GLP-1s for Rheumatoid Arthritis: Can These Weight Loss Drugs Help With RA?

Weight loss drugs known as GLP-1 receptor agonists are sometimes referred to as “miracle drugs,” not only because they help people lose weight, but because they’ve also been shown to help with many other chronic diseases.

While these medications aren’t approved for chronic inflammatory diseases such as rheumatoid arthritis (RA), many people with RA have been prescribed a GLP-1 to manage a coexisting condition. But are they safe to take alongside of the drugs used to manage RA, and do their inflammation-lowering properties translate to improvements in symptoms like joint pain and fatigue, or even slow down disease progression?

Here’s what’s known and what’s still being investigated when it comes to RA and GLP-1 safety and efficacy, as well as expert advice on what you should consider before you start taking the weight loss drugs.

“So far, GLP-1 receptor agonists appear to be generally safe in people with RA, though more research is needed,” says Nancy Lane, MD, an endowed professor of medicine, rheumatology, and aging research at the University of California in Davis.

People with inflammatory arthritis often have comorbidities, including heart disease, renal insufficiency, and diabetes, says Dr. Lane.

“Although GLP-1s aren’t indicated to treat RA, they've been given to patients who have rheumatoid arthritis and a comorbidity such as obesity or diabetes. From what we’ve seen so far, there’s no problem — there's no safety signal — and there appears to be no contraindication at this time to using them,” she says.

But their safety in people with RA hasn’t been specifically tested — or at least those results haven’t been presented or published yet, Lane adds.

Derin Karacabeyli, MD, a rheumatologist and researcher at Vancouver General Hospital in British Columbia, agrees that there’s limited data available about GLP-1s and RA.

“Most large trials didn’t exclude people with RA, but they also didn’t report on them specifically,” Dr. Karacabeyli says.

In theory, GLP-1s should improve RA symptoms. Extra body fat creates additional inflammation, including joint inflammation.

But studies are needed to prove whether GLP-1s improve RA symptoms and disease activity, says Karacabeyli.

“To date, there are no full-length research articles describing changes in RA disease activity following treatment with GLP-1 receptor agonists,” he says.

RA Joint Symptoms

There’s also evidence, including a study of people with obesity and osteoarthritis knee pain published in the New England Journal of Medicine, that GLP-1s can help with other types of arthritis, says Lane.

But Lane and Karacabeyli agree that what is really needed is well-designed clinical trials in people with RA to find out if these medications truly reduce disease activity.

RA Comorbidities, Such as Heart Disease

Karacabeyli and colleagues have conducted a study (submitted for publication but not yet published) comparing GLP-1 medications with another diabetes treatment in people with immune-mediated diseases, including RA.

“A subgroup analysis revealed that GLP-1 users with RA had fewer heart attacks, strokes, and deaths from cardiovascular causes than those on a different diabetes medication. That suggests GLP-1 receptor agonists improve cardiovascular health in people with RA, just as they do in the general population,” he says.

If you're living with rheumatoid arthritis and thinking about starting a GLP-1 medication for weight loss or blood sugar management, there are a few things to consider, says Karacabeyli.

GLP-1s haven’t been proven or approved to treat RA. That means you need to continue to take your RA medications as recommended.

It’s not a substitute for lifestyle changes. Many people think that it’s either GLP-1 or behavior change, but it’s actually both, he says. People do best on the medications when they make healthy diet changes and get regular physical activity.

There are common side effects. Side effects like nausea and diarrhea typically improve with time, but it’s important to start at a low dose and increase gradually.

You may need to stay on it long-term. Most people regain weight if they stop taking a GLP-1.

They aren’t appropriate for everyone. You shouldn’t take a GLP-1 if you have a personal or family history of certain thyroid cancers or conditions like multiple endocrine neoplasia type 2.

Make sure your doctor follows you closely. Substantial weight loss is often followed by some muscle and bone loss, says Karacabeyli. Since people with RA are already more likely to have both sarcopenia, which is loss of muscle, and osteoporosis, they need extra monitoring and dietary guidance to make sure they’re getting enough protein and resistance training, he says.

You’ll also want to make sure your doctor is monitoring you to make sure the GLP-1s don’t interact with any of your RA medications, says Lane.

• GLP-1 receptor agonist weight management medication may benefit people with rheumatoid arthritis by reducing inflammation and helping them manage common comorbidities like heart disease.
• GLP-1s appear generally safe for people with RA who are taking them for other conditions, but more targeted research is needed.
• Although early lab research and studies on other types of arthritis suggest GLP-1 anti-inflammatory effects that could benefit RA, there is a need for trials that look specifically at symptoms and disease activity.
• If you're considering GLP-1 treatment and have RA, it's essential to continue your RA medications, adopt healthy lifestyle habits, and work closely with your healthcare provider to ensure safe, effective use.