BOSTON — In patients with rheumatoid arthritis who underwent bariatric surgery, significant weight loss was associated with improvement in disease activity, reductions in medication use, and a reduction in inflammatory markers, according to results from a retrospective study.
"This is the first study to look at patients with rheumatoid arthritis after bariatric surgery. We wanted to do this because I had two patients whose rheumatoid arthritis resolved after bariatric surgery; they did not need their medications anymore," said researcher Bonnie Bermas, MD, from the Brigham and Women's Hospital in Boston.
"We were very excited and surprised to see how well the data lined up. This kind of data is usually only a dream," she explained. "Fortunately, we have a large bariatric surgery department where we could do the study," she added.
The results were presented here at the American College of Rheumatology (ACR) 2014 Annual Meeting.
The study involved 53 patients with confirmed rheumatoid arthritis who underwent bariatric surgery.
At the time of surgery, mean age was 47.9 years, mean disease duration was 8.6 years, and mean body weight was 282.7 lbs. Most — 95% — of the patients were female, 81% were white, 51% were seropositive, and 40% had joint erosions.
A year after surgery, mean weight loss was 90.4 lbs (P < .001), which was accompanied by a significant decrease in inflammatory markers.
Table. Outcomes 1 Year After Bariatric Surgery
| Mean Outcomes | Before Surgery | After Surgery | P Value |
| Body mass index (kg/m²) | 47.9 | 32.6 | <.001 |
| C-reactive protein (mg/L) | 26.0 | 5.9 | <.05 |
| Erythrocyte sedimentation rate (mm Hg) | 45.7 | 26.1 | <.05 |
At the most recent follow-up, a mean of 5.4 years after surgery, mean C-reactive protein was 4 mg/L and mean erythrocyte sedimentation rate was 18 mm Hg (P < .001).
Disease activity at baseline was assessed with the Disease Activity Score in 28 Joints or chart review. All patients experienced significant reductions in disease activity at all time points (P < .0001).
Moderate or high disease activity was much less common at 1 year than at baseline (6% vs 57%s). In addition, fewer patients were using any medication for their rheumatoid arthritis at 1 year than at baseline (66% vs 98%).
Significantly more patients were in remission at a mean follow-up of 5.4 years than at baseline (74% vs 26%; P < .0001). For these patients, more were off all related medications at follow-up than at baseline (28% vs 2%; P = .28).
"From these findings, we can hypothesize that in obese patients with rheumatoid arthritis, significant weight loss can improve disease activity independent of medication use," Dr Bermas said. "This is another reason for rheumatologists to encourage their obese patients to lose weight."
The results from this study are "very impressive," said Neal Birnbaum, MD, from the California Pacific Medical Center in San Francisco, who is past president of the ACR.
"The benefits of significant weight loss are obvious. It would be interesting to determine whether it matters how that weight loss is achieved," he told Medscape Medical News. "In other words, is it weight loss by any means, or is it bariatric surgery?"
Dr Bermas and Dr Birnbaum have disclosed no relevant financial relationships.
American College of Rheumatology (ACR) 2014 Annual Meeting. Abstract L17. Presented November 18, 2014.
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Cite this: Weight Loss After Bariatric Surgery Improves RA - Medscape - Nov 21, 2014.
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