Impact of Bariatric Surgery on Patients With Rheumatoid Arthritis

Overview

Journal Arthritis Care Res (Hoboken)

Specialty Rheumatology

Date 2015 May 29

PMID 26018243

Citations 30

Authors

Jeffrey A Sparks

Florencia Halperin

Jonathan C Karlson

Elizabeth W Karlson

Bonnie L Bermas

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the effect of weight loss after bariatric surgery among patients with rheumatoid arthritis (RA).

Methods: We conducted a retrospective cohort study of RA patients who underwent bariatric surgery (Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, or sleeve gastrectomy) at 2 medical centers. We obtained information on anthropometrics, laboratory values, RA disease activity, and medication use at baseline (prior to surgery), at 6 and 12 months following surgery, and at the most recent followup visits. RA disease activity was determined by clinical or validated measures. At each postsurgical visit, characteristics were compared to baseline.

Results: We identified 53 RA patients who underwent bariatric surgery. At baseline prior to surgery, mean ± SD body mass index was 47.8 ± 7.7 kg/m(2), mean ± SD weight was 128.2 ± 24.1 kg, and 57% had moderate to high RA disease activity. Twelve months following surgery, subjects lost a mean ± SD weight of 41.0 ± 17.3 kg, mean ± SD 70% ± 24% excess weight (P < 0.001). RA disease activity significantly improved at postsurgical visits (P < 0.001). At 12 months following surgery, 6% had moderate to high disease activity, compared to 57% at baseline (P < 0.001). At the most recent followup (mean ± SD 5.8 ± 3.2 years after surgery), 74% were in remission, compared to 26% at baseline (P < 0.001). Subjects had significantly lower erythrocyte sedimentation rate, C-reactive protein level, and RA-related medication use at followup visits compared to baseline (P < 0.05).

Conclusion: After substantial weight loss from bariatric surgery, RA patients had lower disease activity, decreased serum inflammatory markers, and less RA-related medication use. Weight loss may be an important nonpharmacologic strategy to reduce RA disease activity. However, other factors, such as improved efficacy of medications, improved physical activity, and metabolic changes, may also have contributed to these postsurgical improvements.

Citing Articles

Surgical complications of bariatric surgery among patients with rheumatic diseases.

Soori M, Mirhashemi S, Rashnoo F, Faghih G, Ebrahimi F, Zamani A Caspian J Intern Med. 2024; 15(1):53-57.

PMID: 38463916 PMC: 10921106. DOI: 10.22088/cjim.15.1.5.

When does obesity exert its effect in conferring risk of developing RA: a large study in cohorts of symptomatic persons at risk.

Dumoulin Q, Boeren A, Krijbolder D, Willemze A, de Jong P, van Mulligen E RMD Open. 2024; 10(1).

PMID: 38216289 PMC: 10806477. DOI: 10.1136/rmdopen-2023-003785.

Effect of Remotely Supervised Weight Loss and Exercise Training Versus Lifestyle Counseling on Cardiovascular Risk and Clinical Outcomes in Older Adults With Rheumatoid Arthritis: A Randomized Controlled Trial.

Andonian B, Ross L, Sudnick A, Johnson J, Pieper C, Belski K ACR Open Rheumatol. 2023; 6(3):124-136.

PMID: 38126260 PMC: 10933621. DOI: 10.1002/acr2.11639.

Effect of bariatric and metabolic surgery on rheumatoid arthritis outcomes: A systematic review.

Miladi S, Makhlouf Y, Boussaa H, Zakraoui L, Abdelghani K, Fazaa A PLoS One. 2023; 18(11):e0294277.

PMID: 37976258 PMC: 10655969. DOI: 10.1371/journal.pone.0294277.

[Impact of surgical treatment of morbid obesity on joint diseases].

Panevin T, Zotkin E, Lila A Probl Endokrinol (Mosk). 2023; 69(4):70-76.

PMID: 37694869 PMC: 10520909. DOI: 10.14341/probl13258.

References

Ouchi N, Parker J, Lugus J, Walsh K . Adipokines in inflammation and metabolic disease. Nat Rev Immunol. 2011; 11(2):85-97. PMC: 3518031. DOI: 10.1038/nri2921. View

van den Broek M, Huizinga T, Dijkmans B, Allaart C . Drug-free remission: is it already possible?. Curr Opin Rheumatol. 2011; 23(3):266-72. DOI: 10.1097/BOR.0b013e32834563e3. View

Scher J, Abramson S . The microbiome and rheumatoid arthritis. Nat Rev Rheumatol. 2011; 7(10):569-78. PMC: 3275101. DOI: 10.1038/nrrheum.2011.121. View

Sweeney T, Morton J . The human gut microbiome: a review of the effect of obesity and surgically induced weight loss. JAMA Surg. 2013; 148(6):563-9. PMC: 4392891. DOI: 10.1001/jamasurg.2013.5. View

Hobbs K, Cohen M . Rheumatoid arthritis disease measurement: a new old idea. Rheumatology (Oxford). 2012; 51 Suppl 6:vi21-7. DOI: 10.1093/rheumatology/kes282. View

Anderson J, Caplan L, Yazdany J, Robbins M, Neogi T, Michaud K . Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res (Hoboken). 2012; 64(5):640-7. PMC: 4028066. DOI: 10.1002/acr.21649. View

Sandberg M, Bengtsson C, Kallberg H, Wesley A, Klareskog L, Alfredsson L . Overweight decreases the chance of achieving good response and low disease activity in early rheumatoid arthritis. Ann Rheum Dis. 2014; 73(11):2029-33. DOI: 10.1136/annrheumdis-2013-205094. View

Mallya R, de Beer F, Berry H, HAMILTON E, Mace B, Pepys M . Correlation of clinical parameters of disease activity in rheumatoid arthritis with serum concentration of C-reactive protein and erythrocyte sedimentation rate. J Rheumatol. 1982; 9(2):224-8. View

Katz P, Yazdany J, Trupin L, Schmajuk G, Margaretten M, Barton J . Sex differences in assessment of obesity in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012; 65(1):62-70. PMC: 3501549. DOI: 10.1002/acr.21810. View

10.

Rubino F, Gagner M, Gentileschi P, Kini S, Fukuyama S, Feng J . The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004; 240(2):236-42. PMC: 1356398. DOI: 10.1097/01.sla.0000133117.12646.48. View

11.

Halperin F, Goldfine A . Metabolic surgery for type 2 diabetes: efficacy and risks. Curr Opin Endocrinol Diabetes Obes. 2013; 20(2):98-105. DOI: 10.1097/MED.0b013e32835edbb0. View

12.

Heimans L, van den Broek M, le Cessie S, Siegerink B, Riyazi N, Han K . Association of high body mass index with decreased treatment response to combination therapy in recent-onset rheumatoid arthritis patients. Arthritis Care Res (Hoboken). 2013; 65(8):1235-42. DOI: 10.1002/acr.21978. View

13.

de Hair M, Landewe R, van de Sande M, van Schaardenburg D, van Baarsen L, Gerlag D . Smoking and overweight determine the likelihood of developing rheumatoid arthritis. Ann Rheum Dis. 2012; 72(10):1654-8. PMC: 3786633. DOI: 10.1136/annrheumdis-2012-202254. View

14.

Chen S, Lee Y, Ser K, Chen J, Chen S, Hsieh H . Serum C-reactive protein and white blood cell count in morbidly obese surgical patients. Obes Surg. 2008; 19(4):461-6. DOI: 10.1007/s11695-008-9619-3. View

15.

Eaton C . Obesity as a risk factor for osteoarthritis: mechanical versus metabolic. Med Health R I. 2004; 87(7):201-4. View

16.

Santos J, Salgado P, Santos C, Mendes P, Saavedra J, Baldaque P . Effect of bariatric surgery on weight loss, inflammation, iron metabolism, and lipid profile. Scand J Surg. 2013; 103(1):21-5. DOI: 10.1177/1457496913490467. View

17.

Stavropoulos-Kalinoglou A, Metsios G, Panoulas V, Nevill A, Jamurtas A, Koutedakis Y . Underweight and obese states both associate with worse disease activity and physical function in patients with established rheumatoid arthritis. Clin Rheumatol. 2008; 28(4):439-44. DOI: 10.1007/s10067-008-1073-z. View

18.

Sjostrom L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden A . Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014; 311(22):2297-304. DOI: 10.1001/jama.2014.5988. View

19.

Chen C, Tsai C . From endocrine to rheumatism: do gut hormones play roles in rheumatoid arthritis?. Rheumatology (Oxford). 2013; 53(2):205-12. DOI: 10.1093/rheumatology/ket255. View

20.

Saag K, Teng G, Patkar N, Anuntiyo J, Finney C, Curtis J . American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008; 59(6):762-84. DOI: 10.1002/art.23721. View