HealthDay News — For patients with rheumatoid arthritis (RA), bariatric surgery-associated weight loss correlates with lower disease activity, decreased serum inflammatory markers, and less RA-related medication use, according to a study published in Arthritis Care & Research.1
Jeffrey A. Sparks, MD, from Brigham and Women’s Hospital in Boston, and colleagues conducted a retrospective cohort study involving 53 RA patients who underwent bariatric surgery. Anthropometrics, laboratory values, RA disease activity, and medication use data measures were obtained at baseline (before surgery), at 6 and 12 months after surgery, and at most recent follow-up.
Two board-certified rheumatologists (JAS and BLB) reviewed medical records to determine RA disease activity, the second of whom was blinded to timing of bariatric surgery and the amount of weight lost. RA disease activity was categorized according to accepted criteria into high, moderate, low, or remission. Roux-en-Y gastric bypass was the most frequent type of bariatric surgery (81% of subjects).
The researchers found that at 12 months after surgery, subjects had lost a mean of 41.0kg and 70% of excess weight (P < 0.001). At postsurgical visits there was significant improvement in RA disease activity (P < 0.001). Six percent of patients had moderate to high disease activity at 12 months after surgery, compared with 57% at baseline (P < 0.001).
Seventy-four percent of patients were in remission at the most recent follow-up (mean, 5.8 years after surgery), compared with 26% at baseline (P < 0.001). Compared with baseline, at follow-up visits, erythrocyte sedimentation rate (ESR), and C-reactive protein level (CRP) were significantly lower (P < 0.05). The use of DMARDs, NSAIDs, and glucocorticoids was decreased at all postsurgical time points compared to baseline (P < 0.05).
Summary and Clinical Applicability
Previous studies indicate that obesity worsens RA disease activity and contributes to worse clinical outcomes. It has been suggested that adipocyte-derived proinflammatory cytokines (leptin, resistin, and visfatin) may be contributing to a continuous inflammatory cascade, increasing RA disease activity.2
In this study, there were significant improvements in RA disease activity, serum inflammatory markers, and RA medication use in patients with RA after weight loss associated with bariatric surgery.1 These results suggest that substantial weight loss may play an important role in the management of RA in patients with obesity.
“Other factors, such as improved efficacy of medications, improved physical activity, and metabolic changes, may also have contributed to these postsurgical improvements,” the authors write.
This study was also limited by the fact that most patients included had one specific type of bariatric surgery (Roux-En-Y), and while the mechanism of improved disease activity appears to be linked to total weight loss and not necessarily surgical approach, studies including popular minimally invasive laparascopic approaches should be analyzed.
1. Sparks JA, Halperin F, Karlson JC, et al. Impact of bariatric surgery on patients with rheumatoid arthritis. Arthrit Care Res. 2015;67(12):1619-1626. doi: 10.1002/acr.22629
2. Stavropoulos-Kalinoglou A, Metsios GS, Koutedakis Y, Kitas GD. Obesity in rheumatoid arthritis. Rheumatology (Oxford )2011;50:450–62.
This article originally appeared on Clinical Advisor