Newswise — SAN FRANCISCO — Massive weight loss following bariatric (weight loss) surgery has the potential to greatly improve the quality of life for patients suffering from osteoarthritis, according to research presented this week at the American College of Rheumatology Annual Meeting in San Francisco.
Osteoarthritis, sometimes called degenerative joint disease, is a slowly progressive disease in which joint cartilage breaks down. Normally, cartilage on the ends of bones allows smooth, pain-free joint movements. In OA, cartilage becomes thin and irregular, resulting in symptoms of joint pain and stiffness. Grinding or cracking sensations may occur. Joints that are under high stress due to repeated activity or weight bearing are most susceptible to OA. The hips, knees, hands and spine are commonly affected. OA becomes more common with aging.
While there is little known about the effects of massive weight loss on OA, it is well documented that obesity is a common risk factor for the disease to progress – a challenge for both patients and physicians. Researchers recently looked at the results of massive weight loss through bariatric surgery to see if this may be a possible intervention to help people with OA obtain a higher quality of life.
“This is a huge public health concern,” says M. Elaine Husni, MD, MPH; vice chair, Department of rheumatic and immunologic diseases; director, Arthritis Center, Orthopedic and Rheuamtologic Institute; Cleveland Clinic. “Many people who are obese also have symptomatic osteoarthritis, a condition that leads to life-long disability and pain, and there has been no effective disease modifying treatment for decades other than joint replacement surgery.
Dr. Husni’s team followed 67 patients – who are part of a larger study that looks at bariatric surgery combined with medical management of diabetes versus bariatric surgery alone in people with confirmed OA, who are obese, and have uncontrolled type II diabetes — for three years to determine how bariatric surgery effected their osteoarthritis.
The participants were predominately female (44 of the 67) with an average age of 51 and an average body mass index of 36.6 (signifying obesity). Each participant completed a health assessment questionnaire (called the Short Form-36 or SF-36) to evaluate their overall health and quality of life. Eighteen of the participants were given medical intervention alone, and the other 49 received medical intervention and underwent bariatric surgery.
Over the course of three years, both groups reported on changes in physical functioning, pain, general heath, energy/fatigue, emotional well-being, social functioning and overall mental health. After one year, the participants who received medical intervention and underwent bariatric surgery saw significant improvements in physical functioning, general health, and energy and fatigue. At three years, these improvements remained, but only the improvements in general health remained statistically significant.
“’Would the effects of this treatment stand the test of time?' was an important question," explains Dr. Husni. “Bariatric surgery is not without risk, and we wanted to study patients three years out to see if the possible outcomes were sustained. And, yes, improvements in general health maintained in this population over time.”
These results show promise that massive weight loss following bariatric surgery has the potential to greatly improve the quality of life for people suffering from OA. Although improvements at year three weren’t as significant as one might hope, the changes from the beginning of study to years one and three were significant enough to convince Dr. Husni’s team that further study of activity level, maintenance of weight loss, and metabolic cytokines may need to be performed to understand how the impacts of bariatric surgery can be preserved.
“As health care reforms continue to advocate for the most cost effective ways to manage our patients and keep them mobile, prospective studies are needed to better characterize the impact of bariatric surgery. This surgery is not without risk, but for some patients this may be the best option,” Husni notes.
Finally, Husni advises that maintaining a healthy weight — whether it through referral to dietician or intense medical weight loss — is an important conversation people with OA should have with their physicians.
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About the American College of RheumatologyHeadquartered in Atlanta, Ga., the American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to Advance Rheumatology! In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.
About the ACR/ARHP Annual MeetingThe ACR/ARHP Annual Meeting is the premier meeting in rheumatology. For more information about the meeting, visit http://www.acrannualmeeting.org/ or join the conversation on Twitter by using the official #ACR15 hashtag.
ACR Abstract 321http://acrabstracts.org/
Meeting Link: ACR Annual Meeting, Nov-2015 Meeting Link: ACR Annual Meeting, Nov-2015
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