October 08, 2025
3 min read
Key takeaways:
- GLP-1 receptor agonists may have utility in managing obese or overweight patients with psoriatic arthritis.
- Education about types of pain can benefit patients with PsA and fibromyalgia or central sensitization.
HUNTINGTON BEACH, Calif. — Addressing obesity and fibromyalgia are essential components to managing the most complex patients with psoriatic arthritis, according to a presenter at the 2025 Congress of Clinical Rheumatology-West.
“What we are trying to do is address the really problematic patients you see in your practices,” said Philip J. Mease, MD, of Swedish Medical Center and the University of Washington, in Seattle.
“It takes a team of people to take care of psoriatic arthritis patients,” Philip J. Mease, MD, said. Image: Jason Laday | Healio Rheumatology.
Obesity and concomitant fibromyalgia are two factors that can exacerbate PsA, according to Mease.
“We need to acknowledge that some patients may have persistent pain and fatigue because of factors other than purely immunologic inflammation,” he said.
Obesity is a risk factor for developing PsA, he added.
“If you have psoriasis, obesity may increase the likelihood of developing PsA,” Mease said. “Also, patients with PsA who are obese have more severe disease.”
Managing obesity starts with common sense approaches, according to Mease.
“Of course, we emphasize a good diet, exercise and good sleep,” he said. “These are all mom-and-apple-pie strategies. These are foundational ways of treating obesity.”
Meanwhile, the emergence of GLP-1 receptor agonists has provided a whole new level of treatment for this patient population. Mease urged rheumatologists to familiarize themselves with these medications.
“Whether we like it or not, we as rheumatologists will be in the position of prescribing these medications or working closely with weight loss management to coordinate care for our patients who are on these types of medications,” he said.
An important consideration is that high doses of GLP-1 receptor agonists that lead to rapid weight loss can lead to adverse events, according to Mease. He added that patients who lose too much weight too quickly often put the weight back on as soon as they stop the medications. He advised starting at a low dose and titrating upward.
Regarding fibromyalgia and central sensitization, Mease suggested that as many as 20% of individuals with rheumatic diseases will experience some form of this complication.
“Patients who have concomitant fibro are much more severe in their various disease measures,” he said. “This makes it less likely for them to reach targets for disease activity, regardless of the therapeutic interventions they are using.”
Treatment starts with communication, according to Mease.
“What we do in our practice is treat the underlying PsA, of course, but we also think about what we can do with central sensitization, including talking frankly with the patient about it,” he said.
Some patients will resist this conversation and reject the idea of having fibromyalgia or central sensitization, Mease added.
“Most of the time, though, I find that patients appreciate that we are trying to educate them that there may be different types of pain or reasons for the fatigue they are experiencing,” he said.
Patients who are receptive to the conversation may also be receptive to the potential value of using non-pharmacologic approaches like yoga or meditation, or non-rheumatic medications like serotonin-norepinephrine reuptake inhibitors.
In fact, many patients with PsA will need two or more therapies to manage not just their disease, but the comorbidities that come with it, according to Mease.
“Payers need to know that sometimes dual therapy is going to be needed,” he said. “It is important for the FDA to know this is an unmet need.”
Ultimately, rheumatologists should continue to be open to working with other specialists to manage all the complexities that may come with PsA.
“It takes a team of people to take care of psoriatic arthritis patients,” Mease said. “We are going to be working with psychologists, psychiatrists, physical therapists, orthopedists, we are going to be working with weight management specialists, and so on. You have a Rolodex of people who you trust and who you can call.”
For more information:
Philip J. Mease, MD, can be reached at rheumatology@healio.com.
Sources/Disclosures
Source:
Mease PJ. Update in Psoriatic Arthritis. Presented at The Congress of Clinical Rheumatology West; Sept. 18-21, 2025; (hybrid meeting).
Disclosures:
Mease reports receiving grants, consulting fees and/or speaking fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Genentech, Gilead, Janssen, Novartis, Pfizer, SUN and UCB.
