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Obesity, Surgery, and Optimizing Patient Care

Eric Dein, MD

Rheumatologic care involves multidisciplinary approaches and collaboration with specialties to treat complex, systemic diseases. While many Pods at RheumNow Live are disease specific, the Pod II focused on Advancing Practice on important and emerging areas affecting rheumatologic patients. This session focused on two major areas of need: obesity and peri-operative management.

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Most inhibition of inflammation is via the brain. More GLP1 and GIP1 receptors are in the brain, more than the gut. @RWCSmtg #RWCS26 https://t.co/CNzUqteBLg
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#RNL26 Haque @HopkinsRheum 1/2 of Americans will be obese by 2030 "Obesity is common & obesity is expensive" Adipose tissue - active endocrine organ -> cytokines, chemokines, adipokines Leads to inflamm axis - risk factor similar to 🚬, higher activity, worse response https://t.co/yQLTpE7reY
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RT @ericdeinMD #RNL26 Dx Modification of OA @Tuhina_Neogi Challenge in drug develop: Models in young animal, not like human OA Trial enrollment in pts w late, establ OA- not early interv tx Many paths to OA - target mechanism to correct pt Slow progress of dx, $$ Endpt? Sx or
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RT @ericdeinMD #RNL26 Placebo in Rheumatology - STEP talk Kerschbaumer What plays role in PBO? Treatment adherence effect w better background therapy - may appear to be PBO Impact in globalization of recruitment patterns, affects background PBO Education of pts bridges gap
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RT @richardPAconway Who to screen for RA-ILD is a tricky one. It is not feasible to screen everyone. This is from ACR/Chest 2023 ILD guidelines and is based on identified risk factors. #RNL26 https://t.co/NtAWYCVclJ
Dr. John Cush Tweet
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RT @richardPAconway Disease activity is a strong risk factor for RA-ILD. Particularly for moderate/high disease activity but there appears to be a linear relationship (at least above a certain threshold) #RNL26 https://t.co/ot8ttdmu5G
Dr. John Cush Tweet
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RT @richardPAconway Lifetime risk of ILD by RA/sex/MUC5B status. We can see the synergistic effect. Also note RA>MUC5B in general. #RNL26 https://t.co/L5MOVVGIt3
Dr. John Cush Tweet
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RT @richardPAconway MUC5B is strong risk factor for RA-ILD. Specifically for UIP. Associated with both older-onset RA, and ILD earlier following RA presentation. #RNL26 https://t.co/qeLp1BqOEM
Dr. John Cush Tweet
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RT @ericdeinmd RA-ILD #RNL26 Jeff Sparks MTX and ILD - Rare MTX-induced pneumonitis. 7 cases in n=4786 (0.3% cases) vs <0.1 on PBO, rare diff from ILD - No increase in incident ILD - meta-analysis of 7 studies show OR 0.49 https://t.co/k2XeAzBsYB
Dr. John Cush Tweet
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RT @ericdeinmd #RNL26 RA-ILD Jeff Sparks ILD pooled prevalence 0.11 Sparks: "prevalence is high but not so high that we don't screen everyone," means lots of subclinical ILD Subtypes: UIP 50-60%, fibrotic NSIP 30-40%, inflammatory Less common: LIP, DIP, RB-ILD, DAD
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RT @Gibson_RheumPAC GLP-1 receptor agonists do more than promote weight loss. They impact insulin resistance, inflammation, cardiovascular risk—and may influence musculoskeletal disease. #RNL26 https://t.co/ypKnOJojAm
Dr. John Cush Tweet
RheumNow
RT @Gibson_RheumPAC Obesity doesn’t just increase risk of rheumatic diseases-it worsens outcomes. Patients with obesity have higher disease activity, poorer biologic response, and 20–25% lower remission rates in inflammatory arthritis. #RNL26
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