Lack of dietetic access in rheumatology a growing issue

The ongoing lack of dietetics for rheumatology needs to be addressed as a priority, particularly with the advent of GLP-1 agonists and the impact of excess weight on rheumatic conditions, the Irish Society for Rheumatology (ISR) 2026 Spring Meeting heard.

In a presentation on the dietetic perspective on GLP-1 agonists and their role in managing rheumatological conditions, Ms Aveline O’Neill, Clinical Dietitian, University Hospital Waterford, discussed their increasing usage in the population.

She noted that excess weight is a major public health issue and a key cause of osteoarthritis and joint replacements.

In addition, there are a number of factors that can lead to weight gain in rheumatology patients. They include the fact that pain and joint stiffness reduce activity levels and certain medications, such as corticosteroids, some biologics, and psychiatric drugs, are associated with increased weight.

Ms O’Neill outlined data from recent studies on GLP-1 agonists in various rheumatic conditions such as rheumatoid arthritis, psoriatic arthritis, lupus, and osteoarthritis.

The studies showed, as well as significant weight loss, improvements in disease severity and pain/symptom scores, and even a reduction in the need for some medications for the rheumatic conditions. However, these medications have various dietetic considerations, including potential gastrointestinal side-effects, risk of micronutrient deficiencies, sarcopaenic obesity, and osteoporosis.

She pointed out that despite the obvious need, EULAR guidelines advising the support of weight loss/maintenance in osteoarthritis, and the HSE Model of Care for Rheumatology stating that there should be access to a senior dietitian for every 300,000 population, translating into 18 posts for Ireland, there remains a lack of such public health services in Ireland.

Several rheumatologists in the audience commented on the lack of dietetic services for rheumatology in Ireland and the need to advocate for them.

There was a discussion on whether rheumatology should be prescribing GLP-1 agonists given the benefits to many arthritis patients regarding the impact of excess weight on joints and emerging evidence on their impact on inflammation and thus improving arthritis symptoms.

One ISR audience member said that some rheumatologists are already prescribing them for their patients and that specific guidance and clinical research is needed for the specialty.

Speaking to the Medical Independent following Ms O’Neill’s presentation, ISR President Dr Andrew Cairns said the situation in Northern Ireland is “very similar” regarding a lack of dietetics for rheumatology.

He said that GLP-1 drugs, in line with the emerging evidence of their benefit in conditions like osteoarthritis, will likely become a part of rheumatology practice in the near future, and thus the appropriate support structures and guidance need to be put in place.