GLP-1s Improve Rheumatoid Arthritis Symptoms, Study Suggests

Overweight or obese rheumatoid arthritis (RA) patients taking a GLP-1 saw reductions in their RA symptoms, pain, body weight, cholesterol and blood sugar levels, compared with the control group, according to a recent study published in ACR Open Rheumatology.

A team of researchers, including corresponding author Veena Ranganath, M.D., MS, of the University of California, Los Angeles, examined the medical records of obese and overweight RA patients prescribed GLP-1 agonist drugs and identified 229 patients with a BMI of at least 27. Patients in the treatment cohort were given either subcutaneous semaglutide (84%), oral semaglutide (8%) or subcutaneous tirzepatide (8%).

Of the 173 obese or overweight patients who took their prescribed GLP-1s, 32% saw improvement in their RA symptoms over a year, compared with 17% of the 42 patients who were prescribed a GLP-1 but did not take it. Patients were seen at three-month intervals for up to one year.

Although this difference is not considered statistically significant (P=0.16), decreases were seen in multiple areas.

For example, disease activity was categorized on a scale of 0 to 3 (remission to severe) and for those using GLP-1 agonists, group averages changed by

-0.03 points. On the standard 0-10 self-reported pain scale, pain decreased by an average of 0.6 points, compared with an increase of 1.3 points for those in the control group. Patients taking their GLP-1s also lost an average of 9.7 lbs from baseline, as well as saw drops in triglyceride, low-density lipoprotein and cholesterol levels.

“Our study is among the first to assess the effects of GLP-1RAs on patients with RA, and our findings suggest that they may beneficially impact RA care in several important ways,” Ranganath and her colleagues wrote in the study. “Further study in the form of prospective trials is needed to better characterize their benefits and risks in this patient population.”

More than 30% of RA patients in North America are obese, due to the nature of the diseases exacerbating each other. The overproduction of inflammatory cytokines and adipocytokines caused by RA puts these individuals in a chronic inflammatory state. The leading cause of death in obese RA patients is cardiovascular disease.

The cardiovascular benefits of GLP-1 use in RA patients are well established, while the drug’s possible anti-inflammatory benefits continue to be researched.

“Existing research has shown that GLP-1RA may down-regulate the secretion of multiple proinflammatory cytokines, suggesting a possible mechanism by which they may impact RA disease activity,” Ranganath and her colleagues write. “Additionally, GLP-1RAs have been shown to modulate arthritis pain through multiple possible mechanisms.”

During the study, approximately one-third of patients discontinued their GLP-1 use, the most common reasons being insurance difficulties and gastrointestinal distress.

Limitations of this study include cohort size and lack of diversity. A majority (71%) of patients in the treatment group were White, while only 47% of patients in the control group were White. This may reflect access issues, including insurance approvals or cost, which disproportionately affect Black, Hispanic and Asian patients. Previous data shows lower GLP-1RA treatment rates in these populations, the study says.

This study also included a limited sample size overall and did not measure variables such as the patient’s reason to initiate GLP-1RA therapy.