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It works through a completely different mechanism, stimulating norepinephrine release to suppress appetite

4.4 Interactions between cartilage and synovium 4.4.1 Interplay between cytokines released by chondrocytes and synovial cells When cartilage is damaged, chondrocytes release proteoglycan fragments, type II collagen fragments, and diverse injury-associated factors that synovial cell surface pattern recognition receptors (PRRs) can detect, prompting synovial hyperplasia and proinflammatory cytokine secretion (139)

Additionally, metabolic adaptationsincluding improved insulin sensitivitydevelop over time with continued exposure to the medication

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