GLP-1 agonists like Ozempic capture headlines for their profound impact on weight loss. But what if they are also the next big breakthrough in arthritis treatment? Emerging evidence indicates that these drugs can alleviate joint pain and slow down the progression of arthritis. So have we stumbled upon a game changing treatment that could redefine arthritis management? Let’s delve into the science to find out.
The cornerstone of arthritis management focuses heavily on lifestyle modifications such as diet and exercise. Weight loss also plays a major role in slowing the degenerative process. And now a new class of medications could amplify these effects.
GLP-1 agonists like Ozempic, Wegovy, and Mounjaro were initially approved for managing type 2 diabetes. But recent clinical trials reveal they also have a powerful impact on weight loss. They do this by targeting specific regions in the brain that regulate hunger and appetite. They also slow the rate of gastric emptying, leading to a more gradual release of stomach contents and a longer duration of feeling full. Together, these mechanisms not only enhance feelings of satiety but also promote a calorie deficit which ultimately leads to weight loss.
This study found that GLP-1 agonists administered once a week led to almost 30 pounds of weight loss over the course of 12 to 15 months. This amount of weight loss brings comprehensive health benefits ranging from improved cardiovascular health and lower blood pressure, enhanced insulin sensitivity and better glucose control, improvements to the GI system, and overall positive impacts on self esteem, depression, anxiety, sleep, and cognitive function.
All of this weight loss is also tremendously beneficial for the musculoskeletal system and arthritis sufferers. This study found that weight loss induced by GLP-1 agonists led to improved pain and functional scores, reduced reliance on pain medications, and less frequent need for cortisone injections in people with knee arthritis. Even more encouraging, MRI scans revealed slower progression of arthritis and a reduced likelihood of requiring surgical interventions. Best of all, long term follow up showed that these improvements were not temporary but sustained over time.
Now it's important to keep our excitement in check as we also need to discuss the potential downsides of GLP-1 agonists. First, the observed benefits to arthritis need to be validated by larger, more diverse clinical trials. And let's not forget, GLP-1 agonists come with its share of potential drawbacks, such as cost and side effects. And there are two big concerns that I want to highlight.
Number one. Keep in mind that GLP-1 agonists function by creating a calorie deficit, essentially putting your body in a state resembling starvation. In this state, your body primarily turns to fat as an alternative energy source. However, fat alone cannot provide all the essential nutrients, which is why the body also needs to break down muscle. And while typical weight loss from a caloric deficit leads to approximately 20 to 25% muscle loss, some studies such as this one suggest that GLP-1 agonists result in up to 50% muscle loss.
So the concern here is that okay you’ve lost 30 pounds of weight but it turns out your body composition is actually worse than what it was before because you’ve lost more muscle mass relative to fat. This becomes even more important for people who are dealing with conditions such as arthritis, tendonitis and tendinopathies, or other problems related to muscles and bones. Our muscles play a key role in keeping our joints stable and supported. Muscle loss and muscle weakness often lead to worse pain.
And the reality is, as we age, one of the greatest health threats is losing muscle mass. This is a key contributor to conditions like sarcopenia and loss of functional independence in older adults. Muscle loss increases the likelihood of falls and serious injuries such as hip fractures. And to emphasize how important this issue is, research indicates that 1 year mortality rates following a hip fracture in older adults range from 15% to 30%. Put simply, if 10 older adults suffer a hip fracture, 2 or 3 of them are likely to pass away within one year. This death rate is significantly higher compared to people of the same age who haven't experienced a hip fracture.
So you can see how if GLP-1 agonists are accelerating muscle loss, this can potentially be a big problem. Now the way to seemingly counteract this is to make sure everyone on GLP-1 agonists are also on a resistance and strengthening program to try to counteract and prevent these effects. In addition, newer types of GLP-1 agonists such as Tirzepatide or Mounjaro, may not cause the same reductions to lean muscle mass as Ozempic and Wegovy.
Ok so that was the first big problem with GLP-1 agonists. The second big concern is the tendency for rapid weight regain once the medication is discontinued. This usually occurs because most people don't make lasting changes to their eating and exercise habits. When you take away a medicine that helps control your appetite, it's easy to start eating more again.
Adding to the complexity, eating fewer calories than you're used to can actually slow down your metabolism. For example, instead of burning 2,000 calories a day, your body might go down to burning only 1,500 or 1,200 calories per day. If you then go back to your old eating habits with this slower metabolism, you're setting yourself up for rapid weight gain.
And this is what we see in many of the clinical trials that are now being published. Studies such as this one show that GLP-1 agonists do indeed help tremendously with weight loss. But one year after withdrawal of the medication, participants regained over two thirds of their prior weight loss with similar changes to cardiometabolic variables.
The key takeaway is that while GLP-1 agonists can effectively enhance weight loss and improve health outcomes, they shouldn't be considered a standalone solution or a quick fix. In addition, we still don’t know if there are any potential long term side effects and there’s also the possibility of becoming reliant on the medication to maintain weight loss.
Those who've been most successful with GLP-1 agonists don't just count on the medicine for weight loss. They incorporate it into a comprehensive plan that includes changes in diet, controlling portion sizes, and integrating a balanced exercise routine with both cardio and strength training. The ultimate aim is to establish long-term habits, so you can wean off the medication and still keep a stable weight.
Whether we ultimately use GLP-1 agonists for the treatment of arthritis is going to depend a lot on how the medication affects muscle mass. But the preliminary data seems very promising and if we can combine the effects of weight loss with a strengthening regimen, a lot of people with arthritis are going to see tremendous benefits to their pain and symptoms.