MTX primarily acts by inhibiting dihydrofolate reductase (DHFR), which catalyzes the sequential conversion of folic acid to dihydrofolate (DHF) and tetrahydrofolate (THF)

Physiologically, GLP-1 medications: - enhance glucose-dependent insulin secretion - suppress inappropriate glucagon release - slow gastric emptying - act on central appetite pathways to increase satiety These combined effects improve metabolic efficiency, which is why weight loss is often a secondary outcome rather than the sole therapeutic mechanism. GLP-1 Benefits Go Far Beyond the Scale While weight reduction is often the most visible result, research shows GLP-1 therapy can significantly improve: - insulin resistance - visceral adiposity - systemic inflammation - cardiometabolic risk markers This is why GLP-1s are now being studied as disease-modifying agents, not simply weight loss tools. Cardiovascular Benefits: A Paradigm Shift The landmark SELECT trial demonstrated that semaglutide significantly reduced major adverse cardiovascular events (MACE) in patients with overweight or obesity and established cardiovascular diseaseeven in the absence of diabetes. This finding reshaped clinical thinking by confirming that treating obesity itself reduces cardiovascular risk, independent of glucose status

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BCL-2 and glutathione: alterations in cellular redox state that regulate apoptosis sensitivity
The goal is not to hit the tendon itself, which could cause more damage, but to saturate the surrounding tissue