New Delhi: Two chronic conditions increasingly found to intersect, especially through shared mechanisms of inflammation and metabolic dysfunction, are Rheumatoid Arthritis (RA) and Type 2 Diabetes. In pharmaceutical management, it is crucial to understand the complex relationship between these diseases for the patient who has both. Both RA and Type 2 diabetes have inflammatory pathways that exacerbate each other, hence the need for a holistic and integrated approach to treatment that addresses both the immune system and metabolic processes.
In an interaction with News9Live, Dr. Aravind Badiger Technical Director of BDR Pharmaceuticals, spoke about how inflammation-related health problems can be tackled with medication.
Rheumatoid Arthritis is a systemic autoimmune disease that causes chronic inflammation, mainly affecting the joints. Inflammation in RA is mediated by pro-inflammatory cytokines such as tumor necrosis factor (TNF)-alpha, interleukins (IL)-6, and IL-1. These cytokines have been implicated in the damage to the joint, causing pain and disrupting normal metabolic processes, such as insulin signaling. This systemic inflammation is believed to be associated with the development of insulin resistance, which is a characteristic of Type 2 diabetes. Epidemiological studies have shown that people with RA are at an increased risk of developing diabetes, estimated to be between 30-50% greater than that in the general population.
Pharmaceutically, control of this dually burdened condition of RA and Type 2 diabetes, which is currently increasingly prevalent among populations, seems to be crucial for controlling the inflammatory process simultaneously with optimizing the metabolic health condition. DMARDs, which include biologics, form the core drug for the management of RA as it acts via selective pathways through immune mechanisms inducing inflammation. In biologic DMARDs, for instance, it has been noted that drugs such as TNF inhibitors (adalimumab, etanercept), IL-6 inhibitors (tocilizumab), and Janus kinase inhibitors (tofacitinib) may decrease joint inflammation, but, at the same time, can also improve insulin sensitivity in certain patients. As systemic inflammation, which promotes insulin resistance, decreases, these drugs can also reduce the chances of developing Type 2 diabetes or even facilitate better management in established cases.
In addition to biological DMARDs, the use of conventional DMARDs such as methotrexate continues to be at the core of RA management. Methotrexate is a nonbiologic DMARD. It exerts its effects as an immunosuppressant and as an inhibitor of inflammatory cytokines. Though methotrexate is used primarily for the relief of symptoms of RA, it also can reduce systemic inflammation, which decreases the likelihood of diabetes mellitus developing in susceptible persons. However, the impact of methotrexate on insulin resistance is not as direct as that of biologics, and usually, other treatments are required to control diabetes in RA patients.
On the diabetes side, controlling blood glucose is crucial, especially for RA patients who may already have elevated inflammatory markers. First-line therapy for Type 2 diabetes usually involves metformin, a drug that enhances insulin sensitivity and decreases hepatic glucose production. Notably, it also has an anti-inflammatory action, which will add to its benefits for the RA patient. Some studies do suggest that metformin can reduce RA disease activity as it decreases levels of inflammatory markers, thus benefiting patients with dual conditions.
Other than metformin, newer classes of diabetes drugs, GLP-1 receptor agonists (liraglutide, semaglutide), and SGLT2 inhibitors (empagliflozin, canagliflozin) gained attention with their role in RA treatment in the continuum of diabetes itself. GLP-1 agonists improve insulin sensitivity and help with weight loss, a critical requirement since obesity plays a pivotal role in insulin resistance and stress of the joint. Additionally, it is also revealed that GLP-1 agonists can cut the inflammatory makers which would likely benefit directly for RA patients by reducing or suppressing the processes that increase their joint damage via inflammation. It works by removing excess glucose and glucose reabsorption in kidneys in SGLT2; its anti-inflammatory action was similarly seen and added as an anti-inflammatory drug systemically to mitigate systemic inflammation among RA patients.
Although pharmacological interventions play an essential role, lifestyle modifications should not be underestimated. For instance, both RA and diabetes require a balanced diet, regular physical activity, and weight management. An anti-inflammatory diet supplemented with omega-3 fatty acids and antioxidants will reduce inflammation beyond the pharmaceutical treatments alone. Low-impact exercises can help improve one’s sensitivity to insulin, minimize joint pain, and promote well-being.
In conclusion, RA and Type 2 diabetes represent a dual challenge that needs to be managed strategically and individually in terms of pharmacological intervention: inflammatory pathways should be addressed together with metabolic pathways. Biologic DMARDs, traditional DMARDs, and diabetes drugs such as metformin, GLP-1 agonists, and SGLT2 inhibitors are in the treatment arsenal that can potentially control inflammation while improving insulin sensitivity. By integrating pharmacologic treatment with lifestyle modifications, healthcare providers can offer a more comprehensive management plan for patients suffering from both rheumatoid arthritis and Type 2 diabetes, improving outcomes and quality of life.
Being chronic health problems, rheumatoid arthritis and diabetes cannot fully be treated with medication. Know the perspective of a pharma expert on the subject. Medicine Health News: Latest News from Health Care, Mental Health, Weight Loss, Disease, Nutrition, Healthcare
