and a more positive outlook.

Discuss Medication With Your Doctor

When lifestyle changes don’t lead to sufficient blood work improvements, medication may be considered. Some oral medications can help increase the body’s sensitivity to insulin and improve glycemic control for people with type 2 diabetes. Ongoing monitoring is essential to ensure that your current regimen is working. In addition to oral medications, sometimes insulin or bariatric surgery is needed to get type 2 diabetes under control.

Maintain good communication with your health care team when deciding on the best treatments for your health. Depending on your family history and current blood sugar control, certain psoriatic arthritis treatment options may be more appropriate than others. Ask your doctor or pharmacist about potential medication side effects, and discuss any concerns with your doctor.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriatic disease. On MyPsoriasisTeam, more than 145,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with psoriatic arthritis and diabetes? Share your experience in the comments below, or start a conversation by posting on MyPsoriasisTeam.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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