People withdiabetesare at increased risk of developing joint diseases, or arthropathies, and these conditions can potentially lead to permanent destructive changes in the joints, causing pain and limiting proper mobility needed to perform functional movements and everyday activities.
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What Is Diabetic Arthropathy?
In patients with diabetes, decreased sensation in the joints as a result of diabetic peripheral neuropathy can cause chronic and progressive arthropathy. It occurs as a result of increased laxity of ligaments, increased range of motion of joints, instability, and repetitive microtraumas with poor healing that can damage joints over time. Increased blood sugar that occurs with diabetes also causes structural and molecular changes to the cartilage within joints.
Peripheral Neuropathy
Related Conditions
Charcot Foot
A Charcot foot can develop as a serious complication of diabetes, where progressive destruction of the bones and joints of the foot leads to deformity, increasing the risk ofdeveloping diabetic ulcersand making it very painful and difficult to walk.
Symptoms of a Charcot foot include:
During the initial stages, a Charcot foot can be mistakenly diagnosed ascellulitis.
Patients with diabetes often exhibit an increase in pro-inflammatory cytokines, molecules that increase inflammation, and increased growth of osteoclasts, cells that break down bones. Monocytes, specialized white blood cells, also exhibit a decreased ability to terminate an inflammatory response in patients with diabetes.
Treatment for a Charcot foot involves putting the affected foot in a cast and using crutches or a wheelchair to get around without weight-bearing on that foot for several months. Gradual progression to normal weight-bearing with prescription footwear will begin when redness, warmth, and swelling significantly decrease.
Patients with chronic progression of a Charcot foot that does not respond to other treatments may undergo surgery to removebone spurs, increase the length of the Achilles tendon to improve alignment of the foot and ankle, and fuse bones of the foot together for better stability, although surgery is best avoided to prevent complications with healing after the operation.
Without treatment, a Charcot foot can progress rapidly and result in irreversible damage in six months or less. The altered structure and decreased sensation of the foot increases the risk of foot ulcers, which can become infected. Without proper treatment, ulcers and infections can become severe enough that foot amputation may be necessary.
Osteoarthritis
Osteoarthritisis a chronic inflammatory condition of the joints that causes pain, inflammation, stiffness, and swelling as a result of cartilage degradation.
Symptoms of osteoarthritis include:
Diabetes and osteoarthritis share similar risk factors, including age since pancreatic cell function declines with aging, increasing the risk of developing diabetes. Aging also increases the risk of developing osteoarthritis due to increased cumulative stress on joints and the resulting cartilage wear.
Obesityis another shared risk factor between diabetes and osteoarthritis. Obesity is a major risk factor for developing diabetes since a higher amount of excess fat cells stimulates an inflammatory response in the body and disrupts metabolism, leading to decreased insulin sensitivity and insulin resistance characteristic of diabetes.
Increased body weight also puts a greater amount of pressure on weight-bearing joints, causing faster degradation of the cartilage. In the presence of excess blood sugar, cartilage cells are more likely to secrete enzymes, specifically matrix metalloproteases, which cause cartilage cells to break down. Higher levels of reactive oxygen species are also released in the presence of excess blood sugar, and promote increased release of inflammatory proteins that cause degradation and death of cartilage cells.
The first-line treatment option for improving symptoms of osteoarthritis is exercise, including a combination of aerobic and resistance training. Exercising can help improve muscle weakness, joint stiffness and pain, and mobility. Physical activity can also improve metabolism and glucose tolerance, decrease body weight, and decrease inflammation to improve symptoms of diabetes.
How Arthritis Is Treated
Rheumatoid Arthritis
Rheumatoid arthritis(RA) is an inflammatory autoimmune condition in which the body produces an immune system response to attack its own joints, causing pain, inflammation, and swelling. Over time, the cartilage breaks down, narrowing the space between bones, and joints can become unstable or stiff. If left untreated, RA can cause permanent and irreversible joint damage.
The risk of developing diabetes and arthritis, including RA, goes hand in hand. It is estimated that 47% of adults with diabetes also have some form of arthritis.Researchers also say that people living with RA are 23% more likely to develop type 2 diabetes than those without RA.
Elevated inflammatory responses are associated with both RA and diabetes. Increased blood serum levels of interleukins and C-reactive protein, molecules that increase inflammation, are commonly seen across both conditions.
Medication used to treat RA can also increase the risk of developing diabetes due to its effect on increasing blood sugar. Corticosteroids are commonly used to treat RA to decrease inflammation, but also stimulate the liver to release more glucose, as a side effect, which increases blood sugar levels.
Other treatment options to manage symptoms of RA besides medication include following an anti-inflammatory diet and exercising to decrease joint pain, stiffness, and weakness.
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Frozen Shoulder
Frozen shoulder, also called adhesive capsulitis, is a chronic inflammatory condition of the shoulder joint that causes stiffening of the joint and painful limitations with shoulder movements. The onset is often sudden without any specific incident underlying the pain, and the pathology of how frozen shoulder develops is not fully understood.
Frozen shoulder can be divided into three stages:
Frozen shoulder is more prevalent in people with diabetes, affecting as many as 30% with more severe symptoms and decreased responsiveness to treatment.
It is hypothesized that due to high blood sugar, increased levels of circulating glucose, or sugar molecules, in the blood of people with diabetes can stick to collagen within joints in a process called glycosylation. This causes the collagen that makes up the shoulder joint to become sticky, restricting movement and resulting in stiffening of the joint.
Biopsies of the synovial membrane that lines the shoulder joint capsule also exhibit reduced inflammatory growth factors, suggesting slowing of the inflammatory response. This increases the severity of frozen shoulder symptoms due to increased and prolonged inflammation.
Treatment options for frozen shoulder include oral anti-inflammatory medications, physical therapy to increase joint mobility and range of motion, and cortisone injections within the shoulder joint to decrease inflammation. Cortisone injections should be used with caution in patients withdiabetessince they can increase blood sugar levels up to seven days after the procedure.
Surgery can also be performed with an arthroscopic capsular release where the shoulder joint capsule is surgically cut and loosened. A manipulation under anesthesia can also be performed where the shoulder is maximally stretched while being sedated under anesthesia to break up scar tissue that is restricting movement of the shoulder joint.
A Word From Verywell
Arthropathies that develop as a complication of diabetes can lead to destructive, painful, and potentially permanent changes to joints. If not treated properly, diabetic arthropathies can limit proper joint mobility needed to perform functional movements and everyday activities. If you have diabetes and are experiencing increased joint pain, stiffness, or swelling, it is important that you call your healthcare provider to discuss your symptoms. Managing symptoms early is important to prevent irreversible progression of joint destruction.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.UpToDate.Diabetic neuropathic arthropathy.Johnson-Lynn, SE, McCaskie, AW, Coll, AP, Robinson, AHN.Neuroarthropathy in diabetes: pathogenesis of Charcot arthropathy.Bone Joint Res. 7(5), 373-378. doi:10.1302/2046-3758.75.BJR-2017-0334.R1Piva, SR, Susko, AM, Khoja, SS, Josbeno, DA, Fitzgerald, GK, Toledo, FG.Links between osteoarthritis and diabetes: implications for management from a physical activity perspective.Clin Geriatr Med. 31(1); 67-87. doi:10.1016/j.cger.2014.08.019Barbour KE, Helmick CG, Boring M, Brady TJ.Vital signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation - United States, 2013-2015.MMWR Morb Mortal Wkly Rep. 2017;66(9):246-253. doi:10.15585/mmwr.mm6609e1Tian Z, Mclaughlin J, Verma A, Chinoy H, Heald AH.The relationship between rheumatoid arthritis and diabetes mellitus: A systematic review and meta-analysis.Cardiovasc Endocrinol Metab. 2021;10(2):125-131. doi:10.1097/XCE.0000000000000244Lu, MC, Yan, ST, Yin, WY, Koo, M, Lai, NS.Risk of rheumatoid arthritis in patients with type 2 diabetes: a nationwide population-based case-control study.PLoS One. 9(7):1-6. doi:10.1371/journal.pone.0101528Hordon, LD. UpToDate.Limited joint mobility in diabetes mellitus.Gokcen, N, Cetinkaya Altuntas, S, Coskun Benlidayi, I.et al.An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy.Clin Rheumatol. 38, 927–932.https://doi.org/10.1007/s10067-019-04454-zWhelton, C, Peach, C.Review of diabetic frozen shoulder.European Journal of Orthopaedic Surgery & Traumatology.28, 363-371. doi.10.1007/s00590-017-2068-8.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.UpToDate.Diabetic neuropathic arthropathy.Johnson-Lynn, SE, McCaskie, AW, Coll, AP, Robinson, AHN.Neuroarthropathy in diabetes: pathogenesis of Charcot arthropathy.Bone Joint Res. 7(5), 373-378. doi:10.1302/2046-3758.75.BJR-2017-0334.R1Piva, SR, Susko, AM, Khoja, SS, Josbeno, DA, Fitzgerald, GK, Toledo, FG.Links between osteoarthritis and diabetes: implications for management from a physical activity perspective.Clin Geriatr Med. 31(1); 67-87. doi:10.1016/j.cger.2014.08.019Barbour KE, Helmick CG, Boring M, Brady TJ.Vital signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation - United States, 2013-2015.MMWR Morb Mortal Wkly Rep. 2017;66(9):246-253. doi:10.15585/mmwr.mm6609e1Tian Z, Mclaughlin J, Verma A, Chinoy H, Heald AH.The relationship between rheumatoid arthritis and diabetes mellitus: A systematic review and meta-analysis.Cardiovasc Endocrinol Metab. 2021;10(2):125-131. doi:10.1097/XCE.0000000000000244Lu, MC, Yan, ST, Yin, WY, Koo, M, Lai, NS.Risk of rheumatoid arthritis in patients with type 2 diabetes: a nationwide population-based case-control study.PLoS One. 9(7):1-6. doi:10.1371/journal.pone.0101528Hordon, LD. UpToDate.Limited joint mobility in diabetes mellitus.Gokcen, N, Cetinkaya Altuntas, S, Coskun Benlidayi, I.et al.An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy.Clin Rheumatol. 38, 927–932.https://doi.org/10.1007/s10067-019-04454-zWhelton, C, Peach, C.Review of diabetic frozen shoulder.European Journal of Orthopaedic Surgery & Traumatology.28, 363-371. doi.10.1007/s00590-017-2068-8.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
UpToDate.Diabetic neuropathic arthropathy.Johnson-Lynn, SE, McCaskie, AW, Coll, AP, Robinson, AHN.Neuroarthropathy in diabetes: pathogenesis of Charcot arthropathy.Bone Joint Res. 7(5), 373-378. doi:10.1302/2046-3758.75.BJR-2017-0334.R1Piva, SR, Susko, AM, Khoja, SS, Josbeno, DA, Fitzgerald, GK, Toledo, FG.Links between osteoarthritis and diabetes: implications for management from a physical activity perspective.Clin Geriatr Med. 31(1); 67-87. doi:10.1016/j.cger.2014.08.019Barbour KE, Helmick CG, Boring M, Brady TJ.Vital signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation - United States, 2013-2015.MMWR Morb Mortal Wkly Rep. 2017;66(9):246-253. doi:10.15585/mmwr.mm6609e1Tian Z, Mclaughlin J, Verma A, Chinoy H, Heald AH.The relationship between rheumatoid arthritis and diabetes mellitus: A systematic review and meta-analysis.Cardiovasc Endocrinol Metab. 2021;10(2):125-131. doi:10.1097/XCE.0000000000000244Lu, MC, Yan, ST, Yin, WY, Koo, M, Lai, NS.Risk of rheumatoid arthritis in patients with type 2 diabetes: a nationwide population-based case-control study.PLoS One. 9(7):1-6. doi:10.1371/journal.pone.0101528Hordon, LD. UpToDate.Limited joint mobility in diabetes mellitus.Gokcen, N, Cetinkaya Altuntas, S, Coskun Benlidayi, I.et al.An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy.Clin Rheumatol. 38, 927–932.https://doi.org/10.1007/s10067-019-04454-zWhelton, C, Peach, C.Review of diabetic frozen shoulder.European Journal of Orthopaedic Surgery & Traumatology.28, 363-371. doi.10.1007/s00590-017-2068-8.
UpToDate.Diabetic neuropathic arthropathy.
Johnson-Lynn, SE, McCaskie, AW, Coll, AP, Robinson, AHN.Neuroarthropathy in diabetes: pathogenesis of Charcot arthropathy.Bone Joint Res. 7(5), 373-378. doi:10.1302/2046-3758.75.BJR-2017-0334.R1
Piva, SR, Susko, AM, Khoja, SS, Josbeno, DA, Fitzgerald, GK, Toledo, FG.Links between osteoarthritis and diabetes: implications for management from a physical activity perspective.Clin Geriatr Med. 31(1); 67-87. doi:10.1016/j.cger.2014.08.019
Barbour KE, Helmick CG, Boring M, Brady TJ.Vital signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation - United States, 2013-2015.MMWR Morb Mortal Wkly Rep. 2017;66(9):246-253. doi:10.15585/mmwr.mm6609e1
Tian Z, Mclaughlin J, Verma A, Chinoy H, Heald AH.The relationship between rheumatoid arthritis and diabetes mellitus: A systematic review and meta-analysis.Cardiovasc Endocrinol Metab. 2021;10(2):125-131. doi:10.1097/XCE.0000000000000244
Lu, MC, Yan, ST, Yin, WY, Koo, M, Lai, NS.Risk of rheumatoid arthritis in patients with type 2 diabetes: a nationwide population-based case-control study.PLoS One. 9(7):1-6. doi:10.1371/journal.pone.0101528
Hordon, LD. UpToDate.Limited joint mobility in diabetes mellitus.
Gokcen, N, Cetinkaya Altuntas, S, Coskun Benlidayi, I.et al.An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy.Clin Rheumatol. 38, 927–932.https://doi.org/10.1007/s10067-019-04454-z
Whelton, C, Peach, C.Review of diabetic frozen shoulder.European Journal of Orthopaedic Surgery & Traumatology.28, 363-371. doi.10.1007/s00590-017-2068-8.
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