GLP-1 drugs and lean mass, and starting early RA harder from the outset

The edition in brief

Today's rheumatology edition opens on a question patients increasingly bring to clinic. A meta-analysis of 60 studies and over 1.2 million people found GLP-1 receptor agonists had no measurable effect on bone density, fractures or osteoarthritis symptoms, but were consistently associated with a loss of lean (fat-free) mass (standardised mean difference -0.52), largely tied to weight loss and of low certainty, with no data yet on muscle function. In the ANSWER cohort of 1,423 treatment courses, an early (3-month) fall in rheumatoid factor was independently associated with 12-month remission, and JAK inhibitors produced the greatest RF decline. A nationwide Norwegian study found adults with juvenile idiopathic arthritis carry more hypertension, type 1 diabetes, chronic kidney disease and coeliac disease, and higher all-cause mortality (2.4 vs 1.8 per 1000 person-years) than matched comparators. A clinic pearl restates tuberculosis and hepatitis B screening before biologics. The practice-changer: a 29-trial meta-analysis shows first-line biologic or targeted synthetic DMARDs plus methotrexate achieve remission more often than methotrexate alone in early RA, most clearly in high disease activity and seropositive patients, though guidelines still favour a methotrexate-first, treat-to-target strategy.