From the Division of Rheumatology, Department of Medicine, University of British Columbia.
Arthritis Research Canada, Vancouver, British Columbia, Canada.
J Clin Rheumatol. 2024 Jan 1;30(1):26-31. doi: 10.1097/RHU.0000000000001949. Epub 2023 Mar 6.
Obesity is a proinflammatory state associated with increased disease severity in various types of inflammatory arthritis. Weight loss is associated with improved disease activity in certain forms of inflammatory arthritis such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA). We conducted a scoping review summarizing the literature evaluating the effect of glucagon-like peptide 1 (GLP-1) receptor agonists on weight and disease activity in patients with inflammatory arthritis or psoriasis. MEDLINE, PubMed, Scopus, and Embase were searched for publications evaluating the role of GLP-1 analogs in RA, PsA, psoriasis, axial spondyloarthritis, systemic lupus erythematosus, systemic sclerosis, gout, and calcium pyrophosphate deposition disease. Nineteen studies were included: 1 gout study, 5 RA studies (3 basic science, 1 case report, and 1 longitudinal cohort), and 13 psoriasis studies (2 basic science, 4 case reports, 2 combined basic science/clinical studies, 3 longitudinal cohorts, and 2 randomized controlled trials). No psoriasis study reported on PsA outcomes. Basic science experiments demonstrated weight-independent immunomodulatory effects of GLP-1 analogs through inhibition of the NF-κB pathway (via AMP-activated protein kinase phosphorylation in psoriasis and prevention of IκBα phosphorylation in RA). In RA, improved disease activity was reported. In psoriasis, 4 of 5 clinical studies demonstrated significant improvements in Psoriasis Area Severity Index and weight/body mass index with no major adverse events. Common limitations included small sample sizes, short follow-up periods, and lack of control groups. GLP-1 analogs safely cause weight loss and have potential weight-independent anti-inflammatory effects. Their role as an adjunct in patients with inflammatory arthritis and obesity or diabetes is understudied, warranting future research.
肥胖是一种促炎状态，与各种类型的炎症性关节炎的疾病严重程度增加有关。减肥与某些类型的炎症性关节炎（如类风湿关节炎和银屑病关节炎）的疾病活动改善有关。我们进行了一项范围综述，总结了评估胰高血糖素样肽 1（GLP-1）受体激动剂对炎症性关节炎或银屑病患者体重和疾病活动影响的文献。我们在 MEDLINE、PubMed、Scopus 和 Embase 上搜索了评估 GLP-1 类似物在类风湿关节炎、银屑病关节炎、银屑病、轴性脊柱关节炎、系统性红斑狼疮、系统性硬化症、痛风和焦磷酸钙沉积病中的作用的出版物。共纳入 19 项研究：1 项痛风研究，5 项类风湿关节炎研究（3 项基础科学研究、1 项病例报告和 1 项纵向队列研究）和 13 项银屑病研究（2 项基础科学研究、4 项病例报告、2 项基础科学/临床联合研究、3 项纵向队列研究和 2 项随机对照试验）。没有银屑病研究报告银屑病关节炎的结果。基础科学实验表明，GLP-1 类似物通过抑制 NF-κB 途径（在银屑病中通过 AMP 激活蛋白激酶磷酸化，在类风湿关节炎中防止 IκBα 磷酸化）发挥独立于体重的免疫调节作用。在类风湿关节炎中，报告了疾病活动的改善。在银屑病中，5 项临床研究中的 4 项显示，银屑病面积严重程度指数和体重/体重指数显著改善，且无重大不良事件。常见的局限性包括样本量小、随访时间短以及缺乏对照组。GLP-1 类似物安全地导致体重减轻，并具有潜在的独立于体重的抗炎作用。它们作为肥胖或糖尿病合并炎症性关节炎患者的辅助治疗方法的作用尚未得到充分研究，值得进一步研究。
