Diabetes linked to higher risk of arthritis, musculoskeletal pain
Individuals with diabetes have a higher risk of osteoarthritis, rheumatoid arthritis (RA), and osteoporosis, according to a Danish study presented at EASD 2018.
Multiple logistic regression analysis was conducted using self-reported data from 109,218 individuals (≥40 years) who participated in the 2013 Danish National Health Survey. Of these, 9,238 had diabetes (mean age 65.6 years, 55.6 percent male, body mass index (BMI) 28.9 kg/m2). Those without diabetes (n=99,980) were younger (mean age 59.2 years), had a lower BMI (25.8 kg/m2), and more than half were female (53.3 percent). [EASD 2018, abstract 1112]
Individuals with diabetes had a higher incidence of osteoarthritis (43.5 percent vs 29.4 percent), RA (15.1 percent vs 7.6 percent), and osteoporosis (6.4 percent vs 4.8 percent) than those without (p<0.0001 for all).
After adjusting for age, gender, and BMI, diabetes was significantly associated with osteoarthritis (odds ratio [OR], 1.33, 95 percent confidence interval [CI], 1.25–1.41; p<0.001), RA (OR, 1.71, 95 percent CI, 1.57–1.85; p<0.001), and osteoporosis (OR, 1.29, 95 percent CI, 1.13–1.46; p<0.001).
Although osteoarthritis was more frequent among individuals with diabetes, the most pronounced association was between diabetes and RA which, according to the researchers, could be due to the chronic inflammation leading to type 2 diabetes (T2D) rather than type 1 diabetes. “The exclusion of people younger than 40 meant that the majority of those included in the study probably had T2D,” said the researchers.
Another factor linking diabetes and RA is the use of steroids for RA treatment, they added, as steroids also increase the risk of developing T2D.
Patients with diabetes also had a higher incidence of lower back pain (60.6 percent vs 51.4 percent), arm/leg pain (74.0 percent vs 61.0 percent), and shoulder/neck pain (56.0 percent vs 51.5 percent, OR) than those without diabetes (p<0.0001 for all), which persisted even after adjusting for potential confounders (OR, 1.27, 95 percent CI, 1.21–1.34; OR, 1.44, 95 percent CI, 1.35–1.53; and OR, 1.29, 95 percent CI, 1.22–1.36, respectively; p<0.001 for all).
Pain due to RA increases the risk of physical inactivity, noted the researchers. “It’s likely that the chronic pain experienced by people with arthritis may be a barrier to exercising, which is also a risk factor for [T2D]”, explained lead investigator Dr Stig Molsted from the Department of Clinical Research in Nordsjaellands University Hospital, Hillerød, Denmark.
Molsted underscored that although musculoskeletal pain and arthritis could be barriers to exercise training, they are not contraindications. “Health care professionals should make patients with diabetes aware that regular exercise is a recognized treatment for diabetes and arthritis and can have positive effects on both blood sugar control as well as musculoskeletal pain.”
The positive effects on pain were reflected in the subgroup analysis, which revealed that greater physical activity reduced the risk of having back pain (OR, 0.65, 95 percent CI, 0.57–0.73; p<0.001), arm/leg pain (OR, 0.62, 95 percent CI, 0.53–0.72; p<0.001), and shoulder/neck pain (OR, 0.76, 95 percent CI, 0.68–0.86; p<0.001) among individuals with diabetes.
However, no firm conclusions were drawn given the observational nature of the study, said the researchers. Moreover, self-reported data may have influenced the findings, they added.