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Weight Loss as a Therapeutic Goal in Psoriatic Arthritis
Psoriatic arthritis (PsA) is a complex inflammatory disease often complicated by obesity, which not only worsens disease activity but also impairs treatment response. At ACR Convergence 2025, three compelling studies spanning pharmacologic, lifestyle, and longitudinal observational data converged on a central theme: weight loss is a powerful modulator of PsA outcomes, regardless of the intervention used.
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Biologic choice in PsA: consider factoring in obesity ⚖️
Abstract 2691: In a longitudinal cohort study, obesity associated with ↓ odds of achieving minimal disease activity (MDA) among pts on TNFi, but not with other DMARDs
@RheumNow #ACR25 https://t.co/p4KaH6HKYj
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Abstract 2690: Food as a Medicine
Mediterranean vs low-calorie DASH vs control diet in PsA (multicenter RCT):
🔹 All 3 groups showed significant weight loss & DAPSA by wk 24
🔹 Weight loss not diet type may be the driver of clinical improvement
@RheumNow #ACR25 https://t.co/rBS3HR1HXl
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
#2660 In >8000 women, serum urate rose sharply during the menopausal transition, then plateaued after menopause.
Hyperuricemia reached 4-5% post-menopause, up to 18% in obesity or low eGFR.
Healthy body weight & kidney function pre-menopause may decrease HU later @RheumNow #ACR25 https://t.co/v6ai3lgAd2
Mrinalini Dey DrMiniDey ( View Tweet)
In PsA patients, GLP-1 RA therapy led to significant weight loss and improvements in CRP, pain, lipids, and blood pressure. PsA outcomes improved proportionally with weight loss. Regression analyses revealed that each 1% reduction in body weight was associated with significant https://t.co/Pph1PjfOve
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#2658 In >870k adults with T2DM or obesity, GLP-1 receptor agonists showed no increase in autoimmune or inflammatory disease risk, and were instead linked to lower mortality, heart failure, stroke and dementia. Excellent real-world safety signals. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR25 Clinical Preview by Prof Coates for use now:
GLP-1 agonist & Diet
Abstr#813 GIP/GLP-1 improved MSK pain
Abstr#849 GLP-1 reduced risk of #MACE in PsA
Abstr#2690 RCT = the degree of weight loss regardless specific dietary strategy determined benefit in PsA @RheumNow https://t.co/4jB0fFHosC
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Does diet matter in PsA?
Randomized study comparing advice, DASH low calorie, Mediterranean diet
Seems that weight loss corresponds better with benefit than diet. BMI reduction remains focus in PsA
Laura Coates #ACR25 meeting review @RheumNow https://t.co/CqR25sJdDc
David Liew drdavidliew ( View Tweet)
Nice to see a Dietary intervention study in the
"Top Abstracts That Will Change My Practice in the Near Future" by L. Coates for Year in Preview
Small RCT but fibres significantly improve response to treatment in the MTX treated RA group with a mean reduction of DAS28 of https://t.co/vMeIAK1P5u
Aurelie Najm AurelieRheumo ( View Tweet)
The DIPSA study: can diet improve PsA?
Finally a RCT, and the general message is Loose weight, regardless of the diet!
3 arms:
-Mediterranean diet 31pts
-Low-calorie Dietary Approaches (DASH-LC) 30pts
-Standard of care 31pts
Primary outcome change in DAPSA wk 12
DASH-LC https://t.co/XH9Xdn0g96
Aurelie Najm AurelieRheumo ( View Tweet)
#ACR25 Abstr#LB15 Tell #RA patients on methotrexate that eating high fibre diet is good for them! An RCT showed improved EULAR response vs PBO. Likely due to restoration of Th17/Treg balance @RheumNow https://t.co/NbwQFqJNho
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Gut microbiome on Urate metabolism study- 1500 men and women.
From 3 cohorts- Framingham, nurses health and men's lifestyle with blood and stool data
Focused on 5 urate metbolizing genes
Abst#2590 #ACR25 @RheumNow https://t.co/YxBb3WfcbB
Bella Mehta bella_mehta ( View Tweet)
Semaglutide isn’t just for weight loss?
In RA, users had 20–40% lower risk of synovitis, stiffness & swelling up to 1 year vs matched controls.
GLP-1 agonists may offer anti-inflammatory benefit beyond metabolism.
@RheumNow #ACR25 Abstract#2286
Jiha Lee JihaRheum ( View Tweet)
In case you have a (gut) feeling something’s off…
Abstract 2315: The gut microbiome in #SpA 🔬
⬆️ Proteobacteria (incl. Escherichia spp)
⬇️ Firmicutes (“good” bacteria)
Higher disease activity ↔️ lower alpha diversity
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Hojiej et al. Prevalence and Impact of lifestyle factors in PsA. Lifestyle factors impacted disease activity. Cumulative effect of increasing number of factors @RheumNow #ACR25 Abstr#2309 https://t.co/oDGQyLBRDO
Richard Conway RichardPAConway ( View Tweet)
Macedo et al. Increasing exercise improved QoL in axSpA. Mobility limitation and obesity worsened it. At least to some degree these effects appear independent. @RheumNow #ACR25 Abstr#2326 https://t.co/Ei4cKTNHyn
Richard Conway RichardPAConway ( View Tweet)
SLGT-2 and GLP-1 in RA: More than Weight Loss https://t.co/SRKMHNlHZo
Future of rheumatology is bright , Shreya Sakthivel discussed her work on TriNetX database , looking specifically for effect of SLGT-2. GLP-1 on RA flare incidence.
@RheumKay
@RheumNow
#acr25
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
GLP-1 in Knee Osteoarthritis https://t.co/SxyVEAK1CZ
@bella_mehta Discusses role of GLP1 in OA and possible mechanisms of effectiveness ? weight reduction ? or doses it have anti-inflammatory -anti-fibrotic role ?
@RheumNow
#ACR25
Links:
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Short chain fatty acids (SCFA) and the relevant microbiome have been linked to RA development and severity.
Study of monozygotic twins, where only one has RA, two diff cohorts:
lower SCFA
lower SCFA microbiome
Biomarkers, or even therapeutic target?
#ACR25 ABST0442 @RheumNow https://t.co/HW1YfkfOG3
David Liew drdavidliew ( View Tweet)
GLP1 receptors are present on cartilage, synovial and specific cells such as macrophages.
Also endogenous GLP1 seemed to protect the cartilage in animal models
#ACR25 @RheumNow https://t.co/ekNWbtPO4b
Links:
Bella Mehta bella_mehta ( View Tweet)
