Rheumatic diseases: anti-obesity drugs could revolutionise treatment

Incretin-based medicines (semaglutide and tirzepatide) could also revolutionise rheumatological treatments. Originally developed for the treatment of diabetes and obesity, these treatments have the ability to reduce systemic inflammation. By also contributing significantly to weight loss, they reduce the mechanical and metabolic strain on the joints, thereby alleviating pain. A series of studies is currently underway at Gemelli Hospital specifically to investigate whether these drugs, originally developed for diabetes and obesity, might also play a role in certain rheumatological conditions, such as psoriatic and rheumatoid arthritis.

According to Maria Antonietta D’Agostino, Professor of Rheumatology at the Catholic University of the Sacred Heart and Director of the Rheumatology Unit at the Agostino Gemelli University Polyclinic Foundation (IRCCS) “Using these drugs helps to reduce the burden of pain, as the joints are subjected to less mechanical stress due to weight loss, whilst also reducing inflammation. And one of the tissues that produces the greatest amount of inflammatory cytokines is, in fact, adipose tissue”.

It has long been known that weight loss is beneficial for patients with rheumatic diseases. “But GLP-1-based medicines,” explains Professor D’Agostino, “as well as leading to weight loss, offer further benefits to these patients by reducing inflammation, and this benefit becomes apparent well before the weight loss has become established.”

GLP-1 receptors are found not only in adipose tissue, the gastrointestinal tract and the nervous system. There is also evidence of their presence in certain key cells of the immune system.

“We are conducting a study – reveals the rheumatologist – to assess the possible role of these receptors within the joints as well, and whether, in patients undergoing treatment with GLP-1 receptor agonists, there is an effect on fibroblast activation, which underlies synovial hyperplasia.”