Skip to main content

A Rheumatologist's Guide to Bariatric Surgery

Obesity is epidemic in North America, affecting nearly 76 million adults. Obesity is not only a risk factor for rheumatoid arthritis and osteoarthritis, it clearly worsens pain and function in most musculoskeletal (MSK) conditions and has been shown to blunt DMARD and biologic responses in RA and other inflammatory arthritis patients. 

Bariatric surgery has emerged as an effective treatment modality for the morbidly obese, and it may improve outcomes for very obese MSK patients. Hassan and Hassan have written a nice overview of bariatric surgery in the current issue of Journal of Rheumatology wherein the procedures are described and the outcomes with arthritis patients is reviewed.

Several take-home points from their review article include:

  • Bariatric laparoscopic options include the Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, gastric band, and duodenal switch with or without biliopancreatic
    diversion. 
  • Osteoarthritis patients undergoing bariatric procedures and weight loss have shown significant improvement in WOMAC (pain) scores, biomarkers (COMP) and joint space narrowing X-ray scores. Joint replacement patients also had better outcomes, fewer complications but may have higher reoperation rates.
  • Gout patients had high rates of postoperative gouty attacks, but attacks and serum uric acid levels decreased over time.
  • RA and PsA patients noted significant clinical improvement after bariatric surgery.
  • Reduced drug absorbtion may be seen after surgery. There are no guidelines for use of NSAIDs or DMARDs after surgery - more research is needed.

Join The Discussion

Alan fischman

| May 11, 2016 3:34 pm

Hi jack, I read with interest the article on bariatric surgical options. I think it important and exciting that there is an ongoing phase II study of gastric embolization via a relatively easy access via the radial artery. One of the lead investigators of this study is Dr. Aaron Fischman at Mt. Sinai Hospital in NYC. ( he happens to be my son). I think this option will show significant benefit as an option to other surgical procedures. I have included a link for your consideration. Thanks, Dr. Alan Fischman, Poughkeepsie, NY http://obesitynewstoday.com/2016/04/12/bariatric-embolization-treatment…

If you are a health practitioner, you may to comment.

Due to the nature of these comment forums, only health practitioners are allowed to comment at this time.

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