Friday, 10 Apr 2020

You are here

Bariatric Surgery Improves Rheumatoid Activity

Obesity is a risk factor for the onset of rheumatoid arthritis (RA) and may also an impediment to optimal DMARD and biologic responses.  A new study has shown that after 1 year, obese RA patients undergoing bariatric surgery with weight loss had significantly lower disease activity.

There has been conflicting evidence about the impact of weight loss and bariatric surgery in obese RA patients. Weight loss from bariatric surgery was not shown to alter the risk of developing RA.  On the other hand, weight loss in RA has been linked with improved clinical status, as it has been shown in psoriasis and psoriatic arthritis.

The current study from China looked at a 12-month prospective cohort of 65 obese (BMI ~38) RA patients; 32 met criteria for bariatric surgery plus pharmacotherapy and the other 33 patients received only pharmacotherapy.  Demographic and clinical status were similar between groups. Laparoscopic sleeve gastrectomy was done in 41% ane the remainder had  Roux-en-Y gastric bypassic.

The response rates after 12 months were:

 Bariatic SurgeryNo Surgery 
ACR2075%51.5%<0.05
ACR5953.1%39.4%<0.05
ACR7031.3%21.2%<0.05
CDAI9.515.8<0.05
DAS28-CRP1.22.2<0.05

There was no difference in the use of leflunomide, biological agents, combination treatments, and NSAIDs between the 2 groups either at baseline or at the 12-month follow-up (all p > 0.05).

Postoperative complications were seen at one month in 16% (3 anastomotic ulcer/leak, intra-abdominal hernia, postoperative gastric functional emptying and after 1 month in 9% of patients (incisional hernia, intestinal obstructions, serious wound infection).

These data suggest that weight loss may have an important role in the nonpharmacologic management of RA patients. 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Need for Disruptive Innovation in Rheumatology

A full-read, novel Viewpoint article published in the Annals of Rheumatic Disease (Huizinga TWJ, et al) spotlights a recent international meeting of big thinkers, scientific collaborators and industry dedicated to innovation in rheumatology.

Airway Inflammation Drives Rheumatoid Risk

A cohort analysis of the Nurses' Health Study suggests that asthma and COPD are associated with increased risk for incident rheumatoid arthritis (RA), independent of smoking- thus airway inflammation may be an important factor in the evolution of pre-cllnical RA.

Folate Levels Protect from CV Mortality in RA

In a study of rheumatoid arthritis (RA) patients, JAMA reports that serum folate level of greater than 4.3 ng/mL was associated with lower CV mortality risk.

A cohort study from the third National Health and Nutrition Examination Survey (1988-1994) and 2011 compared assess the risk of CV mortality in 683 RA patients based on their serum folate levels.

Seronegativity on the Rise in RA

Although the overall incidence rates of rheumatoid arthritis (RA) have remained stable over recent decades, there has been a significant increase in seronegative cases, a retrospective study showed.

Alcohols Net Zero Effect in Rheumatoid Arthritis

A report from The National Databank for Rheumatic Disease addressed the impact of alcohol on disease activity and mortality in rheumatoid arthritis (RA) and found that alcohol use was not associated with changes in disease activity or mortality, after addressing confounders.