GLP-1 Analogues in Rheumatology - The Influence of Obesity on the Effectiveness of Biological Treatment

Abstract

Obesity and overweight are becoming a global health challenge and are increasingly prevalent in patients with rheumatic diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and systemic lupus erythematosus (SLE). Adipose tissue serves as an active endocrine organ, secreting adipokines and proinflammatory cytokines, including leptin, tumor necrosis factor alpha (TNF-alpha), and interleukin 6 (IL-6). Obesity exacerbates inflammatory processes, increases the number of classically activated macrophages (M1) and reduces adiponectin levels, which may sustain and amplify the immune response typical of autoimmune diseases. Available studies indicate that obesity is associated with a lower likelihood of achieving minimal disease activity, particularly in RA and PsA. In RA patients, a higher body mass index (BMI) correlates with greater pain, a higher Health Assessment Questionnaire (HAQ) score, and a lower chance of remission, even with similar treatment. In the case of PsA, obesity increases the risk of disease onset. In SLE, a higher BMI is associated with increased disease activity and excessive fatigue. Research suggests that the effectiveness of TNF-alpha inhibitors may be reduced in patients with obesity, while the response to medications such as tocilizumab or abatacept is often independent of BMI. At the same time, abundant data confirm that weight loss brings tangible benefits – improving functional outcomes, and increasing the chance of achieving minimal disease activity, particularly in RA and PsA. Preliminary observations regarding Glucagon-Like Peptide-1 (GLP-1) agonists indicate their possible anti-inflammatory effects, although further research is needed. In summary, obesity significantly affects the course of rheumatic diseases and the effectiveness of therapy, and weight loss is an important element in supporting treatment.