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When initial therapy proves insufficient, treatment escalation includes: Biologic DMARDs targeting specific inflammatory pathways (TNF inhibitors, IL-6 inhibitors, T-cell costimulation blockers, B-cell depleting agents) Targeted synthetic DMARDs such as JAK inhibitors (tofacitinib, baricitinib, upadacitinib), which carry FDA boxed warnings for serious cardiovascular events, malignancy, and thrombosis [24] [25] Combination DMARD therapy Short-term glucocorticoids for symptom control during treatment initiation Before starting biologic or targeted synthetic DMARDs, screening for tuberculosis and hepatitis B is recommended, along with appropriate vaccinations according to ACR guidelines
Muscle is one of the key regulators of metabolism, so losing it during weight loss can significantly impact long term health outcomes
What to Expect in Month 1 Appetite changes: Noticeable suppression begins week 3-4 for most Mild nausea: 40% experience some nausea, usually mild Injection site reactions: Redness, itching, or mild pain at injection site (14% of patients) Fatigue: Some patients report low energy as body adjusts Bowel changes: Either constipation or looser stools as medication affects gut motility 4 Essential Strategies for Month 1 1
But for most, he says, there's an element of negative reinforcement
GLP-1 side effects do not have to be completely gone by month 3, although nausea, vomiting, or diarrhea may decrease over time in patients who tolerate treatment
