The PsA Weight-Loss Treatment Gap: Are We Missing the Bigger Picture? Save

Rheumatology is preparing for a week filled with exciting research, emerging therapies, and perhaps a little Disney magic at ACR Convergence 2026. But among the groundbreaking clinical trials and new treatment strategies, one of the most important stories may be about something we aren't doing enough of: addressing obesity and cardiometabolic risk in our patients with psoriatic arthritis (PsA).

Unlike a Disney fairy tale, this problem won't disappear with the wave of a magic wand.

Two abstracts being presented at ACR Convergence highlight a troubling disconnect between recognizing obesity as a significant comorbidity in PsA and treating it.

Abstract #1315, presented by Ryan Rex and colleagues, examined US rheumatologists' perceptions and use of GLP-1 therapies in patients with PsA across five survey waves from early 2025 through mid-2026.

The findings were revealing. Rheumatologists estimated that more than 50% of their patients with PsA were overweight or obese. Yet estimated GLP-1 use increased only modestly, from 9% to 14%, despite the proportion considered strong treatment candidates rising from 28% to 37%.

Perhaps most interesting? Only 1% of surveyed rheumatologists reported personally prescribing a GLP-1 therapy, although nearly half anticipated doing so within the next year.

Abstract #1343, from Nirja Kaka and colleagues, offers an equally concerning perspective. Using NHANES data, investigators identified 227 adults classified as having PsA and found that 52.4% had metabolic syndrome, compared with 23.2% of the general-population comparator.

Even more striking, approximately 76.7% met the study's operational criteria for GLP-1 treatment eligibility, yet no GLP-1 prescriptions were identified in the PsA sample. Only 8.7% were receiving statin therapy.

The NHANES PsA classification relied on self-reported conditions rather than rheumatologist-confirmed diagnoses, the subgroup was relatively small, and the analysis was cross-sectional. The absence of recorded GLP-1 use in this sample does not mean that there were not patients with PsA receiving these medications. Likewise, potential treatment eligibility does not automatically translate into a prescription.

Still, the larger message is difficult to ignore.

We have become increasingly sophisticated at controlling inflammation, but are we giving equal attention to the metabolic factors influencing our patients' long-term outcomes? And more thought provoking is, who is going to be responsible for prescribing and managing patients on GLP-1s? 

We measure swollen joint counts, assess enthesitis, monitor skin involvement, and celebrate improvements in disease activity. But what happens when a patient achieves low disease activity while continuing to struggle with obesity, hypertension, insulin resistance, or untreated dyslipidemia?

Have we truly optimized their care?

The conversation becomes even more relevant as emerging evidence, including the TOGETHER-PsA trial, raises interest in combining targeted inflammatory therapy with metabolic treatment. For me, the practical takeaway is that we need to recognize metabolic health as an essential part of comprehensive PsA care.

That means routinely discussing weight without stigma, evaluating cardiovascular risk factors, screening for diabetes and sleep apnea when appropriate, and collaborating more closely with primary care and obesity medicine colleagues. It also means helping patients navigate the very real barriers of medication access, insurance coverage, and affordability. 

As we explore the latest data surrounding obesity and advances in therapy while in Orlando, perhaps it's time to expand our definition of a successful treatment outcome.

After all, the goal isn't simply to help our patients move more comfortably through the Magic Kingdom. It's to help them remain healthier, more active, and at lower long-term risk.

The real magic may be in treating the whole patient—not just the joints.

And if these two abstracts tell us anything, it's that we still have some work to do before we can call that a happily ever after.