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Nonbiologic DMARDs exert their effects by relatively nonspecific immunosuppressive, antiinflammatory and cytotoxic mechanisms

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By lowering insulin levels, they can help reduce excess androgen production, which in turn may regulate menstrual cycles, decrease acne, and lessen unwanted hair growth

maintaining hydration is important Common side effects (affecting up to 1 in 10 people): Vomiting Constipation Due to slowed gastric emptying Abdominal pain or discomfort Reduced appetite This is partly how the medication aids blood glucose control Indigestion or acid reflux Fatigue or dizziness Hypoglycaemia (low blood sugar) Particularly when used with other diabetes medications such as sulphonylureas or insulin Gallbladder problems Including gallstones When to seek medical advice: Contact your GP or diabetes team promptly if you experience: Severe, persistent abdominal pain particularly if radiating to the back, as this could indicate pancreatitis (rare but serious)

Semaglutide targets GLP-1 receptors to control appetite and blood sugar, while tirzepatide targets both GLP-1 and GIP receptors

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