Antiobesity medications in rheumatology. Quo vadis?

Abstract

Obesity is a well-recognised comorbidity in the context of rheumatic and musculoskeletal diseases (RMDs), adversely affecting disease-related outcomes. Adipose tissue, through immunological mechanisms, induces a low-grade inflammatory state; as a result, there has been growing interest in evaluating the potential role of antiobesity drugs in the management of RMDs. Although they were initially approved for type 2 diabetes mellitus, obesity, and their cardiorenal associations, there is increasing evidence that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in particular may exert immunomodulatory and anti-inflammatory effects in the setting of RMDs. In this viewpoint, we discuss current data regarding the effects of GLP-1 RAs on several conditions, including osteoarthritis, systemic lupus erythematosus, rheumatoid arthritis, fibromyalgia, and osteoporosis. We also highlight ongoing studies, which appear to be promising. Furthermore, we propose that these drugs could be administered to difficult-to-manage cases or in people at an increased risk of developing RMDs (like obese psoriatic patients) or even as adjunctive therapy, considering also the cost barrier that exists in most countries. Preliminary findings are encouraging; however, as most of the available evidence is limited to a small sample size, large-scale randomised controlled trials are needed to evaluate also the long-term safety of these drugs throughout the spectrum of rheumatic disorders.