Psoriatic arthritis is an inflammatory type of arthritis that affects the joints, skin, and organs. There’s a strong genetic influence (one study found that genes are responsible for about 25% of the development of PsA), with environmental triggers like stress, toxins, and infections also playing an important part. An estimated 30% of people with psoriasis go on to develop psoriatic arthritis.
“Psoriatic arthritis is a systemic disease,” says rheumatologist Ernest Vina, M.D., an associate professor of medicine in the rheumatology division of the University of Arizona College of Medicine in Tucson. In psoriatic arthritis, an overactive immune system attacks the joints and other areas of the body, leading to joint destruction, pain, and an increased risk for cardiovascular disease, metabolic fatty liver disease, and more due to inflammation.
Psoriatic arthritis symptoms can range from mild to severe. Per the Arthritis Foundation, they can include:
Joint pain, heat, stiffness, and/or swelling (in many cases there may be no obvious swelling) in four or fewer joints, but generally not symmetrically
Skin plaques—thick, raised, red, itchy patches with a silvery, scaly appearance
Dactylitis, or excessive swelling and inflammation in the affected fingers
Fatigue (ranging from moderate to severe)
Heart, kidney, liver, or lung issues
Inflammation in the eye called uveitis (or other eye problems)
Nail changes, which might show cracking, pitting, white spots, and separation of the nail from the bed
When you eat carbohydrates (which are strands of sugar molecules), your blood sugar (a.k.a. blood glucose) increases. Glucagon-like peptide-1 (GLP-1) is a hormone that prompts insulin to be released in order to shuttle blood sugar out of the blood and into cells. “It normalizes blood sugar and slows gastric emptying, which helps people feel full, even after eating a small amount of food,” explains Ziyad Al-Aly, M.D., the chief of research and development at the Veteran’s Administration (VA) St. Louis Health Care System in Missouri. “In addition, it suppresses appetite and cravings.” (These craving-blunting effects in the brain make medication similar to GLP-1 promising for fighting non-food addictions as well, including alcohol.)
Ozempic is part of a class of drugs called GLP-1 receptor agonists, which mimic the GLP-1 hormone’s actions in the body. Note that Ozempic itself is the brand name of the drug semaglutide and was approved by the FDA specifically to treat diabetes; the weight loss equivalent, called Wegovy, uses the same active ingredient. Other drugs in this class include Trulicity (dulaglutide), and Victoza or Saxenda (liraglutide). Another related drug, tirzepatide (sold under brand names Mounjaro for diabetes and Zepbound for weight loss), activates two different receptors, GIP and GLP-1.
Can Ozempic Help Psoriatic Arthritis?
Physicians know that weight loss, whether via diet and exercise or GLP-1 drugs, is helpful for overweight or obese people with psoriatic arthritis. In a small study on the effects of weight loss (from diet) on psoriatic arthritis, published in Arthritis Research & Therapy, researchers tracked BMI, inflammatory markers, disease activity, and other PsA scores. The median amount of weight lost was 41 pounds, or 18.6% of baseline weight, and most of the disease parameters showed significant improvement. The percentage of people achieving minimal disease activity (a common treatment target when at least five of seven goals are met), almost doubled, to 54%.
Carrying around extra body fat also has an impact on how you respond to PsA treatment: In another large review of research, published in PLOS One, researchers reviewed 54 studies (encompassing 19,372 patients), and found that every one point increase in body mass index (BMI) above normal (25 kg/m2 or less)—for example, going from 28 to 29 kg/m2— corresponded with a 6.5% increase in not responding to certain biologic medications for PsA.
“Weight loss is associated with improved disease activity in different types of inflammatory arthritis, including psoriatic arthritis,” Dr. Vina says. “Previous clinical studies demonstrated that these medicines could improve psoriasis.” However, he notes, none of the studies reported on psoriatic arthritis outcomes specifically. “There is no strong evidence that GLP-1 agonists can directly treat inflammatory arthritis such as psoriatic arthritis.” That means while these drugs may help indirectly through weight loss, it’s not clear if they can affect the underlying disease mechanism itself.
However, more doctors are continuing to find favour with GLP-1s for the people they treat with psoriatic arthritis, largely because of the role they can play in helping to both modify the severity of the disease and therefore the amount of medication needed to treat it. “Patients’ requirement for DMARDS (disease-modifying anti-rheumatic drugs, which are a foundational part of PsA treatment) is lower, they can move better, and they’re more active,” observes Anca Askanase, M.D., M.P.H., a rheumatologist and a professor of medicine at Columbia University Irving Medical Center in New York City. “It might just be due to the weight loss, but we know fat is pro-inflammatory, so there may be additional mechanisms as well. We don’t know. For psoriatic arthritis, the data [for GLP-1’s] isn’t as robust as we’d like yet. There are some trials but the numbers are still small.”
For example, a review of research published in 2024 in the Journal of Clinical Rheumatology looked at GLP-1 use in people with various rheumatic disorders. While outcomes for psoriatic arthritis were limited, according to researchers, in the majority of clinical studies with psoriasis, people saw improvements in the Psoriasis Area and Severity Index, a scoring system that includes scaling, redness and swelling, and skin thickness/hardening.
The medications may also make a difference in certain comorbidities, including metabolic syndrome. This combination of high blood pressure, high cholesterol, high blood sugar, and/or excess weight increases the risk of being diagnosed with psoriatic arthritis, according to a 2024 review published in Therapeutic Advances in Musculoskeletal Disease. In addition, people with psoriatic arthritis who also had metabolic syndrome reported worse joint problems and a reduced response to treatment, and many drugs used to treat PsA can potentially worsen metabolic syndrome. But research has shown that losing weight through GLP-1s (along with exercise) can also do much to reduce the severity of metabolic syndrome.
In the meantime, researchers predict that the health benefits of using GLP-1s will continue to expand. One large recent study done by Dr. Al-Aly and others published in Nature Medicine mapped the association between GLP-1 use and 175 different health conditions in close to 216,000 GLP-1 users (and almost 2 million controls who weren’t using GLP-1’s but who were being treated for diabetes at the VA). While they didn’t look at psoriatic arthritis in particular, they found that GLP-1 use was associated with a reduced risk of dozens of health outcomes, including clotting and cardiometabolic disorders, infectious illnesses, substance use and psychotic disorders, and neurocognitive disorders, such as dementia, among other conditions. There was a slightly reduced risk of rheumatoid arthritis and systemic lupus erythematosus (a.k.a. lupus), both rheumatic disorders, in people who took GLP-1’s. “When we saw the breadth of the effects of these medications across organ systems, it was sort of an ‘a ha’ moment,” says Dr. Al-Aly, who adds there’s more research to be done here.
Should You Consider GLP-1s for Psoriatic Arthritis?
Despite the potential wins from using a GLP-1, there are question marks over whether it truly benefits someone with psoriatic arthritis. In Dr. Al-Aly’s analysis, GLP-1 use brought an increased risk of low blood pressure, gastrointestinal disorders, kidney stones, fainting, and—to his surprise—arthritis, specifically osteoarthritis and arthralgia (joint pain). “We went into it expecting the opposite,” he says. “We thought that losing a lot of weight would help people with these [joint] conditions feel better. Your knees don’t have to carry as much weight, but we found the opposite. One of the possibilities for this is people think they’re losing fat but they’re also losing muscle.” The muscle around a joint helps reduce pressure and provide stability; losing muscle can make joint pain worse. (That’s why so many weight-loss experts emphasize the importance of strength training while taking GLP-1s.)
Like any medication, there are side effects and risks associated with Ozempic and other GLP-1s. The most common of these are gastrointestinal complaints, including:
Bloating
Constipation
Diarrhoea
Gas
Heartburn
Nausea
Vomiting
Still, if you’re overweight or obese and have psoriatic arthritis, taking Ozempic or a similar drug could improve your condition, doctors say. “Across the board of rheumatic diseases, in the patients I take care of, I’m seeing improvements,” says Dr. Askanase. “Not to the point where I feel like I can remove DMARDs but maybe we can lower the dose.” Of course, if the reason you can lower your DMARD dose is due to GLP-1s, that means you are essentially swapping one drug for another.
If you are interested in starting the medication, you’ll probably have to ask your primary care doc or endocrinologist for a prescription, although it’s important to tell your rheumatologist if you plan to take GLP-1s.
Who Shouldn't Take Ozempic?
Besides anyone who’s pregnant, people who have pancreatic problems or kidney disease should avoid GLP-1’s, according to the Cleveland Clinic. In addition, people with diabetes-related retinopathy, an eye condition, should skip it as well. Having a history (personal or family) of a certain type of thyroid cancer called medullary thyroid carcinoma or certain endocrine problems are red flags. Inform your doctor about your complete health picture (and family history) before starting the medication.
Bottom Line
Ozempic and other GLP-1 medications are wildly popular, but there’s still a lot that experts don’t know. On the one hand, these medications have been shown to help people lose weight, which can be helpful if you have psoriatic arthritis and are carrying excess pounds. However, they do come with side effects. “It all comes down to risk-benefit,” says Dr. Askanase. Always tell your rheumatologist if you’re taking any medications, including GLP-1s, and closely monitor how the drug may be affecting your psoriatic arthritis symptoms.
