Endocrine Abstracts

Obesity and diabetes mellitus type 2 are proinflammatory states associated with increased disease severity in rheumatoid arthritis (RA). Weight loss is associated with improved disease activity in rheumatoid arthritis (RA). Furthermore science experiments demonstrated weight-independent anti-inflammatory and immunomodulatory effects of GLP-1 receptor agonists. Moreover, in vitro studies found anti-inflammatory effects of GLP-1 receptor agonists in fibroblast-like synoviocytes (FLS) from patients with RA. FLS are the main cell population in synovium. They can secrete pro-inflammatory cytokines like interleukin-6, interact with immune-related cells, and subsequently cause inflamed joints. These anti-inflammatory and immunomodulatory effects of GLP-1 receptor agonists in RA are associated with inhibition of the activation of proinflammatory signaling pathways like NF-kB, improvement of mitochondrial dysfunction induced by TNF- α, prevention of NOX-4 expression and oxidative stress, reduction of the expression of proinflammatory mediators like IL-6 and IL-1β, reduction of the expression of matrix metalloproteinases. The objective of this study was to determine whether treatment with GLP-1 receptor agonists is associated with improved disease activity in certain forms of inflammatory arthritis such as rheumatoid arthritis.

Methods: To estimate the role of GLP-1 receptor agonists in RA, we observed 30 patients (27 women and 3 men) with obesity, diabetes mellitus type 2 and RA treated with GLP-1 receptor agonist between 1 May 2023 and 1 January 2024. They are still receiving this medication. In this period observed patients did not take any disease-modifying anti-rheumatic drugs, steroids or biologic agents. The patients had morning stiffness in more than one joint, swelling in more than one joint and pain in fingers. In addition to symptoms we focused on measuring C-reactive protein (CRP) levels and erythrocyte sedimentation rate as inflammatory markers. They were elevated before starting the applications of GLP-1 receptor agonists.

Results: For 6 months of treatment in the observed group we found out 10% weight reduction, improvement of patient’s morning stiffnes and swelling and relieved pain in fingers. Furthermore the CRP levels and erythrocyte sedimentation rate were decreased after 6 months of treatment with GLP-1 receptor agonists.

Conclusions: These results suggest that GLP-receptor agonist could improve disease activity in RA associated with weight loss. Moreover GLP-1 receptor agonists have potential weight-independent anti-inflammatory effects. Their role as an adjunct in patients with rheumatoid arthritis, obesity and diabetes is understudied, require future research. The limitations of our study are low countability of patient group, short follow-up period, and lack of control group.