Can GLP-1 Drugs Help Your Arthritis?

Released March 17, 2026 

PODCAST OPEN: Thank you for tuning in to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. You may have arthritis, but arthritis doesn’t have you. Here, you’ll get information, insights and tips you can trust — featuring volunteer hosts and guest experts who live with arthritis every day and have experience with the challenges it can bring. Their unique perspectives may help you — wherever you are in your arthritis journey. The Arthritis Foundation is committed to helping you live your best life through our wide-ranging programs, resources and services. Our podcast is made possible in part by the generous financial contributions of people like you. Now let’s listen in. (MUSIC BRIDGE) 

Trina Wilcox: Welcome to the Live Yes! With Arthritis podcast. We're glad you're here. My name's Trina Wilcox, your host for this episode. I was finally diagnosed with juvenile rheumatoid arthritis at age 6, and we're always looking to bring you information that can help you live better with your arthritis, anywhere you are in your journey. And by now, just about everyone has heard about Ozempic, Wegovy and other diabetes drugs that have become popular for helping people lose weight, which is one of the best things that you can do if you're overweight and have arthritis. But the potential benefits of these medications for arthritis and related conditions don't stop there. They have some important downsides, too. So, joining us to talk about these medications and their potential pros and cons is Dr. David Kellner, a rheumatologist at UCLA Health. Welcome, Dr. Kellner. 

David Kellner, MD: Hi, Trina. Thanks so much for having me. 

Trina Wilcox: Of course. Tell me a little bit about your journey to working with rheumatology patients. 

David Kellner, MD: Yeah, absolutely. I'm a rheumatologist and a clinical researcher at UCLA. I'm from the East Coast, but I came out to UCLA for medical school and stayed there for residency and fellowship, so something in the water, or I guess maybe the weather I really love. So, I'm doing a third year of fellowship, getting a master's in clinical research. And my work focuses on inflammatory arthritis and specifically the intersection between obesity, metabolic health and immune-mediated disease. 

Many patients with rheumatoid arthritis and psoriatic arthritis and other conditions live with overweight and obesity. And we know that weight and cardiometabolic risk can influence both symptoms and long-term outcomes in these diseases. And as GLP-1-based medications have become more widely used, I wanted to better understand whether these therapies, when they're prescribed for obesity or diabetes, might also affect arthritis and cardiovascular risk in our patients. 

Trina Wilcox: It's in the news constantly. You can't go a day without seeing something about a GLP-1, which is the most common reference to them that we've heard. But what exactly does that stand for? I mean, can you break it down for us, like glucagons, peptides, all the stuff that we hear. What's that mean? And how do we understand it? 

David Kellner, MD: GLP-1 stands for glucagon-like peptide-1, which is a complicated sounding name, but basically it's a hormone that your body naturally releases after you eat. And its job in the body is to, A) regulate your blood sugar, and B) it also signals fullness to the brain, or something in research we call satiety — that feeling of, you know, after you've had a big meal, where you feel very full; that's in large part due to GLP-1. And then, what these medications are GLP-1 receptor agonists. And so, they're medications that mimic the natural hormones’ effects in our body. And so, what they do is they reduce appetite, and they improve blood sugar control, and they promote weight loss. 

Some medications only act on this specific GLP-1 receptor, like semaglutide. Others, like tirzepatide, which is one of the newest ones, it acts on the GLP-1 receptor and another hormone pathway called GIP. And that has some implications for the degree of weight loss and also side-effect profile. The medications overall: They're all kind of within the same family, and they're all metabolic therapies. But they do differ a little bit in terms of how much weight loss you can expect, the dosing schedule, and obviously, as many patients are familiar with, insurance coverage, too. 

Trina Wilcox: If someone starts looking into these, how do they know which one of those is going to be most beneficial for their weight loss, their journey, what other medications they're on for their arthritis? 

David Kellner, MD: These medications are all kind of in the same family. So, I would just recommend talking with your doctor to see maybe which one they are most comfortable prescribing, and then which one insurance is going to potentially cover. I think those are the big two factors. 

Trina Wilcox: So, they all started out treating specifically diabetes, is that correct? 

David Kellner, MD: That's right. 

Trina Wilcox: And now approved for weight loss? 

David Kellner, MD: That is right. Some of them are approved for weight loss. But you're right. Originally, they were diabetes medications to improve blood glucose control. They've actually been around for quite a while in that capacity, but subsequent trials showed that, "Hey, these medications have substantial weight loss benefits, too." And so, now some are approved specifically for chronic weight management. And certain agents have also demonstrated cardiovascular risk reduction in high-risk populations with diabetes or obesity. So, that's a third indication for some of these drugs now. 

Trina Wilcox: And how is this beneficial for people who are overweight, especially if they've got osteoarthritis? 

David Kellner, MD: Yeah. For osteoarthritis, particularly knee osteoarthritis, the most established mechanism linking weight and pain is mechanical. Extra weight increases load across the knee joint, and weight reduction can help reduce that stress. And this is actually where we have some of the best data. In a 2024 randomized, double-blind, placebo-controlled trial published in the New England Journal of Medicine, which is one of our most prestigious journals, adults with obesity and moderate knee osteoarthritis received once weekly semaglutide or placebo for over a year, along with lifestyle counseling. And participants taking the semaglutide lost about 14% of their body weight, and they had significantly greater reductions in knee pain and improvements in physical function compared with the placebo group. 

So, that really provides some high-quality evidence that substantial, medically supported weight loss can meaningfully improve knee osteoarthritis symptoms. One caveat is the study was not designed to determine the exact mechanism of how pain was improved. Weight reduction is likely a major contributor, through reduced biomechanical stress, but other pathways can't be excluded. And that's kind of a very interesting question in ongoing research. 

Trina Wilcox: That's really promising, and that sounds like it's really beneficial. But what about overweight folks with the inflammatory arthritis, like rheumatoid, psoriatic, juvenile? 

David Kellner, MD: With inflammatory arthritis, we know that obesity is associated with higher disease activity — with more pain, worse function and, in some cases, even reduced response to certain biologic therapies. We know that weight can influence both symptoms and treatment outcomes in inflammatory arthritis, but the data about weight loss, and specifically GLP-1s, is a little bit more limited. In rheumatoid arthritis, our group conducted a retrospective study of patients with RA and overweight or obesity. And we looked at those who were prescribed GLP-1-based medication and compared them with those who were not. And over about a year, those who took the medication had greater reductions — in their RA disease activity, in pain, in inflammatory markers, such as ESR and CRP, and several cardiovascular risk markers — compared to those who did not take it. But because this was not a randomized, controlled trial, like the other trial I talked about, it shows an association rather than proof of causation. 

So, it's an encouraging signal, but definitely needs confirmation in prospective studies. There's actually some hot-off-the-press new data in psoriatic arthritis, which evaluated patients with active psoriatic arthritis and obesity, and one group was treated with an IL-17 biologic medication. The other group was treated with that medication plus tirzepatide, one of the GLP-1 weight loss medications, and the combination biologic plus GLP-1 group had higher rates of joint improvement at 36 weeks. A couple of caveats: The study was open label and the primary endpoint included both joint response and weight loss. So, clearly, the patients on the weight loss medication are going to achieve that outcome more easily. The full peer-reviewed data will be important, but it really does suggest that addressing obesity, alongside immune-targeted therapy, may improve outcomes. 

For other conditions, we really don't have much data. For juvenile arthritis and ankylosing spondylitis, we don't really have robust clinical data evaluating these therapies. So, I would say overall, at this point, the evidence in inflammatory arthritis is emerging rather than definitive. The strongest data remain in weight loss and cardiometabolic outcomes, but arthritis-specific benefits are being actively studied, so excited to see where this goes. 

PROMO: Videos in the Arthritis Foundation’s Your Exercise Solution, or YES, program feature accessible, low-impact workouts designed specifically for people with arthritis. These resources can help improve strength, flexibility and overall well-being while minimizing pain. With expert guidance and encouragement, our YES tool empowers you to stay active and enhance your quality of life. Check it out at arthritis.org/yourexercisesolution. 

Trina Wilcox: If someone with RA does start a GLP-1, should they anticipate that they're going to be able to go into remission, or what does that look like for them? 

David Kellner, MD: My short answer would, unfortunately, be no. These medications are not substitutes for disease-modifying anti-rheumatic drugs, or DMARDs, as we call them. Rheumatoid arthritis generally requires immune-targeted therapy, such as methotrexate or biologic medications. So, a GLP-1 medication may be helpful as an adjunct in patients who meet criteria for obesity treatment, but patients shouldn't expect it to independently induce remission, I would say. 

Trina Wilcox: OK. So, what is the safety with biologics, methotrexate and GLP-1s? 

David Kellner, MD: In general, GLP-1 drugs can be taken safely with biologics or with methotrexate. There's no standard contraindication to combining these therapies. I would say the primary concern is tolerability. If significant nausea or gastrointestinal symptoms occur, that can affect one's ability to take these medications together. It's always good to have your providers coordinate. If your rheumatologist is prescribing methotrexate and your endocrinologist or primary care doctor is prescribing a GLP-1 medication, it's good that they communicate with each other and be aware of what the other's prescribing. 

Trina Wilcox: Why might these drugs be especially relevant for people with RA from a heart health perspective? 

David Kellner, MD: I'm really glad you asked this question, because people with rheumatoid arthritis have an increased risk of cardiovascular disease, and it's actually the leading cause of death in RA patients. So, this is really important to address. And the thought is that it's due to the systemic inflammation in RA, which can actually cause atherosclerosis and heart disease. And so, GLP-1 therapies improve weight, blood sugar and lipid profiles, and some have demonstrated cardiovascular event reduction in high-risk populations, which makes them particularly relevant for patients with RA who also have diabetes or obesity-related cardiovascular risk. 

Beyond arthritis, the strongest evidence base remains in diabetes, in obesity management, and cardiovascular and kidney outcomes in selected populations. There's ongoing research in autoimmune and other conditions, but these are kind of still the strongest data that we have for these medications. 

Trina Wilcox: I've heard things about addiction, lupus, gout… Still kind of up in the air? 

David Kellner, MD: Yeah. I would say it's still early days. There's a lot of emerging research. It's like every day I see a new study on, about, GLP-1s in a new condition. It's very exciting, but I don't think we have definitive data in these conditions. 

Trina Wilcox: Well, let's talk about something we don't want to, but we have to: the downsides to taking them. (laughs) 

David Kellner, MD: I would say the most common side effects with these medications are gastrointestinal, so nausea, diarrhea, constipation, acid reflux, and this is especially during dose increases. In our study in rheumatoid arthritis, we saw that nearly one-third of patients actually discontinued therapy within a year, and most commonly that was due to gastrointestinal or GI symptoms. A couple of other considerations include gallbladder disease risk, rarely pancreatitis, and then there's a potential for loss of muscle mass with rapid weight reduction. That can be said for weight reduction of any kind, even through diet. And then, this is a common question, is when can I or can I even stop this medication eventually? Unfortunately, many patients regain weight after discontinuation, so these medications are currently seen as a long-term therapy. And then, of course, cost and insurance coverage remain huge barriers to uptake of this medication. 

Trina Wilcox: So, when muscle loss does occur for some of the patients who take the GLP-1s, is there any way to mitigate that with nutrition, or is there something they should be doing or completely go off? What are the options when that happens? 

David Kellner, MD: It's area where there's not a lot of definitive data, but it is known that when you lose weight with a GLP-1 medication, some of that weight is going to be muscle mass. Now this does happen when you lose weight for any reason. So, if it's through diet or exercise, invariably some of the weight is going to be muscle mass. There's no randomized, controlled trial data on what patients should do specifically if they have RA and if they've lost muscle mass with a GLP-1 medication. 

What I would recommend is just getting an adequate amount of dietary protein — what'srecommended for all patients. I don't have a specific target or threshold for patients on GLP-1. And then, if you're able to tolerate it, a low-impact exercise is a great way to try and keep muscle mass. I would recommend adequate dietary protein and exercise if that's safe and appropriate for you. Discuss these things with your doctor, too. It's a great question, though. 

Trina Wilcox: Strength training is important in so many aspects. Low impact, light weights, what your joints can handle could really be beneficial. 

David Kellner, MD: I think so. These are things we know are beneficial in many, many different circumstances and can help you maintain or improve your muscle mass. 

Trina Wilcox: What are some of the biggest unanswered questions about GLP-1s and diseases? 

David Kellner, MD: I think we need prospective randomized trials. I'm most interested in rheumatoid arthritis and psoriatic arthritis, so I'm a little biased there, but in all of the diseases we've been talking about. And I think the big question is to determine whether improvements in disease activity that we might see, whether they're entirely due to weight loss, or are there actually direct anti-inflammatory effects of these medications, which could be really interesting. I think that we also need longer-term safety data in rheumatology populations in particular, because they haven't been very well studied in these populations. And then just better understanding of which patients are going to benefit the most. We still don't have a great idea. 

Trina Wilcox: Expense is always a big conversation, especially when you have a chronic condition. So, I've read that Medicaid and Medicare have been negotiating with GLP-1 makers to bring costs down and make them more available. What are your thoughts on this? Do you know much about that? 

David Kellner, MD: I'm definitely not an expert on the insurance coverage. I know it's been really frustrating for a lot of my patients. And I think this is an area that's really rapidly evolving, too. Access  and affordability remain the major issues with these medications, and they can be extremely expensive. I don't have any great advice or revelations here. I would just say that it's important for patients to discuss options with their clinicians and to talk with insurers as well, if possible, to just make sure they're the most up-to-date on what might be covered for them. I think it's also worth exploring the various indications for these medications. For example, you know, if a patient has obesity and sleep apnea, that could be a reason why it's covered. So, I would just recommend discussing with your doctor. 

PROMO: Supporting the Arthritis Foundation’s scientific research initiatives is crucial for developing new treatments and improving patient care. Your contributions fuel groundbreaking studies that explore the causes and treatments of arthritis, while also investing in workforce development to address the rheumatologist shortage. By backing this innovative research, and inspiring the next generation of specialists, we can enhance quality of life for millions affected by arthritis. See what we’re up to at arthritis.org/science. 

Trina Wilcox: So, who should and should not consider trying these medications? 

David Kellner, MD: In general, patients who meet medical criteria for obesity treatment, which is generally a BMI of 30 or higher, or 27 or higher with weight-related comorbidities — for example, sleep apnea or diabetes. These patients may be candidates. For patients with arthritis, they may be particularly relevant when obesity contributes to symptoms or cardiovascular risk. Just a note: These medications are generally avoided in patients with a history of medullary thyroid carcinoma or MEN2, due to some safety signals in the trials where they were studied. And then caution is advised in those with prior pancreatitis or significant gallbladder disease. And patients who are frail or at risk of malnutrition probably require an individualized assessment to see if these medications are safe and appropriate. 

Trina Wilcox: Sounds good. Thanks so much. For each podcast, we post a question about the topic, and we share some of the responses. So, I'd love for you to share your thoughts on these responses. We'll start with one from Melissa Ann, who says, "My inflammation and mobility greatly improved. I haven't had a flare in almost two years. My lab results came back normal for the first time in 15 years. I've been on Zepbound for almost two years and have lost around 120 pounds." 

David Kellner, MD: Wow. Well, I'll just say I'm really happy for Melissa that her symptoms and her labs have improved so much. And that's a really significant weight loss, 120 pounds. That we know can meaningfully reduce mechanical stress, systemic inflammation and metabolic burden. It's plausible that those changes contributed to improved mobility and lab normalization. And individual experiences like this are really encouraging. But I'll say that we still would like to see controlled trials to determine how much of the effect is directly attributable to the medication versus just the weight reduction itself. 

Trina Wilcox: Yeah. Well, Jennifer Coleman said, "Inflammation is down, and the pain in my legs is reduced by about 75%. I'm no longer limping. I'm also sleeping better and using less pain meds, but I'm paying about $500 a month out of pocket for it. It's a luxury, and I can find a way to afford it, sort of, but it needs to be available for more conditions with insurance." 

David Kellner, MD: I 100% agree with Jennifer on that. Reduced pain and improved function after substantial weight loss are consistent with both osteoarthritis and inflammatory arthritis improvements seen in studies. And the financial burden she describes is real and a very important issue, as cost limits access for many patients. And it's unfortunate that our patients often have to make these trade-offs. So, hopefully this will improve in the future. 

Trina Wilcox: Do a lot of those have copay assistance, like you can often do for the RA meds? Can you go onto the site and find copay assistance for these? 

David Kellner, MD: So, this is another question about… Do rheumatologists generally prescribe these medications? Most rheumatologists, I would say, are still not totally comfortable with them. In my patient panel, actually, I haven't prescribed too many because my patients are A) already on them, or B) have tried and have had such difficulties with insurance that they've given up. I'm not sure, and I think you have to talk with the company, talk with your doctor, and see if their administrative staff can find out about that from the company. I know that the federal government has recently been negotiating directly with some of these companies to try and bring down costs, but that's actually independent of insurance coverage, so that would be if you're paying out of pocket. 

Trina Wilcox: Emily Moshinsky says, "My C-reactive protein levels have gotten to almost zero after microdosing. My C-reactive levels have been well over 1.5 for five years until starting the microdose." 

David Kellner, MD: I would say a decrease in CRP, or C-reactive protein, is encouraging. However, CRP can fluctuate for many reasons, and we don't yet have high-quality evidence supporting microdosing as an anti-inflammatory strategy independent of weight loss. So, that remains an open research question. 

Trina Wilcox: Since she mentioned microdosing, can you elaborate on exactly what that means for those of us who have never really heard that term? 

David Kellner, MD: Microdosing is when someone takes a medication or a drug at a significantly lower dose than what is typically prescribed or indicated. To be honest, I was not familiar with microdosing in the GLP-1s until very recently. What I'll say is that we really don't have good, robust data to support it, or to say what are the potential risks and benefits of doing this. I certainly understand that a lot of patients are very interested in the possible anti-inflammatory effects of these medications and that typical doses that are prescribed are quite expensive. Microdosing is not something that I would recommend as a physician. Just because these medications have been studied at a certain dose; their safety, their tolerability and their efficacy are all for that dose that's been studied. And so, once we go off these doses, it's very hard to predict what the outcome might be. It's a very interesting and intriguing hypothesis, though, that microdosing could be effective. 

Trina Wilcox: Does that mean typically when you hear the term microdose, is that usually something that the patient has done on their own and not been prescribed a lower dose by the doctor? 

David Kellner, MD: Exactly, yeah. This is something that patients are generally doing on their own. Especially in rheumatology, we are not doing microdosing or prescribing medications at those doses. 

Trina Wilcox: OK. Jen de Simone says, "People are microdosing so they get the anti-inflammatory effects without significant weight loss." 

David Kellner, MD: I would say again, at this time there is no robust clinical evidence demonstrating that microdosing GLP-1-based therapies provides anti-inflammatory benefit separate from weight loss. That hypothesis is very biologically interesting, but at this time, not proven. 

PROMO: Don’t face arthritis alone. The Arthritis Foundation’s Helpline is a valuable resource to get answers to your questions about arthritis. You can also get referrals to a variety of resources tailored to your specific needs. Our friendly Helpline team offers guidance and information to help you navigate your unique arthritis journey. Call 800-283-7800. Or look for the chat button online at arthritis.org/helpline. 

Trina Wilcox: We wrap up each episode with our top three takeaways from this discussion. So, do you have three takeaways that you can share with us from this episode? 

David Kellner, MD: Sure. I would say number one, for osteoarthritis, high-quality, randomized evidence shows that substantial weight loss with semaglutide can significantly reduce knee pain and improve function. Number two, in inflammatory arthritis, emerging data, including our RA findings and the new psoriatic arthritis combination data suggests that addressing obesity alongside immune-targeted therapy may improve outcomes. And three, I would say that these medications are powerful metabolic tools, but they're not replacements for disease-modifying anti-rheumatic drug therapy, and further prospective trials are needed to define their role in rheumatology. 

Trina Wilcox: I think mine would be: Hang in there, have hope, new data's coming out constantly. Start the conversation with your doctor and doctors, because you've probably got more than one. Keep them all in the loop. And be patient with yourself, because medication can do a lot, but sometimes it's not for you, but you just have to wait and see. Things are changing constantly. So, thank you, Dr. Kellner, for your time. Appreciate it. 

David Kellner, MD: Of course. 

Trina Wilcox: You can always find out more at arthritis.org, and, of course, send your questions, comments and thoughts to [email protected]. We'll see you next time. 

PODCAST CLOSE: Thank you for listening to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. Get show notes and other episode details at arthritis.org/podcast. Review, rate and recommend us wherever you get your podcasts, on Apple, Spotify and other platforms. This podcast and other life-changing Arthritis Foundation programs, resources and services are made possible in part by generous donors like you. Consider making a gift to support our work at arthritis.org/donate. We appreciate you listening. And please join us again!