Weight loss after bariatric surgery was associated with lower rheumatoid arthritis (RA) disease activity, according to a recent study. The findings suggested that bariatric surgery may be feasible for patients with RA and obesity.
Overweight and obesity can aggravate disease activity and clinical outcomes in patients with RA. However, the role of weight loss in treatment of RA has not been confirmed, the researchers noted.
The 12-month prospective cohort study included 65 patients. According to the patient’s decision and surgery indications, 32 patients were classified into the bariatric surgery group and received pharmacotherapy for RA, and 33 patients received only pharmacotherapy. All patients had active disease, which was reflected by erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values and high 28-joint count disease activity score (DAS28) and clinical disease activity index (cDAI) scores. Nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose glucocorticoids of £50 mg prednisone or equivalent/day were allowed when necessary.
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Patients who underwent bariatric surgery experienced significant weight loss and a better response to treatment. The mean weight loss was 111.8±11.8 kg at baseline, 92.8±19.3 kg at 4 months, 86.2±23.7 kg at 8 months, and 78.2±25.6 kg at 12 months. At the 12-month follow-up, in the bariatric surgery cohort, the response rates of American College of Rheumatology 20 (ACR20), ACR50, and ACR70 were 75.0%, 53.1%, and 39.4%, respectively, compared with 51.5%, 39.4%, and 21.2%, respectively, in the nonsurgical cohort. The mean DAS28-ESR, DAS28-CRP, and cDAI scores in the surgery group compared with the nonsurgical group were 1.5 ± 0.9 vs 2.4 ± 1.4, 1.2 ± 0.9 vs 2.2 ± 1.7, and 9.5 ± 6.8 vs 15.8 ± 12.5, respectively.
A significant reduction in the use of leflunomide, biological agents, combination treatment, and NSAIDs was observed in both groups after 12 months compared to the baseline. However, medication use did not differ between the two groups at baseline or after the 12-month follow-up, suggesting that medication tapering for patients with RA who underwent bariatric surgery was not superior to that in the nonsurgical patients.
“To the best of our knowledge, this is the first cohort study to evaluate the treatment efficacy of bariatric surgery on RA patients with obesity compared with nonsurgical patients,” concluded the researchers. “The present results suggest that weight loss may have an important role in the nonpharmacologic management of RA patients. These findings warrant further study concerning the treatment of RA patients, especially those with obesity.” —Eileen Koutnik-Fotopoulos
Xu F, Yu C, Li, DG, et al. The outcomes of bariatric surgery on rheumatoid disease activity: a prospective cohort study. Sci Rep. 2020;10(1):3167. doi:10.1038/s41598-020-59723-8