Axial Spondyloarthritis after bariatric surgery: a 7-year retrospective analysis

Abstract

Background: In recent decades, obesity has become a public health problem in many countries. The objective of this study was to evaluate the main joint and extra-articular manifestations related to spondyloarthritis (SpA) after bariatric surgery (BS) in a retrospective cohort. Methods: Demographic, clinical, laboratory and imaging data from nine patients whose SpA symptoms started after a BS have been described. Modified New York (mNY) criteria for ankylosing spondylitis (AS) and the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial (ax-SpA) and peripheral (p-SpA) spondyloarthritis were applied. Results: The mean weight reduction after BS was 49.3 ± 21.9 kg. The BS techniques were Roux-en-Y gastric bypass (n = 8; 88.9%) and biliopancreatic diversion with duodenal switch (n = 1; 11.1%). Four (44.4%) patients had no axial or peripheral pain complaints before BS, while the other four (44.4%) had sporadic non-inflammatory back pain that had been attributed to obesity. One patient (11.1%) had persistent chronic back pain. In all nine cases, patients reported back pain onset or pattern (intensity or night pain) change after BS (mean time 14.7 ± 18 months). In addition, 8 of them (88.9%) were human leukocyte antigen (HLA)-B27 positive. All nine patients could be classified according to ASAS criteria as ax-SpA and five (55.6%) patients were classified as AS, according to the mNY criteria. Conclusion: Our data highlight a temporal link between SpA onset symptoms and the BS, suggesting a possible causal plausibility between the two events.

Microbiome in immuno-rheumatology

“…Additionally, 8 of them (88.9%) had positive HLA-B27 (human leukocyte antigen). All patients were classified according to the ASAS criteria as ax-SpA and five (55.6%) patients were classified as ankylosing spondylitis (AS), according to the mNY criteria [11].…”

HLA-B27 did not protect against COVID-19 in patients with axial Spondyloarthritis – Data from the ReumaCov-Brasil Registry

“…On the other hand, it is involved with beginning and chroni cation of reactive arthritis in predisposed patients and in experimental models, showing a de nitive proof of concept, particularly regarding Chlamydia and other pathogens from gut microbiota. (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Therefore, the antigen presenting properties and/or to the co-inheritance of gene variants may contribute to an altered homeostasis in case of microbial infections or tissue injury.…”

“…Since that Brewerton and Schlosstein (7)reported a close relationship between ankylosing spondylitis and HLA-B27, many other aspects have been pointed out over time, especially related with some protective role regarding infections (occurrence and severity). (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) Considering the HLA-827 is ubiquitous worldwide, some authors have addressed this potential advantage during the human evolution among B27-carriers regarding to in uenza virus, herpes simplex type 2 virus, malaria, Epstein-Barr virus, HIV, HCV and reactivation of latent toxoplasmosis infection after TNFi. (8-10).…”