How does weight loss surgery affect rheumatoid arthritis disease activity?

This study investigated the effect of bariatric surgery (BS; weight loss surgery) in patients with rheumatoid arthritis (RA). 

They found that BS was associated with lower disease activity in patients with RA and obesity.

Rheumatoid arthritis (RA) is a chronic condition. It is caused by excessive inflammation in the joints. This causes pain and disability. The aim of RA treatment is to lower disease activity (DA). Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat RA. Lifestyle modifications can also help lower DA.

Patients that are overweight or obese may be more likely of developing RA. Obesity is associated with higher levels of inflammation. RA patients with obesity may also have a poorer response DMARDs. Also, extra weight can put pressure on the joints. This may aggravate inflammation and pain. One treatment option for obesity is bariatric surgery (BS). BS can aid weight loss in people with obesity. It is unclear if BS has an effect on lowering DA in patients with RA and obesity. 

This study included 65 patients with RA and obesity. Both groups were treated with DMARDs. One group of patients also underwent BS. The main outcomes were weight loss and DA. DA was measured using ACR scores. ACR20 represents a 20% reduction in DA. ACR50 represents a 50% reduction. ACR70 represents a 70% reduction.

Patients that underwent BS lost a substantial amount of weight. The average excess weight loss was 79.4% after 12 months. At 12 months, an ACR20 response was observed in 75% of BS patients. This compares to 51.5% of patients that did not have surgery. ACR50 scores were also higher (53.1%) in BS patients compared to non-BS patients (39.4%) at 12 months. ACR70 scores at 12 months were 31.3% in the BS group compared to 21.2% in the non-BS group. There were no significant differences in lowering DMARDs doses between both groups.

The authors concluded that BS was associated with a lower DA in patients with RA and obesity.

The number of patients in this study was low. Lifestyle modifications like diet and physical exercise were not measured. This could have influenced weight loss in BS patients. A larger controlled study is needed. 

If you have any concerns regarding RA management please discuss this with your physician.