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Psoriatic Arthritis and Diabetes: What’s the Connection?

Posted on December 09, 2021
Medically reviewed by
Robert Hurd, M.D.
Article written by
Anastasia Climan

One of the biggest concerns about diabetes is that it places people at higher risk for other health problems, including cardiovascular disease and kidney disease. However, there’s not as much awareness about the potential impact of diabetes 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.”

The overall prevalence of type 2 diabetes is between 2.4 percent and 14.8 percent of the general population, but this rate can be as high as 20.2 percent among people with psoriatic arthritis. Research into the connection is still ongoing. Here’s what’s currently known about why people with diabetes may be at an increased risk for developing psoriatic arthritis.

What Is Psoriatic Arthritis?

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

Some common symptoms of psoriatic arthritis include:

  • Fatigue
  • Nail pitting
  • Red and irritated eyes (uveitis)
  • Reduced range of motion
  • Swollen fingers and toes
  • Tender and stiff joints and tendons (including the Achilles tendon)
  • Back pain, often on one side in the buttocks or down one or both legs

People with psoriatic arthritis should meet with a rheumatologist to address their symptoms. Managing pain, reducing inflammation, and slowing joint damage are typically the primary goals of treatment.

How Do Psoriatic Arthritis and Diabetes Impact Each Other?

Diabetes and psoriatic arthritis are both chronic diseases. There are two types of diabetes: type 1 and type 2. Psoriatic arthritis is typically associated with type 2 diabetes. The exact causes of the relationship are unknown, but researchers suspect several possible reasons for the higher rates of psoriatic arthritis in people with diabetes. These possible reasons include genetic factors, lifestyle factors, and inflammatory factors inside the body.

Sometimes psoriatic arthritis symptoms appear before other signs of psoriasis. If you notice joint pain, swelling, or stiffness, work with your health care provider to determine if psoriatic arthritis might be to blame.

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 complicate things. Decreased physical activity due to joint damage and pain can further contribute to issues with weight management, increasing the potential risk of diabetes. This cycle is challenging, but it doesn’t mean exercise is out of the question.

One member of DiabetesTeam suggests water aerobics as a low-impact activity. Ask your health care team about meeting with a physical therapist to develop an exercise routine that’s safe and effective for you.

Inflammation

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

Some studies suggest that people with psoriatic arthritis have elevated levels of tumor necrosis factor (TNF-alpha), a protein that contributes to inflammation in the body. Increased TNF-alpha levels 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 psoriatic arthritis. Thinking of chronic inflammation as an underlying driver of multiple health problems (rather than a side effect of diabetes or psoriatic arthritis) can help you better manage both conditions.

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.

Genetic Risk Factors

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

Treatments for Psoriatic Arthritis

Some of the treatments prescribed for psoriatic arthritis may help 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 With Diabetes

Knowing that poorly controlled blood glucose levels can exacerbate chronic inflammation and joint pain is a great incentive to keep up with your regular doctor’s appointments. Other approaches may also help you decrease your risk or better control the impact of your conditions on your quality of life.

Avoid Psoriatic Arthritis Triggers

Staying away from trigger foods that promote inflammation, including sugar, alcohol, and saturated fats, is important for both diabetes and arthritis.

Maintain Healthy Habits

Fortunately, the lifestyle changes that doctors recommend for diabetes prevention and treatment — including maintaining a healthy body weight and keeping stress to a minimum — can be beneficial for managing autoimmune diseases like psoriatic arthritis.

Losing excess weight, cutting back on refined sugars, increasing your fiber intake, getting more exercise, and improving your sleep habits 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 go a long way toward improving your blood glucose levels and reducing arthritis symptoms. However, if excess body weight appears to be the underlying cause of multiple health issues (known as metabolic syndrome), bariatric surgery may also be recommended to improve your overall health and well-being.

Maintain good communication with your health care team when deciding on the best treatments. Depending on your family history and current blood sugar control, some 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 health care team.

Talk With Others Who Understand

DiabetesTeam is the social network for people with diabetes and their loved ones. On DiabetesTeam, more than 115,000 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.

All updates must be accompanied by text or a picture.
Robert Hurd, M.D. is a professor of endocrinology and health care ethics at Xavier University. Review provided by VeriMed Healthcare Network. Learn more about him here.
Anastasia Climan is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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