Bariatric surgery and the incidence of rheumatoid arthritis - a Swedish Obese Subjects study

Cristina Maglio, Yuan Zhang, Markku Peltonen, Johanna Andersson-Assarsson, Per-Arne Svensson, Christian Herder, Anna Rudin, Lena Carlsson, Cristina Maglio, Yuan Zhang, Markku Peltonen, Johanna Andersson-Assarsson, Per-Arne Svensson, Christian Herder, Anna Rudin, Lena Carlsson

Abstract

Objective: The aim of this study was to determine the effect of bariatric surgery on the incidence of RA in participants of the Swedish Obese Subjects (SOS) study.

Methods: The SOS is a longitudinal study aiming to assess the effect of bariatric surgery on mortality and obesity-related diseases. This report includes 2002 subjects with obesity who underwent bariatric surgery and 2034 matched controls; none of them had RA at baseline. Cases of incident RA were identified through the Swedish National Patient Register by searching for International Classification of Diseases codes. Both intention-to-treat analyses and per-protocol analyses are reported. In the per-protocol analysis, participants from the control group who underwent bariatric surgery later on during follow-up were censored at the time of surgery.

Results: During follow-up, 92 study participants developed RA. The median follow-up was 21 years (range 0-29). Bariatric surgery was neither associated with the incidence of RA in the intention-to-treat analysis [hazard ratio (HR) 0.92 (95% CI 0.59, 1.46), P = 0.74], nor in the per-protocol analysis [HR 0.86 (95% CI 0.54, 1.38), P = 0.53]. Weight change at the 2 year follow-up, expressed as the change in BMI compared with baseline, did not associate with the development of RA. Higher serum CRP levels and smoking associated with the future development of RA independent of other factors.

Conclusions: We did not detect any association between bariatric surgery and the incidence of RA in subjects affected by obesity followed up for up to 29 years.

Clinicaltrials.gov: (https://ichgcp.net/clinical-trials-registry/NCT01479452" title="See in ClinicalTrials.gov">NCT01479452.

Keywords: adipose tissue; clinical trials and methods; epidemiology; rheumatoid arthritis; surgery.

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Figures

Fig . 1
Fig. 1
Cumulative incidence of RA in the SOS study (A) Intention-to-treat analysis. (B) Per-protocol analysis.

References

    1. McInnes IB, Schett G.. The pathogenesis of rheumatoid arthritis. N Engl J Med 2011;365:2205–19.
    1. Smolen JS, Aletaha D, Barton A. et al. Rheumatoid arthritis. Nat Rev Dis Primers 2018;4:18001.
    1. Feng J, Chen Q, Yu F. et al. Body mass index and risk of rheumatoid arthritis: a meta-analysis of observational studies. Medicine (Baltimore) 2016;95:e2859.
    1. Qin B, Yang M, Fu H. et al. Body mass index and the risk of rheumatoid arthritis: a systematic review and dose-response meta-analysis. Arthritis Res Ther 2015;17:86.
    1. Ljung L, Rantapaa-Dahlqvist S.. Abdominal obesity, gender and the risk of rheumatoid arthritis – a nested case–control study. Arthritis Res Ther 2016;18:277.
    1. Zhou Y, Sun M.. A meta-analysis of the relationship between body mass index and risk of rheumatoid arthritis. EXCLI J 2018;17:1079–89.
    1. Vidal C, Barnetche T, Morel J, Combe B, Daïen C.. Association of body mass index categories with disease activity and radiographic joint damage in rheumatoid arthritis: a systematic review and metaanalysis. J Rheumatol 2015;42:2261–9.
    1. Schulman E, Bartlett SJ, Schieir O. et al. Overweight and obesity reduce the likelihood of achieving sustained remission in early rheumatoid arthritis: results from the Canadian Early Arthritis Cohort study. Arthritis Care Res (Hoboken) 2018;70:1185–91.
    1. Sandberg ME, Bengtsson C, Kallberg H. et al. Overweight decreases the chance of achieving good response and low disease activity in early rheumatoid arthritis. Ann Rheum Dis 2014;73:2029–33.
    1. Ellerby N, Mattey DL, Packham J, Dawes P, Hider SL.. Obesity and comorbidity are independently associated with a failure to achieve remission in patients with established rheumatoid arthritis. Ann Rheum Dis 2014;73:e74.
    1. Gonzalez-Gay MA, Gonzalez-Juanatey C.. Rheumatoid arthritis: obesity impairs efficacy of anti-TNF therapy in patients with RA. Nat Rev Rheumatol 2012;8:641–2.
    1. Gremese E, Carletto A, Padovan M. et al. Obesity and reduction of the response rate to anti-tumor necrosis factor α in rheumatoid arthritis: an approach to a personalized medicine. Arthritis Care Res (Hoboken) 2013;65:94–100.
    1. Ottaviani S, Gardette A, Tubach F. et al. Body mass index and response to infliximab in rheumatoid arthritis. Clin Exp Rheumatol 2015;33:478–83.
    1. Sparks JA, Halperin F, Karlson JC, Karlson EW, Bermas BL.. Impact of bariatric surgery on patients with rheumatoid arthritis. Arthritis Care Res (Hoboken) 2015;67:1619–26.
    1. Sjöström L, Narbro K, Sjöström CD. et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007;357:741–52.
    1. Carlsson LM, Peltonen M, Ahlin S. et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med 2012;367:695–704.
    1. Maglio C, Peltonen M, Neovius M. et al. Effects of bariatric surgery on gout incidence in the Swedish Obese Subjects study: a non-randomised, prospective, controlled intervention trial. Ann Rheum Dis 2017;76:688–93.
    1. Maglio C, Peltonen M, Rudin A, Carlsson L.. Bariatric surgery and the incidence of psoriasis and psoriatic arthritis in the Swedish Obese Subjects study. Obesity (Silver Spring) 2017;25:2068–73.
    1. Brolin RE. Results of obesity surgery. Gastroenterol Clin North Am 1987;16:317–38.
    1. Pocock SJ, Simon R.. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics 1975;31:103–15.
    1. Sjöström L, Larsson B, Backman L. et al. Swedish obese subjects (SOS). Recruitment for an intervention study and a selected description of the obese state. Int J Obes Relat Metab Disord 1992;16:465–79.
    1. Zentenius E, Andersson-Assarsson JC, Carlsson LMS, Svensson PA, Larsson I.. Self-reported weight-loss methods and weight change: ten-year analysis in the Swedish Obese Subjects study control group. Obesity (Silver Spring) 2018;26:1137–43.
    1. Ludvigsson JF, Almqvist C, Bonamy AE. et al. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol 2016;31:125–36.
    1. Veale DJ, Fearon U.. What makes psoriatic and rheumatoid arthritis so different? RMD Open 2015;1:e000025.
    1. Hernandez Avila M, Liang MH, Willett WC. et al. Reproductive factors, smoking, and the risk for rheumatoid arthritis. Epidemiology 1990;1:285–91.
    1. Turesson C, Bergstrom U, Pikwer M, Nilsson JA, Jacobsson LT.. A high body mass index is associated with reduced risk of rheumatoid arthritis in men, but not in women. Rheumatology (Oxford) 2016;55:307–14.
    1. Rodriguez LA, Tolosa LB, Ruigomez A, Johansson S, Wallander MA.. Rheumatoid arthritis in UK primary care: incidence and prior morbidity. Scand J Rheumatol 2009;38:173–7.
    1. Linauskas A, Overvad K, Symmons D. et al. Body fat percentage, waist circumference and obesity as risk factors for rheumatoid arthritis: a Danish cohort study. Arthritis Care Res (Hoboken) 2019;71:777–86.
    1. Wesley A, Bengtsson C, Elkan AC. et al. Association between body mass index and anti-citrullinated protein antibody-positive and anti-citrullinated protein antibody-negative rheumatoid arthritis: results from a population-based case-control study. Arthritis Care Res (Hoboken) 2013;65:107–12.
    1. Lahiri M, Luben RN, Morgan C. et al. Using lifestyle factors to identify individuals at higher risk of inflammatory polyarthritis (results from the European Prospective Investigation of Cancer-Norfolk and the Norfolk Arthritis Register–the EPIC-2-NOAR Study). Ann Rheum Dis 2014;73:219–26.
    1. Debnath M, Agrawal S, Agrawal A, Dubey GP.. Metaflammatory responses during obesity: pathomechanism and treatment. Obes Res Clin Pract 2016;10:103–13.
    1. George MD, Baker JF.. The obesity epidemic and consequences for rheumatoid arthritis care. Curr Rheumatol Rep 2016;18:6.
    1. Johansson L, Pratesi F, Brink M. et al. Antibodies directed against endogenous and exogenous citrullinated antigens pre-date the onset of rheumatoid arthritis. Arthritis Res Ther 2016;18:127.
    1. Deane KD, O’Donnell CI, Hueber W. et al. The number of elevated cytokines and chemokines in preclinical seropositive rheumatoid arthritis predicts time to diagnosis in an age-dependent manner. Arthritis Rheum 2010;62:3161–72.
    1. Nielen MM, van Schaardenburg D, Reesink HW. et al. Increased levels of C-reactive protein in serum from blood donors before the onset of rheumatoid arthritis. Arthritis Rheum 2004;50:2423–7.
    1. Masi AT, Rehman AA, Elmore KB, Aldag JC.. Serum acute phase protein and inflammatory cytokine network correlations: comparison of a pre-rheumatoid arthritis and non-rheumatoid arthritis community cohort. J Innate Immun 2013;5:100–13.
    1. Lapidus J. Private health insurance in Sweden: fast-track lanes and the alleged attempts to stop them. Health Policy 2017;121:442–9.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner