Saxenda (liraglutide 3.0 mg) is a GLP-1 receptor agonist licensed in the UK for weight management in adults with obesity or those overweight with weight-related conditions. For people with rheumatoid arthritis (RA), excess weight can worsen joint symptoms and inflammation, making weight management particularly important. Whilst there is no contraindication preventing Saxenda use in RA, the decision requires careful assessment of disease control, current medications, and realistic physical activity goals. This article examines the evidence, potential benefits, safety considerations, and practical aspects of using Saxenda when you have rheumatoid arthritis.

Understanding Saxenda and Its Primary Use

Saxenda (liraglutide 3.0 mg) is a prescription medicine licensed in the UK for weight management in adults with obesity or those who are overweight with weight-related health conditions. It also has a UK/EU licence for adolescents with obesity. Saxenda belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists, which were originally developed for treating type 2 diabetes.

The mechanism of action involves mimicking a naturally occurring hormone called GLP-1, which is released after eating. Saxenda works by:

• Slowing gastric emptying, which helps you feel fuller for longer after meals

• Reducing appetite by acting on areas of the brain that regulate hunger

• Improving blood sugar control through effects on insulin and glucagon secretion

Saxenda is administered as a once-daily subcutaneous injection, typically starting at a low dose (0.6 mg) and gradually increasing over five weeks to the maintenance dose of 3.0 mg daily. This gradual titration helps minimise gastrointestinal side effects, which are common when starting treatment.

The medication is intended to be used alongside a reduced-calorie diet and increased physical activity. Per the UK SmPC, Saxenda should be discontinued if less than 5% weight loss is achieved after 12 weeks on the 3.0 mg dose (or maximum tolerated dose). It is not a standalone solution but rather one component of a comprehensive weight management programme.

In the NHS, Saxenda is usually initiated within specialist weight-management services, subject to local commissioning arrangements. Concomitant use with other GLP-1 receptor agonists or other weight-loss medicines is not recommended. It's also worth noting that the slowed gastric emptying effect can affect the absorption of some oral medicines, which may require monitoring.

Rheumatoid Arthritis: Overview and Weight Considerations

Rheumatoid arthritis (RA) is a chronic autoimmune condition characterised by inflammation of the joints, causing pain, swelling, stiffness, and progressive joint damage. The condition affects approximately 400,000 people in the UK and can significantly impact quality of life, mobility, and overall health.

The relationship between body weight and rheumatoid arthritis is complex and bidirectional. Research suggests that:

• Excess weight can worsen RA symptoms by placing additional mechanical stress on already inflamed joints, particularly weight-bearing joints such as knees, hips, and ankles

• Adipose tissue produces pro-inflammatory cytokines, which may contribute to systemic inflammation and potentially exacerbate disease activity

• Obesity may be associated with reduced response to certain disease-modifying antirheumatic drugs (DMARDs) and biologic therapies

• Physical limitations from RA can make exercise challenging, potentially contributing to weight gain and creating a difficult cycle

Some people with RA experience unintentional weight loss, particularly during active disease flares or due to medication side effects. Unexplained or unintentional weight loss warrants clinical review. However, overweight and obesity remain significant concerns in the RA population.

Weight management in RA presents unique challenges. Joint pain and reduced mobility can limit exercise capacity, whilst some medications (particularly corticosteroids) may promote weight gain. NICE guidelines for RA management (NG100) acknowledge the importance of addressing modifiable risk factors, including obesity, as part of comprehensive care. Achieving and maintaining a healthy weight may help reduce joint stress, potentially improve medication efficacy, and decrease cardiovascular risk, which is already elevated in people with RA.

Can Saxenda Be Used in People with Rheumatoid Arthritis?

There is no official contraindication preventing people with rheumatoid arthritis from using Saxenda for weight management. According to the UK SmPC, the presence of RA itself does not exclude someone from being prescribed liraglutide, provided they meet the standard eligibility criteria for the medication and do not have other contraindications.

The standard eligibility criteria for Saxenda in the UK include:

• A body mass index (BMI) of 30 kg/m² or above (obesity), or

• A BMI of 27 kg/m² or above (overweight) with at least one weight-related comorbidity such as type 2 diabetes, hypertension, or dyslipidaemia

• Commitment to a reduced-calorie diet and increased physical activity programme

People with rheumatoid arthritis who meet these criteria may be considered for Saxenda treatment. However, the decision requires individualised assessment by a healthcare professional who can evaluate:

• The severity and current control of the RA

• Current medications and potential drug interactions

• Presence of other health conditions

• Realistic expectations regarding physical activity modifications

• Overall suitability for weight management intervention

• Manual dexterity and ability to self-inject (with training or support devices if needed)

It is important to note that clinical trial data specifically examining Saxenda use in people with RA is limited. Most studies of liraglutide for weight management have not specifically focused on this population, though people with various chronic conditions were included in broader trials.

If you take warfarin, your INR (blood clotting test) should be monitored when starting Saxenda, as the slowed gastric emptying may affect warfarin absorption. Similarly, the absorption of other oral medicines might be affected, which should be reviewed by your healthcare team.

Potential Benefits and Risks of Saxenda in Rheumatoid Arthritis

For people with rheumatoid arthritis who are overweight or obese, successful weight loss with Saxenda may offer several potential benefits:

Potential benefits may include:

• Reduced mechanical stress on weight-bearing joints, potentially decreasing pain and improving mobility

• Potential improvement in inflammatory markers, as weight loss may be associated with reduced systemic inflammation

• Possibly enhanced response to RA medications, as some studies suggest obesity may affect efficacy of some DMARDs and biologics

• Better cardiovascular health, addressing the elevated cardiovascular risk in RA

• Improved glucose metabolism, particularly relevant as RA and corticosteroid use can increase diabetes risk

• Increased ability to engage in physical activity, creating a positive cycle of improved fitness and weight management

However, there are also important considerations and potential risks to be aware of:

Common side effects of Saxenda that may be particularly relevant in RA include:

• Gastrointestinal symptoms – nausea (very common, affecting >1 in 10 people), vomiting, diarrhoea, constipation (common, affecting up to 1 in 10 people)

• Injection site reactions (common), which might be challenging for those with joint inflammation or limited dexterity

• Fatigue (common), which may compound existing RA-related tiredness

• Small increases in resting heart rate (average 2-3 beats per minute)

Specific concerns in the RA context include the potential challenge of meeting the physical activity requirements when joint pain and stiffness limit mobility. Whilst Saxenda can facilitate weight loss through appetite reduction, optimal outcomes are achieved when combined with increased activity. Healthcare teams should work with patients to develop realistic, joint-friendly exercise programmes that accommodate RA limitations, such as swimming, water aerobics, or gentle resistance training.

If you have diabetes and take insulin or sulfonylureas, there is an increased risk of hypoglycaemia when adding Saxenda, and dose adjustments of these medications may be needed.

There is currently no evidence suggesting that Saxenda directly affects RA disease activity or interferes with common RA medications such as methotrexate, hydroxychloroquine, or biologic agents. However, comprehensive medication reviews remain essential.

Important Safety Considerations and Contraindications

Before starting Saxenda, people with rheumatoid arthritis should be aware of absolute contraindications that apply to all potential users:

• Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)

• Hypersensitivity to liraglutide or any excipients

• Pregnancy and breastfeeding – Saxenda must be discontinued if pregnancy occurs

Conditions requiring careful assessment include:

• Inflammatory bowel disease or diabetic gastroparesis, as Saxenda slows gastric emptying

• History of pancreatitis – liraglutide has been associated with acute pancreatitis in rare cases

• Severe renal or hepatic impairment – limited data exists for these populations

• Heart failure – limited experience in NYHA class I-III; no experience in class IV

Monitoring requirements during Saxenda treatment include:

• Regular weight and BMI measurements

• Assessment of treatment response – discontinue if less than 5% weight loss after 12 weeks on 3.0 mg (or maximum tolerated dose)

• Monitoring for signs of pancreatitis (persistent severe abdominal pain)

• Awareness of gallbladder disease symptoms (substantial weight loss increases gallstone risk)

• Blood glucose monitoring if diabetic or at risk

• INR monitoring if taking warfarin

Important safety advice for patients:

Contact your GP or healthcare team immediately if you experience:

• Severe, persistent abdominal pain (potentially radiating to the back) – stop Saxenda and seek urgent medical attention if pancreatitis is suspected

• Signs of allergic reaction (rash, swelling, difficulty breathing)

• Symptoms of thyroid tumours (lump in neck, hoarseness, difficulty swallowing)

• Severe or persistent vomiting or diarrhoea leading to dehydration

• Thoughts of self-harm or suicide (rare but reported)

Rotate injection sites to reduce local reactions. If you experience palpitations or rapid heartbeat that persist or are associated with other symptoms, seek medical advice.

For people with RA taking corticosteroids, it is worth noting that weight loss may allow for dose reduction in some cases, potentially reducing steroid-related side effects. However, any changes to RA medications should only be made under specialist rheumatology supervision.

Report any suspected side effects to the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or via the Yellow Card app).

Consulting Your Healthcare Team: Making an Informed Decision

The decision to use Saxenda when you have rheumatoid arthritis should be made collaboratively with your healthcare team, ideally involving both your GP or weight management specialist and your rheumatologist. This multidisciplinary approach ensures that all aspects of your health are considered.

Questions to discuss with your healthcare team:

• Is my RA sufficiently controlled to undertake a weight management programme?

• Are there any interactions between Saxenda and my current RA medications?

• What realistic physical activity goals can I set given my joint limitations?

• How will we monitor both my weight loss progress and RA disease activity?

• What support is available to help me succeed with dietary changes?

• Are there alternative weight management options I should consider?

• Do I have the dexterity to self-inject, or would I need support or training?

Preparing for your appointment:

• Keep a record of your current weight, any recent weight changes, and previous weight loss attempts

• List all medications, including over-the-counter drugs and supplements

• Note any concerns about side effects or practical aspects of daily injections

• Consider your readiness to commit to dietary changes and adapted physical activity

Your healthcare team will assess whether Saxenda is appropriate by considering your individual circumstances, including RA severity, current treatment regimen, other health conditions, and realistic treatment goals. They should provide clear information about expected outcomes, potential side effects, and the commitment required.

In the NHS, access to Saxenda is usually via specialist (Tier 3/4) weight-management services and may be subject to local funding policies. NICE quality standards (QS127) recommend that specialist obesity services should be available for people with complex needs, which may include those with significant comorbidities like RA.

Remember that Saxenda is not suitable for everyone, and there may be alternative approaches to weight management that better suit your individual situation. These might include structured dietary programmes, physiotherapy-led exercise interventions, or psychological support for eating behaviours. The goal is to find a safe, effective, and sustainable approach to achieving a healthier weight whilst managing your rheumatoid arthritis effectively.

For additional support, consider resources from the NHS weight management programmes and organisations like Versus Arthritis, which offer guidance on joint-friendly physical activity.

Frequently Asked Questions