A Rheumatologist's Guide to Bariatric Surgery Save

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.