One of the main concerns about type 2 diabetes is its association with the higher risk for several serious health conditions, including cardiovascular (heart and blood vessel) disease, kidney disease, and liver disease. However, fewer people are aware that diabetes may also have an impact on joint health.

Several members of DiabetesTeam have described having joint issues:

• “A few nights ago, the toes on my left foot were hurting really badly. I took some Tylenol, but I don’t know if it was an arthritis flare or diabetic neuropathy.”
• “I wish I could walk more, but I have severe psoriatic arthritis. It makes it hard to walk, or even stand, for very long.”
• “When I wake up, my joint pain is awful. I sometimes wonder how I sleep through the pain.”

About 10.5 percent of Americans (34 to 36 million people) are estimated to have type 2 diabetes. However, the global prevalence of type 2 diabetes among people with psoriatic arthritis (PsA) may be as high as 20.2 percent. Research is ongoing to better understand the connection, but here’s what is currently known about why people with diabetes may be at higher risk of developing psoriatic arthritis.

What Is Psoriatic Arthritis?

Psoriasis is an autoimmune condition that primarily affects the skin. About 30 percent of people with psoriasis also develop inflammation in the joints, a condition known as psoriatic arthritis. PsA symptoms can appear at any time, but they most often start around 10 years after psoriasis first develops.

Some common symptoms of psoriatic arthritis include:

• Fatigue
• Nail pitting
• Uveitis (red, painful, and irritated eyes)
• Reduced range of motion
• Swollen fingers and toes
• Tender and stiff joints and tendons (including the Achilles tendon)
• Back pain, often affecting one side of the buttocks or radiating down one or both legs

In some cases, symptoms of psoriatic arthritis may appear before other signs of psoriasis. If you notice joint pain, swelling, or stiffness, consult your health care provider to determine if psoriatic arthritis could be the cause.

People with psoriatic arthritis are typically advised to see a rheumatologist to address their symptoms. Primary goals of treatment usually focus on managing pain, reducing inflammation, and slowing joint damage.

Is Psoriatic Arthritis Related to Diabetes?

Diabetes and psoriatic arthritis are both chronic diseases. There are two types of diabetes: type 1 and type 2. Psoriatic arthritis is most often associated with type 2 diabetes.

Psoriatic arthritis is linked to insulin resistance, which is a main factor of type 2 diabetes. Skin and joint inflammation, both common in PsA, can also affect blood glucose (blood sugar) levels. Blood sugar metabolism is how the body uses sugar for energy, and problems with this process are central to diabetes. Type 2 diabetes usually develops when the body has difficulty managing blood sugar properly.

The combination of diabetes and psoriatic arthritis can prove difficult. One DiabetesTeam member shared, “I have psoriatic arthritis as well as diabetes, and sometimes it really challenges me.”

The exact link between psoriatic arthritis and diabetes is still being studied. Researchers believe that several factors may contribute to the higher rates of diabetes in people with PsA, including genetics, lifestyle factors, and inflammation.

Genetic Risk Factors

Research suggests that certain genes may increase a person’s risk for both diabetes and psoriatic arthritis, making them more likely to develop one or both conditions.

Physical Inactivity

Obesity, diagnosed in those with a body mass index (BMI) of 30 or higher, is a common risk factor for both diabetes and psoriatic arthritis. However, joint pain and stiffness from psoriatic arthritis can make it hard to stay active, creating a cycle: Reduced physical activity can lead to weight gain, which then increases the risk of diabetes.

Staying active may be challenging, but it’s important for managing weight and preventing diabetes. Keeping a healthy BMI and active lifestyle can help protect your joints, maintain flexibility, and reduce long-term damage.

One member of DiabetesTeam suggests water aerobics for a low-impact activity: “Try your local YMCA and do the water aerobics class. I have super bad legs and really enjoyed the low impact.”

Ask your health care team about meeting with a physical therapist to develop an exercise routine that’s safe and effective for you.

Inflammation

Psoriatic arthritis is linked to high levels of inflammation, especially from proteins like tumor necrosis factor-alpha (TNF-alpha). This protein can make it harder for your body to use insulin properly, which can lead to insulin resistance and increase the risk of type 2 diabetes. Insulin is a hormone that helps move sugar from your blood into your cells, where it’s used for energy. When the body becomes resistant to insulin, blood sugar builds up, which can lead to diabetes.

The increased diabetes risk in people with psoriatic arthritis likely comes from a combination of chronic inflammation, genetics, and lifestyle factors. For example, metabolic syndrome — a group of conditions including obesity, high blood pressure, and unhealthy cholesterol levels — is common in both type 2 diabetes and psoriatic arthritis.

Decreased Insulin Sensitivity

People with psoriatic arthritis tend to have lower levels of certain biomarkers that normally enhance insulin sensitivity (help your body control blood sugar levels). Two examples are adiponectin and omentin. Lower levels of these biomarkers may increase the risk of diabetes.

Treatments for Psoriatic Arthritis

Some of the treatments for PsA can affect blood sugar. For example, long-term use of systemic corticosteroids may worsen insulin resistance, making it harder to manage blood sugar levels.

Managing Psoriatic Arthritis With Diabetes

Regular doctor visits are essential for monitoring blood sugar levels and keeping them under control, which can help reduce chronic inflammation and joint pain. Additional strategies may also help you manage the effects of psoriatic arthritis and diabetes on your quality of life.

Avoid Psoriatic Arthritis Triggers

Avoiding foods that trigger inflammation — such as sugar, alcohol, and saturated fats — can be beneficial for managing both diabetes and psoriatic arthritis.

Maintain Healthy Habits

Fortunately, many lifestyle changes recommended for diabetes management, such as maintaining a healthy weight and reducing stress, can also help with autoimmune diseases like psoriatic arthritis.

Losing excess weight, cutting back on refined sugars, eating more fiber, exercising regularly, and improving sleep can all help bring blood sugars back into the normal range and promote a healthy immune system.

Discuss Treatment Options With Your Doctor

Lifestyle changes and medication can help improve your blood glucose levels and reduce arthritis symptoms.

Excess body weight can often contribute to multiple health issues related to metabolic syndrome. For people with obesity, or when other treatment options are not enough to maintain healthy blood sugar levels, bariatric surgery may be recommended to improve overall health and well-being.

Your doctor can help you choose medications for psoriatic arthritis that won’t negatively affect psoriatic comorbidities such as diabetes. Research suggests that apremilast (Otezla), used to treat psoriatic arthritis, may help improve insulin sensitivity, assist with weight management, and lower blood sugar levels.

Similarly, methotrexate (Otrexup, Xatmep, Rasuvo) and other antimetabolites are safe for people with diabetes and can treat psoriatic arthritis without raising blood sugar levels.

Maintain open communication with your health care team to decide on the best treatment options for you. Based on your family history and current blood sugar control, certain psoriatic arthritis treatments may be more suitable. Be sure to discuss any medication side effects or concerns with your doctor or pharmacist.

Talk With Others Who Understand

DiabetesTeam is the social network for people with diabetes and their loved ones. On DiabetesTeam, more than 159,000 members come together to ask questions, give advice, and share their stories with others who understand life with diabetes.

Are you living with diabetes and psoriatic arthritis? How does joint pain or stiffness affect your ability to manage your blood sugar? Share your experience in the comments below, or start a conversation by posting on DiabetesTeam.