Diabetes and Arthritis
In this month’s magazine, Arthritis Today, there is an article discussing the link between diabetes and arthritis. I think it is worth summarizing. The article titled “The Diabetes Arthritis Connection” was written by Linda Rath (Rath, 2013). The article has some amazing statistics. For instance “half of the adults in the United States with doctor-diagnosed diabetes-close to 10 million people- also have arthritis” (Rath, 2013, p. 55). Looked at another way the total amount of arthritis patients is more than diabetics so “15 percent of people with arthritis also have diabetes” (Rath, 2013, p. 55). That is amazing and the cause of the association is not as straight forward as I thought. Actually there is a bit of a difference between the statics that Rath uses and those used by the CDC. In 2008 the CDC estimated that “25.6 million (aged 20 and above) people in the United States had diabetes” (Centers for Disease Control, 2010) half of that would be 12.5 million not 10 million. While 2.5 million is a lot, it is really depends what one might call an adult. At any rate it is a rounding error.
With the issue of Rheumatoid Arthritis (RA) it is well known that both RA and Type 1 Diabetes (Type 1) are autoimmune diseases. It is also well known that people who have one autoimmune disease tend to have others. I have three, one of which is RA, so I thought well most Arthritis cases must be type 1’s with RA. To support this notion Rath states that “People with RA are more likely than others to have a close relative with type 1” (2013, p. 55). In fact the drugs used for RA tend to cross over in some respects to Type 1 diabetes. Here is a statistic that interesting diabetic researchers, however it may not have a good bearing on the drug regiment for type 1. According to “JAMA in 2011, anti-TNF drugs and hydrochloroquine cut the diabetes risks by 38% and 50% respectively” (Rath, 2013, p. 55). However, having used these TNF inhibitors in particular and knowing about how hydrochloroquine is administered it is unlikely that people who do not have RA would ever receive either drug to prevent Type 1 (Rath, 2013). However of course if scientists figure out the relationship between these drugs and preventing type 1 then we might have something. Right now it is simply interesting information.
The real shocking information is the second part. It have been found that Type 2 diabetes (Type 2) or at least high blood sugars may be one of the root causes of Osteoarthritis (OA) (Rath, 2013). One explanation is that excess weight may simply stress joints and therefore be a root cause of OA. Of course we know that not all type 2’s are overweight. A more detailed look at the evidence shows other factors. According to Linda Sandell as quoted by Rath “A persons overall metabolic state may be instrumental in determining what happens to cartilage. So we need to examine the whole patient” (2013). Not just weight. Though weight may have some bearing it may not even be the most important factor in OA. Remember like Type 2, OA is an inflammatory disease. It affects the whole body not just a single body factor.
In fact OA is being explored for various subtypes. We used to think of OA as a single disease, something you got, and it was thought that most everybody who had OA developed it because of age, or weight. But the discovery of subtypes give us a different view of how OA may occur. One of those major subtypes that has been identified is “metabolic OA” (Rath, 2013, p. 55) . Metabolic OA is in fact linked to type 2, it may be said that they have similar if not the same disease components. It is interesting that metabolic OA includes other noncartilage related issues. These include “high Blood sugar, high blood pressure, high cholesterol and excess abdominal fat” (Rath, 2013, p. 55). It is interesting that these are often thought of as being caused by type 2 and in some cases are thought to be the cause of type 2.
“Some studies show that overweight patients who have metabolic syndrome are more likely to have OA than people in general” (Rath, 2013, p. 55). This indicates that there must be some kind of association between metabolic OA and diabetes (Rath, 2013). People with OA and type 2 were more likely to need a hip or knee replacement, so there are real issues with having both.
Of course if type 2 affects OA, what is the effect of OA in type 2’s? There seems to be one major relationship between OA and Diabetes. Joints in an OA patient hurt a great deal, “meaning that exercise is tough for type 2 patients who have OA” (Rath, 2013, p. 56). Of course it is a strong association. When one hurts, or when one’s joints are detonating, it is easy to remember that exercise to assist blood sugar controls, may not have available the simplest of diabetic controls, more exercising.
In whole the symbiotic relationship is tough to overlook. It seems that OA and type 2 have more relationship cross overs than most of us have ever dreamed of. Scientifically it is interesting but the human relationship is even more interesting. Imagine knowing for certain, sometime in the future, that your diabetes is not your fault rather it is part of a more complex body system gone askew.
References
Centers for Disease Control. (2010). 2011 National Diabetes Fact Sheet. Retrieved November 27, 2013, from http://www.cdc.gov/diabetes/pubs/estimates11.htm
Rath. (2013). The Diabetes Arthritis Connection. Arthritis Today, 54 - 56.
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Rick