The first-ever study of bariatric surgery among obese patients with rheumatoid arthritis (RA) shows that it produces a 70% weight loss and a significant reduction in disease activity after a year - – maintaining a majority of the benefits 5 years later.
The small retrospective study of 53 RA patients who weighed an average of almost 128.2 kg (282.63 lbs) before their surgery shows that 68% achieve remission after losing an average of 41 kg (90 pounds).
Serum markers of disease activity all dropped -– including ESR and CRP. Patient use of DMARDs also declined substantially (97% vs. 59%) 12 months after surgery.
Obesity is known to lead to or exacerbate RA and reduce the effectiveness of medications. Results of this study show that “weight loss may have an important role in the nonpharmacologic management of RA in patients with obesity,” the researchers comment.
The patients, almost all women in their late 40s with a mean BMI of 47.0 (class III or severe obesity) who’d had RA an average of 8 years, underwent bariatric surgery (n=81%) at 2 Boston medical centers between 2000 and 2012.
The study tracks their weight, disease activity, and other factors at 6 months and 1 year via electronic health records, with a mean follow-up of 5 years post-surgery.
At the most recent follow-up 74% were in remission. This compares with just over one quarter when the study began.
After their surgery, the mean BMI was 32.6--just over cut-off for obesity (a BMI of 30).
While participants re-gained some weight, around 12 kg (27 lbs), it was not enough to wipe out the benefits.
This study is limited by its small size, lack of validated patient data, and the fact that participants are mostly white women. Still, it raises interesting questions that only more detailed analysis can answer, including “whether the observed improvements in RA are attributable to substantial weight loss, specific effects of bariatric surgery, decreased inflammatory burden, reduced mechanical joint stress, improved quality of life, or a combination of these factors,” the authors observe.