Obesity and musculoskeletal pain: possibilities of pharmacotherapy. A narrative overview

Overweight and obesity — one of the fundamental factors determining the development of chronic musculoskeletal pain (MSP). The role of adipose tissue in chronic MSP pathogenesis is determined not only by increased mechanical load on the musculoskeletal system elements, but also by systemic inflammation, which is associated with hypoxia and necrobiotic changes of adipocytes. In addition, the latter produce a wide range of anti-inflammatory hormones — adipokines (leptin, lipocalin, resistin, visfatin, chemerin and others), capable of participating in chronic inflammation and development of degenerative processes in joints, tendons and entheses. Significance of obesity is clearly defined for osteoarthritis (OA). The association of this disease and metabolic disorders allows many experts to emphasize the metabolic phenotype of OA. Consequently, weight control should be considered as one of the essential elements for management of patients with chronic MSP, especially when it comes to OA. Recently, a great interest of scientists and medical practitioners has been fixed on the drugs from the group of glucagon-like peptide-1 receptor agonists. These drugs are used for treatment of type II diabetes mellitus and have high therapeutic potential for obesity treatment. Semaglutide (SGT) is one of the most popular members of this group. Its effectiveness for the treatment of obesity has been proven by a series of large-scale studies and corresponding meta-analyses: mean weight loss after SGT course is 11.5 kg, probability of body mass reduction ≥10% in presence of active therapy 4.5 times higher than on placebo. Recently, there have been works confirming the effectiveness of SGT for OA treatment. There is also evidence that long-term use of GLP-1 receptor agonists can slow the development of OA and reduce the need for endoprosthetics in affected joints. Considering that weight loss is a time consuming process, it is advisable to combine CGT and slow-acting symptomatic drugs, SASD (SYSADOA) in the treatment of patients with OA and obesity. For example, the course of injectable SASD, namely Ambene Bio reduces joint pain by at least a third after 20 days. It is important to note that this drug is characterized by good tolerability and can be used in the presence of pronounced comorbid pathology, which consistently accompanies the phenotype of OA associated with overweight and obesity.