QD Clinic: Bariatric Surgery "Curing" Arthritis? Save

Hello everyone. I'm Richard Conway from Dublin, Ireland and this is QD Clinics for this obesity campaign on RheumNow. So I'm here to talk to you today about two patients of mine, kind of on the same topic.

These were both ladies in their 30s. So we all know that the big new hot topic in obesity is the weight loss that can be achieved with GLP-1 analogues with or without a bit of GIP thrown in there for good measure, and these have revolutionized the obesity area. And more recently we are seeing potential and real, I think, benefits within rheumatology from these agents, both through the weight loss itself but also seemingly through this effect of GLP-1 itself on inflammatory and immune activity within various types of arthritis.

But we're going to forget about all of that for now and we're going to go back to the past and talk about the older treatment for obesity, which was bariatric surgery. So this is what both my patients ended up having.

So the first of these was a lady, as I said, in her 30s with seropositive rheumatoid arthritis, and she had awful rheumatoid arthritis. Her disease activity was high. She had lots of synovitis. Her inflammatory markers were high. But what made her particularly difficult is that she probably had the most refractory case of rheumatoid arthritis I've come across, or certainly one of the most refractory. And we gave her all of our standard usual treatments, all of our unusual treatments for rheumatoid arthritis. And what was remarkable is that none of these agents did anything. They didn't shift her disease activity one single point. She came in every time exactly the same, except that she was often having some side effect from the medication — nothing terrible, just infections and little bits and pieces — but she definitely felt worse on the medicines than off the medicines.

So eventually we had a chat about it and we said, "Look, nothing is working here. I'm making you worse rather than helping at all. Maybe let's just stop doing things for now and we'll see what happens." So she came back to me then — I was seeing her kind of annually just to keep an eye on things. She came back after about a year and she was completely different. She had lost a shedload of weight. She'd gone from a BMI of about 40 down to a BMI of about 25. She told me what had happened — she'd had bariatric surgery in the interim
the interim and but what she was really really excited to tell me was that her joints were great and I examined her there was nothing there there was no sign of itis anymore checked her inflammatory markers or CRP was zero something truly remarkable something I'm that still surprises me um but it seemed for this lady that the bariatric surgery the weight loss had cured her rheumatoid or put it into drug-free remission. Um, at least for now. Um, we're now a couple of years out from this and things haven't changed. Hasn't gotten any worse. It's still doing just as well. Um, hasn't needed or warranted any disease modifying uh therapy. So, this is a fantastic success story. Um and something that I said still surprises me but um it was truly remarkable.

And then couple of years after this lady I had another uh woman also in her 30s um who came into me. This lady had psoriatic arthritis um and she was overweight. I she wasn't as overweight as the previous lady. Her BMI was probably low 30s at most and said she had psoriatic arthritis. Um we tried a couple of uh conventional synthetic DMARDs without well they did work but there were side effects that meant we couldn't stay on them. We eventually ended up on biologics. Um I think on our second biologic um she had a good response um went into remission and was doing well.

Um and again patients doing well seeing her every six months every year relatively infrequently.

Um and she also went off um and had bariatric surgery and she came back to me um after bariatric surgery. Um she had lost significant weight again. Her BMI was down through probably low 20s um following this. Um she was very happy uh with life. She said she was still on her biologic. She said her joints felt the best they ever had um since starting this process. And she asked me like, "Can we stop the biologic and see what happens?" And [clears throat] as I usually do when somebody asked me this, um I kind of went, "Yeah, we can, but I mean the studies all show that eventually you're going to flare and eventually you're going to have to go back on the biologic and like is it worth it?" Um but she was very um determined. She didn't want to try reducing the dose. She said, "No, let's just stop it and see what happens. If I need to go back on it, we'll go back on it and we can work from there."

Um so we stopped her biologic. Um and we are now 3 years down the road. Um nothing has happened. I saw her again recently. No disease activity, no psoriasis, no arthritis.

Doing fantastically well
again. It seems doing fantastically well again, it seems purely from bariatric surgery. So I think there there's important lessons here that one, we shouldn't throw bariatric surgery away just because we have these new medicines. It is still a potential option for patients.

The responses to this profound weight loss seen with bariatric surgery maybe do give us some further support for what we can envisage GLP-1 analogues achieving in our diseases and the potential benefits of those.

So I'm Richard Conway. This has been QD Clinics and check out RheumNow for all these sessions over this obesity month.