Diabetes Associated With Elevated Risk for Arthritis, Osteoporosis

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Rheumatoid pain can lead to a lifestyle of reduced physical activity that is associated with the development of T2D.
Rheumatoid pain can lead to a lifestyle of reduced physical activity that is associated with the development of T2D.

Diabetes has been associated with significantly elevated odds of having arthritis and musculoskeletal pain, according to research presented at the 54th annual meeting of the European Association for the Study of Diabetes in Berlin, Germany. The findings indicated that osteoarthritis was the most common form of arthritis in patients with diabetes but that rheumatoid arthritis had the most pronounced association with diabetes.

Data from previous studies have associated musculoskeletal pain with type 2 diabetes (T2D). Researchers in this study aimed to investigate the association between diabetes and arthritis, particularly osteoarthritis, osteoporosis, and rheumatoid arthritis.

The study included individuals aged ≥40 years from the Danish National Health Survey in 2013. Of the study's 109,218 participants, 9238 reported having diabetes (8.5%). This group with diabetes had an average age of 66 years and an average body mass index (BMI) of 29 kg/m2. The cohort of 99,980 individuals without diabetes had an average age of 59 years and an average BMI of 26 kg/m2. Multiple logistic regression analyses were conducted on self-reported data adjusting for age, gender, and BMI and using diabetes as the exposure variable. Outcome variables included arthritis, back pain, shoulder/neck pain, and physical activity.

Compared with patients without diabetes, individuals with diabetes had increased prevalence of osteoarthritis (29% vs 44%, P <.0001), osteoporosis (5% vs 6%, P <.0001), and rheumatoid arthritis (8% vs 15%, P <.0001). Increased back pain occurred in 61% of patients with diabetes compared with 51% of patients without diabetes, and shoulder/neck pain was reported in 56% of patients with diabetes compared with 52% of patients without diabetes.

Diabetes was significantly associated with osteoarthritis (odds ratio [OR], 1.33; 95% CI, 1.25-1.41), osteoporosis (OR, 1.29; 95% CI, 1.13-1.46), and rheumatoid arthritis (OR, 1.71; 95% CI, 1.57-1.85). Diabetes was also associated with back pain (OR, 1.27; 95% CI, 1.21-1.34) and shoulder/neck pain (OR, 1.29; 95% CI, 1.22-1.36). In a subanalysis of participants with diabetes, being physically active (n = 6220 [71.6%]) was inversely associated with back pain (OR, 0.65; 95% CI, 0.57-0.73) and shoulder/neck pain (OR, 0.76; 95% CI, 0.68-0.86).

While this study showed a significant link between diabetes and forms of arthritis, the association between diabetes and rheumatoid arthritis may not exist in patients with type 1 diabetes, as individuals aged <40 years were excluded from the study and the majority of study participants with diabetes likely had T2D. The link between diabetes and rheumatoid arthritis may be a product of the inflammation that is symptomatic of the two diseases. The investigators also noted that use of steroids for the treatment of rheumatoid arthritis may increase a patient's risk for T2D.

Rheumatoid pain can lead to a lifestyle of reduced physical activity, which is associated with the development of T2D. “Healthcare professionals should remember to inform patients with diabetes that musculoskeletal pain and arthritis not are contraindications to exercise training,” stated the researchers.

Reference

Molsted S, Bjørkman ASD, Andersen MB, Ekholm O. Diabetes is associated with elevated risks of osteoarthritis, osteoporosis, and rheumatoid arthritis. Presented at: 2018 European Association for the Study of Diabetes Annual Meeting; October 1-5, 2018; Berlin, Germany. Abstract 1112.

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