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

Maglio, Cristina; Zhang, Yuan; Peltonen, Markku; Andersson‐Assarsson, Johanna C.; Svensson, Per‐Arne; Herder, Christian; Rudin, Anna; Carlsson, Lena

doi:10.1093/rheumatology/kez275

Cited by 27 publications

(26 citation statements)

References 35 publications

(36 reference statements)

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“…www.scandjrheumatol.se .60, p = 0.01) ( Table 2). As previously shown (29), bariatric surgery was not associated with the incidence of the RA in the SOS study, whereas serum CRP levels and current or former smoking were associated with an increased risk for the disease (Table 2). Gender, ESR, and BMI were not risk factors for RA in this cohort of subjects with obesity.…”

Section: Baseline Characteristicssupporting

confidence: 56%

“…In subjects with preclinical RA, auto-antibodies, chemokines, and cytokines are elevated in blood up to several years before the onset of the disease, suggesting an early activation of the immune system (33,36). CRP levels are also increased years before the diagnosis of RA (29,(33)(34)(35). CRP and adiponectin levels showed poor correlation, suggesting different mechanisms behind the regulation of these proteins (37).…”

Section: Discussionmentioning

confidence: 99%

“…In this cohort of subjects with obesity, we have previously analysed the effect of bariatric surgery on the future development of RA, since obesity is thought to be a risk factor for the development of the disease, in particular if combined with other factors (27,28). However, we were not able to detect any association between bariatric surgery and the incidence of RA (29). Serum adiponectin levels have been measured in SOS study participants at baseline and at 2 and 10 year follow-up, and this has allowed us to study the association between circulating adiponectin and the development of RA in subjects with obesity.…”

mentioning

confidence: 93%

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Elevated adiponectin predicts the development of rheumatoid arthritis in subjects with obesity

Zhang

Peltonen

Andersson‐Assarsson

et al. 2020

Scandinavian Journal of Rheumatology

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Objective The aim of the current study is to determine whether baseline serum adiponectin levels predict the development of rheumatoid arthritis (RA). Method The current report includes 3693 individuals from the Swedish Obese Subjects (SOS) study. The original SOS study is a longitudinal non-randomized controlled study aiming to assess the effect of bariatric surgery on obesity-related mortality and morbidity. Participants included in the present report had adiponectin measurement available at baseline and no prevalent RA. The diagnosis of RA was retrieved through the Swedish National Patient Register. Results During a follow-up for up to 29 years, 82 study participants developed RA. Elevated baseline adiponectin levels were associated with a higher risk of developing RA independently of other factors, including C-reactive protein (CRP) and smoking [hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.12-2.60 for an increase in adiponectin of 10 mg/L, p = 0.01]. After stratifying the population according to adiponectin and CRP median at baseline, study participants with both adiponectin and CRP above the median had a higher risk of developing RA compared to subjects with adiponectin and CRP below the median (HR 2.80, 95% CI 1.25-6.31, p = 0.01). Conclusions In this cohort of subjects with obesity followed up for up to 29 years, high serum adiponectin levels at baseline were associated with an increased risk for RA. Moreover, subjects with both high adiponectin and CRP levels at baseline were at particular risk of developing RA. ClinicalTrials.gov Identifier: NCT01479452. Adiponectin is a relatively abundant adipokine in plasma, with concentrations ranging from 2 to 30 mg/L and accounting for up to 0.05% of total plasma proteins (1, 2). Although mostly produced by the adipose tissue, adiponectin levels are inversely correlated with fat mass and are low in subjects with obesity (3, 4). Low serum adiponectin is associated with an unhealthy metabolic profile, including a higher risk for type 2 diabetes and insulin resistance (5-7). It has been hypothesized that the low adiponectin levels observed in obesity and its comorbidities are a consequence of the chronic low-grade inflammation that affects the adipose tissue under these circumstances (8, 9). However, other studies show that adiponectin levels are elevated in inflammatory and autoimmune diseases (10-12). Indeed, in patients with established rheumatoid arthritis (RA), adiponectin is increased in both serum and synovia, and subjects with early treatment-naïve RA have higher circulating adiponectin levels than controls. Moreover, plasma adiponectin is associated with pro-inflammatory cytokines in a population without RA but at high risk of developing the disease (13), suggesting that adiponectin may play a role in the early phases of disease development (14-17). This

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Section: Baseline Characteristicssupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 93%

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Elevated adiponectin predicts the development of rheumatoid arthritis in subjects with obesity

Zhang

Peltonen

Andersson‐Assarsson

et al. 2020

Scandinavian Journal of Rheumatology

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“…The larger number of cohort studies in the present analysis contributed to more precise risk estimates, and enabled assessment of associations of other adiposity measures, such as waist circumference and BMI in early adulthood, with risk of rheumatoid arthritis. Some studies have suggested that bariatric surgery may improve symptoms in patients with rheumatoid arthritis 40,41 , however, www.nature.com/scientificreports/ a recent Swedish study found no significant association between bariatric surgery and the risk of developing rheumatoid arthritis (HR = 0.92, 95% CI 0.59-1.46), but statistical power to detect a moderate association may have been low and confidence intervals were wide 42 . The finding that high BMI in early adulthood (at age 18 years) was associated with an increased risk of rheumatoid arthritis might suggest that early life risk factors may be of importance in the aetiology of rheumatoid arthritis 43,44 .…”

Section: Discussionmentioning

confidence: 99%

Adiposity and the risk of rheumatoid arthritis: a systematic review and meta-analysis of cohort studies

Ohno

Aune

Heath

2020

Sci Rep

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Several studies have investigated associations between overweight/obesity and risk of developing rheumatoid arthritis, however, the evidence is not entirely consistent, and previous meta-analyses mainly included case–control studies, which can be affected by various biases. We therefore conducted a systematic review and meta-analysis of cohort studies on adiposity and risk of rheumatoid arthritis. Relevant studies were identified by searching PubMed and Embase databases. Random effects models were used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs) for rheumatoid arthritis in relation to different measures of adiposity. Thirteen cohort studies (10 publications) were included. The summary RR per 5 kg/m2 increase in body mass index (BMI) was 1.11 (95% CI 1.05–1.18, I2 = 50%), but the association was restricted to women (1.15, 95% CI 1.08–1.21, I2 = 17%) and not observed in men (0.89, 95% CI 0.73–1.09, I2 = 58%). The summary RR per 5 kg/m2 increment in BMI at age 18 years was 1.17 (95% CI 1.01–1.36, I2 = 26%, n = 3), and per 10 cm increase in waist circumference was 1.13 (95% CI 1.02–1.25, I2 = 44%, n = 2). Higher BMI in middle age, BMI at age 18 years, and waist circumference were associated with increased rheumatoid arthritis risk, suggesting adiposity could be targeted for primary prevention.

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“…Santos et al 31 enrolled 46 patients with obesity-related metabolic dysfunction and showed that gastric banding surgery resulted in a significant decrease in the inflammation process associated with adipose tissue loss. Interestingly, in a Swedish study followed up for 29 years, there was no association between bariatric surgery and the incidence of RA in obese patients 32 , which might demonstrate that bariatric surgery has no preventive effect on the occurrence of RA.…”

Section: Discussionmentioning

confidence: 94%

The outcomes of bariatric surgery on rheumatoid arthritis disease activity: a prospective cohort study

et al. 2020

Sci Rep

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Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that primarily affects the joints. Overweight and obesity can aggravate disease activity and clinical outcome in patients with RA. However, the role of bariatric surgery in inducing weight loss in the treatment of RA has not been confirmed. In this 12-month prospective cohort study, RA patients with obesity who were referred to our hospital were included. Thirty-two patients were classified into the bariatric surgery group according to the patient's decision after a comprehensive assessment of surgery indications, and 33 patients received only pharmacotherapy for RA. At the 12-month follow-up, the response rates of ACR20, ACR50 and ACR70 were 75.0% vs. 51.5%, 53.1% vs. 39.4% and 31.3% vs. 21.2% in the bariatric surgery and non-surgery groups, respectively (all p < 0.05); the mean DAS28-ESR, DAS28-CRP and cDAI scores were 1.5 ± 0.9 vs. 2.4 ± 1.4, 1.2 ± 0.9 vs. 2.2 ± 1.7 and 9.5 ± 6.8 vs. 15.8 ± 12.5, respectively, in surgical patients compared to non-surgical patients (all p < 0.05). Compared to baseline, after 12 months, a significant reduction was observed in the use of leflunomide, biological agents, combination treatments, and nSAiDs in both groups (p < 0.05 or p < 0.01). However, there was no difference in medication use between the 2 groups either at baseline or at the 12-month follow-up (all p > 0.05). Compared to non-surgical patients, in RA patients with obesity, weight loss after bariatric surgery was associated with lower disease activity. Medication tapering for RA in patients who underwent bariatric surgery was not superior to that in non-surgical patients.

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

Cited by 27 publications

References 35 publications

Elevated adiponectin predicts the development of rheumatoid arthritis in subjects with obesity

Elevated adiponectin predicts the development of rheumatoid arthritis in subjects with obesity

Adiposity and the risk of rheumatoid arthritis: a systematic review and meta-analysis of cohort studies

The outcomes of bariatric surgery on rheumatoid arthritis disease activity: a prospective cohort study

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