Skip to Accessibility Tools Skip to Content Skip to Footer
Take a Pill, Gain a Pound

Take a Pill, Gain a Pound

There is a lot of discussion of obesity and rheumatoid arthritis (including many great articles on this site). But I am given to wonder, which came first – the RA or the weight? Or specifically, how much are the medications I’m taking for my RA contributing to my weight gain and/or preventing me from losing the excess pounds?

While I am a decade older now than I was when I was diagnosed, I am also at least 25 pounds heavier – in spite of ongoing efforts to get to a healthier weight and maintain it. This resistance to shedding excess bulk seems to have solidified the past year. As I tried to figure out what has been going on, I noticed a direct link with my RA treatment. There are three main culprits in my life.

Steroids

I’ve written before about my love/hate relationship with prednisone and related steroids. My rheumatologist trusts me with a prednisone prescription that she knows that I will use sparingly when needed to calm (or ward off) a flare, or when I get close to my next infusion and the last treatment is obviously wearing off. One of the reasons for the “hate” in the love/hate relationship is that prednisone puts on the pounds. Prednisone is in a class of drugs called glucocorticoids. Among the many effects of these medications is they affect the levels of glucose in the body which, in turn, has a direct impact on weight. If I take 5 mg. of prednisone a day for five days, I will literally gain five pounds. And the pounds don’t disappear when I stop taking the drug.

Lyrica and Gabapentin

I first took Lyrica to help treat nerve pain while I was recovering from spinal fusion surgery. I switched to gabapentin, a similar but generic drug when my insurance would no longer cover Lyrica. One of the things I discovered is that I slept really, really well when I was taking either of these medications. Since sleep disturbance is a major issue for me, I talked to my rheumatologist who approved my continued use of gabapentin at night to help me sleep. At first, I took it every night. After the first couple of weeks, I noticed that even though I was walking four miles most days and watching my diet, I was gaining weight. Research revealed that both Lyrica and gabapentin have weight gain as a listed side effect. I stopped taking gabapentin and the pounds started once again to drop. I still take gabapentin once or twice a week – usually after several nights of not getting a decent night’s sleep. If I take it more than that, I see the numbers on my scale rise.

TNF Inhibitors

TNF Inhibitors are the most established biologics for RA. They include Enbrel, Remicade, Humira, Cimzia and Simponi and additionally include the recently approved biosimilars Cyltezo, Amjevita, Renflexis, Inflectra, and Erelzi (some of which are not yet available in the U.S.). While I haven’t been prescribed any of the biosimilars, I’ve been on all of the original “reference” TNF medications and am currently on the infused version of Simponi, Simponi Aria. While I was able to take off 25 pounds the year before I started Simponi (when I was on Actemra, an IL-6 inhibitor), my attempts at weight loss since going back on a TNF inhibitor have been stalled. The National Institute of Health reports a study of psoriasis patients who gained weight being treated with TNF inhibitors as opposed to patients who were treated with other therapies. While RA patients were not specifically studied, it’s not much of a stretch to assume the weight gain effects of the drugs would be similar.

I’m pretty good at overcoming all kinds of obstacles, including those associated with RA (and the related insurance, medical, disability, and other issues). However, I have to admit that this one has me stumped. The implications of not treating RA are substantial (and not good). However, being overweight has its own multitude of health concerns – including the fact that it can contribute to RA symptoms.

The answer? Time to talk to my doctor.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Cyd
    10 months ago

    Well count me in!! My first rheumatologist, the one who diagnosed me 4 years ago had me on a maintenance dose of 10 mgs. of prednisone – after a roughly 25mgs, two-week (?) step-down series. What do I know?? It made sense to me. When I was forced to switch rheumys due to changing insurance, the new (and current) doc., was surprised & unhappy that I had been on prednisone for so long (I’m also on dmards and a biologic). So she slowly weaned me off of it only to end up deciding to keep me at 6mgs. daily as I haven’t shown any improvement and we have not yet found the right cocktail to put me in remission (I’m on my 3rd biologic). My weight gain over the last 4+ years is 35 pounds!! It’s horrible. I do exercise; however, since my less-than-supportive husband recently “informed” me that what I do isn’t “real” exercise (what the hell?) I have a type of stationary bike – approved by the Arthritis Foundation – on which I can pedal, but then easily can turn the vertical bar on which the pedals and hand grips are mounted so that I can then pedal with my hands; I “ride my bike” for 20-30 minutes, then turn the bar to pedal with my hands for about 10 minutes. Because I also have fibromyalgia, I do a series of stretching too. I was exercising 4-6 days a week, but he said I exaggerate and that I do it maybe 4-6 times every 2 weeks. Now I KNOW very well that what he says shouldn’t affect what I do, but since he poo-poo’d my efforts, I find myself not caring so much about doing it…so, whatever. Everything else aside, I’m happy to know that “it’s not just me.” But I too am sorry that you each must endure this additional struggle due to this damned disease. Hand in there!! My best to all of you for a rest-filled, pain-free weekend! And P.S – thanks for letting me vent;)

  • Dave
    10 months ago

    Thanks for sharing this article. I retired about 2 1/2 years ago after almost 50 uninterrupted years in the work-place and consequently had a lot more time on my hands than I had ever had. I went thru 3 or 4 rounds of Prednisone due to a series of flares. That and the free time lead to a lot of snacking which resulted in my gaining 30 pounds. I went for a Drs. appointment, got on the scales and was at 249 lbs. (At that weight I am not obese as I am 6’5″ tall.) That was the most that I had ever weighed in my life. Immediately I made a decision that I was NOT going to 250. Time to do something about this. I went home and told my wife not to make any more tea and cut out just about all processed sugar and reduced the amount of food that I was taking in. About 3 or 4 months later I had lost the 30 lbs that I had gained and I have kept it off. Prednisone has always made me gain weight but the 30 lbs slipped up one me. It won’t happen again!

  • Mary Sophia Hawks moderator
    10 months ago

    I too noticed weight gain with oral prednisone, as well as increased appetite and crankiness. When I have a flare now, I get a steroid shot. I don’t have those side effects from the shot. I am currently on Xeljanz, have switched to the keto diet and am losing weight.
    When it’s a struggle just to get out of bed, it’s hard to lose weight.
    MS

  • Monica Y. Sengupta moderator
    10 months ago

    That’s really interesting how your side effects are different between the oral meds and the shot. Just goes to show how people react differently to different things!

    I’m glad the combination of Xeljanz and the keto diet are working for you! The frustration of weight gain/loss is a major one amongst the RA community. Please know you are not alone! I thought you might like this article on this contributor’s journey with weight loss: https://rheumatoidarthritis.net/living/up-and-down-weight-loss-ra/

    All the best, Monica

  • happygirl
    10 months ago

    I couldn’t agree more with this article. I have steadily gained weight since being diagnosed with RA 7 years ago. I started with Mtx and Enbrel. The Mtx had a weight loss effect on me, but my dose was eventually lowered so the weight loss didn’t last. Also, I had a high liver enzyme test and my doc took me off of the Mtx. Since then I’ve been on Plaquenil, Celebrex, Humira etc. My biologic was just changed to Orencia, and I’m back on Mtx, so I’m hoping for the best. More recently, I’m exercising through my discomfort because I’ve become so weak from my lower activity level. What do you all think of Orencia?

  • Monica Y. Sengupta moderator
    10 months ago

    Hey happygirl!

    I personally have not experienced anxiety from Orencia but this study reported that two people did. Here is the link if you want more information: http://factmed.com/study-ORENCIA-causing-ANXIETY%20DISORDER.php

    This, of course, does not mean that your concerns are not valid so it’s important to bring up any new symptoms or concerns about the medication with your prescribing doctor. Have you started the Orencia yet?

    Please keep me updated!! All the best!

  • Monica Y. Sengupta moderator
    10 months ago

    Hey happygirl! Thanks for sharing! I personally am on Orencia and MTX and the combination has worked wonders for me. That being said, everyone responds differently to medications so I hope this combination also works for you!

    Here is a little more information on Orencia: https://rheumatoidarthritis.net/treatment/orencia-reviews-how-well-does-it-work/

    Best of luck and I hope you feel better! ~Monica

  • happygirl
    10 months ago

    Thank you! Have you experienced any anxiety with Orencia?

  • DenverMom
    10 months ago

    I am SO happy just to hear I am not alone in this weight struggle. When I was initially got very sick last year I was so bad the ER put me on 50mg of steroids a day for almost 2 weeks until I could get into a rheumatologist (there are far too few rheumy docs in Denver). Of course I ballooned. Now, having been on 3 or 4 courses of steroids over the past 12 months as well as starting Enbrel last fall, I’ve gained 35 lbs. I am 36 and was in very good shape before this. Not anymore. I walk daily but my knees won’t allow much more. I even did a juice/clean food cleanse for 4 days and lost less than a pound. When I talked to my Rheumy he just acted like there is nothing that could be done and he said “try not to gain any more”. So I mentioned it to my Endocronologist and she put me on a low dose of Phentermine (15mg) daily. I haven’t had any side effects at all but now, 3 weeks later, I’ve lost 6 pounds! I know this isn’t the answer for all of us with our many medical issues but I hope it may help others to weigh (no pun intended) the risks and benefits with their doctors. It has, so far, given me hope when I had none. Thanks all for being a voice and outlet for me this past year. Each time I read one of your stories I want to cry because I know I’m not alone in these struggles!! Xo

  • Monica Y. Sengupta moderator
    10 months ago

    Hey DenverMom! You are definitely not alone with the weight frustration and I am glad the Phentermine is working for you!

    The steroids for me plus the MTX and lower mobility all contributed to my weight gain so I try to stay active, like you! Tamara, one of the contributors on this site, recently wrote an article on her weight loss journey – I thought you might like it: https://rheumatoidarthritis.net/living/up-and-down-weight-loss-ra/

    Also, I wanted to touch on what you said about Denver rheumatologists. I used to go to school in Fort Collins (go RAMS!) and there was only one rheumatologist office there. I wasn’t thrilled with her but I mostly only went to the office for my infusions and saw my primary rheumatologist during breaks at home on the East Coast. I was very surprised to see there weren’t many rheumatologists in general but I wish there were so that we could get a second opinion or see another doctor!!

    All the best and thank you for sharing! ~Monica

  • cannonsplash
    10 months ago

    I knew that the Enbrel was causing weight gain, but couldn’t prove it. I walked daily, went to the gym regularly and ate healthy. When I stopped taking it 2 years ago, 20 extra pounds came off very easily and I’ve kept it off. Yeah, I’m still overweight, but feel so much more comfortable in my own skin.

  • Monica Y. Sengupta moderator
    10 months ago

    Ooh! Congrats, cannonsplash. I’m glad you’re feeling better and more confident!! All the best, Monica

  • Wren moderator
    10 months ago

    I’ve never taken steroids, but I do take gabapentin, and I’ve taken two of the TNF inhibitors. And I take other DMARDs, which may or may not include weight gain as a side effect. Under RA treatment over the years I’ve gained more than 30 extremely stubborn pounds. Add that to increasing age, menopause, and an admittedly less-than-physically-vigorous lifestyle, and here I am, unhappy with my obesity but frustrated with my inability to slim back down.
    You’ve hit a really sore point for many of us, Carla. Thanks for writing this article. It’s at least a little comfort to know that being tubby isn’t *totally* because we occasionally overindulge.

  • Lawrence 'rick' Phillips
    10 months ago

    I suggest. Ahh heck I have no suggestions. Good luck Carla. Many blessings.

  • DParker
    10 months ago

    I am on Simponi Aria for several years. In 2016 I went on a low carb ketogenic diet and I lost 50 pounds. I was also feeling wonderful and definitely in remission. Unfortunately I have gained 30 back since August a year ago. Mostly due to cheating and thinking oh one little ice cream won’t hurt me. I sit here in pain, with a Barbie pink cast on my left hand/arm because RA ate my cartilage in my thumb joint and I had surgery to get it replaced. He also scraped a bunch of arthritis nodules off the bones while he was in there.
    My point being that it is possible to lose weight while on a biologic. It came back quickly going off and eating carbs again. I need to get back where I was 30 pounds ago. I worked out, used an arthritis pool and I could not believe how much better everything felt.

  • Poll