A patient who was diagnosed in 1974 with type 1 diabetes and in 2000 with rheumatoid arthritis weighed 366 pounds in 2014. He found he was gasping for breath while doing even simple tasks like walking across the room. He contacted his rheumatologist believing he might be suffering from lung issues related to RA.

His rheumatologist referred him to his heart specialist who after performing an examination ultimately referred him to a pulmonologist.

Treatment:

The pulmonologist performed diagnostic tests and a complete examination and found no RA related lung issues. However, he did find that the patient was suffering from a fractured sternum emulating from open heart surgery in 2005. With that finding the pulmonologist referred the patient to a thoracic surgeon for repair. The surgeon performed an examination acknowledging the patient’s sternum was fractured along the lines of the open-heart surgery. The thoracic surgeon declined to operate unless patient lost at least 100 pounds.

The patient decided to consult his endocrinologist who suggested a routine of prescribed food consumption and education. The patient was also selected for a bariatric surgery program. The patient elected to pursue the strict dietary program offered by his endocrinologist, and over the course of 14 months, he lost 93 pounds. The thoracic surgeon acknowledged the patient’s commitment to weight loss and performed the sternum repair in 2015.

Following thoracic surgery, the patient gained 14 pounds, and his rheumatologist suggested he pursue a sustained weight management program. With the oversight of his endocrinologist and rheumatologist, the patient selected a long-term weight management program, and to date, the patient has lost an additional 43 pounds. He now weighs 222 pounds or 9 pounds more than his high school graduation weight. Patient and his rheumatologist have set a weight goal of 200 pounds.

Maintenance:

Patient regularly attends meetings tracks his food intake and loves riding his bicycle. He consults with his rheumatologist and endocrinologist about his progress.

Quality of Life:

Patient has found his quality of life has been greatly improved. He is using his 5^th biologic treatment for ra which has been maintained for the past 4 years Thus halting a rapid succession of treatments that failed. Patient has decreased average insulin usage by 63 units per day and has steadily maintained an A1C of less than 6.0 for the past 4 years. The patient reports his quality of life has significantly improved.

Patient photographed in 2012 before the start of the weight loss journey

Patient photographed in April 2018

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/sustained-weight-loss-managed-by-multiple-medical-specialists/