Background/Purpose:

Osteoarthritis (OA) remains a debilitating burden
for patients and a challenge to their physicians, as there is no known cure.
Obesity has been linked to OA progression and is a possible modifiable risk
factor. Consequently patients undergoing bariatric surgery may help elucidate
the complex relationship of massive weight loss in patients with OA. This is
the first randomized, controlled study that will evaluate the effects of
massive weight loss through bariatric surgery on long-term quality of life for
obese patients with OA. 

Methods:

Medical records of the 150 subjects in the STAMPEDE
trial were individually reviewed for documented evidence of OA. STAMPEDE is a
randomized, controlled trial that evaluated the efficacy of medical therapy
alone (n=50) versus medical therapy in combination with bariatric surgery
(n=100) in 150 obese patients with uncontrolled Type II diabetes. The criteria
used for OA diagnosis for each patient included one or more of the following:
American College of Rheumatology criteria for knee or hip OA (26.9%);
radiographic evidence of degenerative change in the hip, knee, ankle, foot or
spine (37.3%); or physician documented OA (35.8%). A total of 67 OA patients
were included: 18 in the medical group and 49 in the surgical. Demographics at
baseline were similar between both groups with no significant differences in
patient characteristics (mean age 51, female 44/67, mean BMI 36.6). Linear
mixed effect models were used to compare changes in SF-36 scale scores at 1 and
3 years between surgical and medical groups and were adjusted for baseline
scores.   Analyses were performed using SAS software (version 9.3;
Cary, NC).

Results:

At 1 year following intervention, patients who
received bariatric surgery when compared to those treated with medical
management alone demonstrated statistically significant improvements in the
following SF-36 domains: physical functioning, general health, and
energy/fatigue. Improvement in the overall physical component score was also
statistically significant.  At 3 years post-intervention, although
improvements were preserved in these domains, only the general health category
sustained statistical significance. (See Table 1)

Conclusion:

These results demonstrate that massive weight loss
following bariatric surgery has the potential to greatly improve the quality of
life for patients suffering from osteoarthritis. Although statistical
significance was not preserved for all SF 36 domains at 3 year follow-up,
statistical trends in these domains at 3 years reflect similar improvements
from 1 year.  Further study elucidating factors such as activity level,
maintenance of weight loss, and metabolic cytokines, may need to be performed
to understand how we can preserve the impacts of bariatric surgery.

Table 1.

*overall physical and mental scores represent a mean
of the physical and mental components of the SF-36 respectively