Background/Purpose: Obesity increase the incidence of rheumatic diseases (1-3). Bariatric surgery (BS) improve obesity-related comorbidities (4). The aim of our study was to assess currently available literature the impact of BS on rheumatic disease such inflammatory rheumatic disease, gout, musculoskeletal disorder and surgical management of osteoarthritis.

Methods: We systematically searched literature (via Pubmed, Embase, Cochrane library and abstracts from recent ACR and EULAR congresses) for studies evaluating the effects of BS on rheumatics diseases. A meta-analysis was performed with Review Manager Software, with random effects models, whenever methodologically possible and relevant. Data were extracted by one investigator and independently checked by another.

Results: The literature search revealed 399 articles and abstracts of potential interest, and further examination resulted in 124 studies include in systematic review and 24 studies fulfilling required criteria for preplanned analyses regarding the impact of BS on rheumatic diseases. For musculoskeletal disorder, the mean difference between before and after BS was -468.14 (95% confidence interval [95% CI] -646.76 ; -289.51)  for WOMAC function, -95.18 [ -127.06 ; -63.29] for WOMAC pain, 30.45 [22.02 ; 38.87] for SF36 physical function, 22.91 [ 16.58 ; 29.24] for SF36 bodily pain (Figure 1). For surgical management of osteoarthritis incidence of reoperation, the Odd ratio (OR) was 1.41 [0.88;2.27] and for incidence of infection the OR was 0.91 [0.53;1.59]. For gout, the effect size was 0.83 [0.79;0.87] for hyperuricemia before and after, the mean difference between before and after BS was -1.45 [-1.95; -0.94] for uric acid (Figure 2).

Conclusion: This study supports the interest of BS in rheumatology, with improvement of function and pain in musculoskeletal disorders, decrease of acid uric level.

References:

1. Lee R, Kean WF. Obesity and knee osteoarthritis. Inflammopharmacology 2012;20:53-8.

2. Juraschek SP, Miller ER 3rd, Gelber AC. Body mass index, obesity, and prevalent gout in the United States in 1988-1994 and 2007-2010. Arthritis Care Res 2013;65:127-32.

3. Soltani-Arabshahi R, Wong B, Feng BJ, Goldgar DE, Duffin KC, Krueger GG. Obesity in early adulthood as a risk factor for psoriatic arthritis. Arch Dermatol 2010;146:721-6.

4. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al; Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351:2683-93.