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VBCR - December 2015, Volume 4, No 6 - Psoriatic Arthritis
Phoebe Starr

San Francisco, CA—Yet another benefit of weight loss! The loss of excessive weight aided by bariatric surgery appears to improve symptoms of psoriasis and psoriatic arthritis, according to a retrospective pilot study presented at the annual meeting of the American College of Rheumatology.1

“Recent studies suggest that obesity is a risk factor for the development of psoriasis and psoriatic arthritis and precedes the onset of these conditions in many cases. Obesity is thought to drive systemic inflammation because adipose tissue [is] known to produce proinflammatory molecules, known as adipokines, and cytokines. In addition, increased biomechanical stress at the entheses due to obesity is also proposed as another mechanism that may trigger systemic inflammation at this site,” said lead author Soumya M. Reddy, MD, Co-Director of the New York Univerity (NYU) Psoriatic Arthritis Center, New York City.2

The study was conducted to ascertain the effects of weight loss from bariatric surgery on psoriasis and psoriatic arthritis. The database comprised 9073 bariatric surgeries performed at a single center between the years 2002 and 2013. Of these surgeries, 128 patients had a diagnosis of psoriasis prior to surgery. Patients were interviewed regarding their histories of psoriasis and psoriatic arthritis as well as changes in symptoms, treatments, and therapies pre- and postsurgery.

Of the 128 patients, 86 agreed to participate in the study. Almost two-thirds of the study population were female, and the average age was about 46 years. Twenty-four percent of patients with psoriasis also had a presurgery diagnosis of psoriatic arthritis.

Duration of psoriasis at the time of surgery was a mean of 18.7 years, and mean age at time of diagnosis was 28.2 years. Mean duration of psoriatic arthritis at the time of surgery was 16.9 years, and mean age at diagnosis was 38.3 years. Prior to surgery, 62% of patients had undergone biologic treatments.

Mean weight before surgery was 288 pounds, and mean body mass index was 45.8 kg/m2.

Of the 86 patients, 91% underwent laparoscopic adjustable gastric banding. The types of gastric banding included Realize Band-C, LAPBAND System, and LAPBAND APL APS System.

Follow-up monitoring was done for about 6 years, and the average excess weight loss was 46.2% of body weight.

Improvements in symptoms from before surgery to 1 year after were reported by 55% of those with psoriasis and 62% of those with psoriatic arthritis. On a 10-point scale of symptom severity (0-10 with 10 being the most severe), psoriasis participants dropped from an average of 5.6 to 4.4 and psoriatic arthritis patients dropped from 6.4 to 4.5.

Improvements were more robust in patients with psoriasis and psoriatic arthritis who reported baseline symptoms of 5 or higher before surgery: their symptom severity score dropped from an average of 7.7 to 5.7 and from 8.2 to 4.8, respectively (P < .01 for both).

Dr Reddy noted that people diagnosed at age 37 years or older also did better than those with an earlier diagnosis of psoriasis or psoriatic arthritis.

She said that the study suggests an association between surgical weight loss and subjective improvements in psoriasis and psoriatic arthritis but “does not demonstrate a causal link.” Further studies will be needed to explore this association.

Even without large well-designed trials, rheumatologists should discuss maintaining a healthy weight with their patients, including those with psoriatic arthritis.

“Recent studies show that weight loss may improve a person’s response to medications for psoriasis and psoriatic arthritis and increase the chances of achieving a minimal disease activity state. While we do not have enough information yet to make clear recommendations for medication or surgical interventions for weight loss at this time, there is enough literature that points to the need to have conversations about weight management with our patients now,” she told listeners.

At NYU Psoriatic Arthritis Center, a multidisciplinary approach is used, and patients are referred to a dedicated nutritionist on-site when appropriate. Not all medical centers have a dedicated nutritionist, but at the very least, rheumatologists can start the discussion and increase patient awareness of the importance of weight loss.

Future plans include a study to compare changes in skin and joint scores following bariatric surgery and changes in the microbiome, she said.

References

  1. Sethi M, Ren-Fielding C, Caminer AC, et al. Clinical improvements in psoriasis and psoriatic arthritis with surgical weight loss. Presented at: 2015 American College of Rheumatology Annual Meeting; November 7-11, 2015; San Francisco, CA. Abstract 688.
  2. Weight loss surgery may improve symptoms of psoriasis and psoriatic arthritis [press release]. San Francisco, CA: American College of Rheumatology; November 8, 2015. www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/703/Weight-Loss-Surgery-May-Improve-Symptoms-of-Psoriasis-and-Psoriatic-Arthritis. Accessed November 23, 2015.
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