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Bariatric Surgery Improves Rheumatoid Activity

Feb 25, 2020 9:12 am

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 Surgery No Surgery 
ACR20 75% 51.5% <0.05
ACR59 53.1% 39.4% <0.05
ACR70 31.3% 21.2% <0.05
CDAI 9.5 15.8 <0.05
DAS28-CRP 1.2 2.2 <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. 

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

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