From the Guidelines
Leg and knee pain after stopping Wegovy (semaglutide) is unlikely to be directly related to discontinuation, and the patient should be evaluated for other causes of joint pain. The patient's symptoms could be related to the rapid weight loss experienced while on Wegovy, which can sometimes unmask underlying joint issues or change biomechanics 1. A thorough physical examination focusing on the lower extremities, basic blood tests including complete blood count, comprehensive metabolic panel, inflammatory markers (ESR, CRP), and possibly rheumatoid factor and anti-CCP antibodies if autoimmune conditions are suspected, should be performed. Imaging studies like X-rays of the affected joints may also be appropriate. Some key points to consider in the workup include:
- Evaluating the patient's weight loss history and its potential impact on joint health 1
- Assessing for any underlying conditions that may have been unmasked or exacerbated by the weight loss 1
- Considering the potential benefits and risks of resuming Wegovy or other weight management pharmacotherapy 1 For immediate symptom relief, acetaminophen or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) may help if not contraindicated, and physical therapy might also be beneficial 1. The patient should be advised to resume Wegovy only under medical supervision, as the pain is unlikely to be a direct withdrawal effect but could be related to weight changes or an unrelated condition that emerged coincidentally 1.
From the Research
Possible Causes of Leg and Knee Pain
- The patient's complaint of leg and knee pain could be related to various conditions, including medial tibial stress syndrome, tibial bone stress injury, chronic exertional compartment syndrome, arterial endofibrosis, popliteal artery entrapment syndrome, and entrapment of the common peroneal, superficial peroneal, and saphenous nerves 2.
- Other possible causes of knee pain include osteoarthritis (OA), patellofemoral pain, and meniscal tears, which are among the most common causes of knee pain 3.
- The patient's age, activity level, and medical history can help narrow down the possible causes of knee pain, with osteoarthritis being more common in older adults and patellofemoral pain being more common in younger, physically active individuals 3, 4.
Workup for Knee Pain
- A thorough history and physical examination are essential in evaluating knee pain, including assessing for morning stiffness, anterior knee pain during squatting, and joint line tenderness 3, 5.
- The McMurray test and radiographic imaging may be useful in diagnosing meniscal tears and osteoarthritis, respectively 3.
- A systematic approach to evaluating knee pain can help primary care physicians make the correct diagnosis and formulate an appropriate therapeutic strategy for patients 5.
Relation to Wegovy
- There is no direct evidence in the provided studies to suggest a link between Wegovy and leg or knee pain.
- However, it is possible that the patient's symptoms may be unrelated to Wegovy or may be a result of an underlying condition that was exacerbated by the medication. Further evaluation and investigation are necessary to determine the cause of the patient's symptoms.