Bariatric surgery outcomes in patients with systemic lupus erythematosus

Corcelles, Ricard; Daigle, Christopher R.; Talamas, Hector Romero; Batayyah, Esam; Brethauer, Stacy A.; Schauer, Philip R.

doi:10.1016/j.soard.2014.10.006

Cited by 27 publications

(17 citation statements)

References 20 publications

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“…The study of bariatric surgery's efficacy on 31 patients with systemic lupus erythaematosus demonstrated that 42% of patients showed a reduction in the number of immunosuppressive medications and that 19.3% were off steroids completely at a mean follow-up of 3 years 33 . These findings suggest that surgery-induced weight loss is associated with decreased SLE immunosuppression medication requirements 33 . The study has the same issue that, due to the lack of comparison group data, it is uncertain whether the medication reduction is attributable to bariatric surgery or SLE-related treatment.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

Sci Rep

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“…In one small cohort study of 31 patients with systemic lupus erythematous who underwent LSG or RYGB, three-fourths of whom were immunosuppressed at the time of surgery, early complications occurred in 13%, but by three years, almost half saw a reduction in their immunosuppression needs or were off of immunosuppressive medications altogether (9) . In an ACS-NSQIP analysis of all bariatric procedures, steroid use was associated with 1.4 times the odds of post-discharge complications (5) .…”

Section: Discussionmentioning

confidence: 99%

Expanded indications for bariatric surgery: should patients on chronic steroids be offered bariatric procedures?

Kaplan

Schecter

Rogers

et al. 2017

Surgery for Obesity and Related Diseases

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Background Patients who take chronic corticosteroids are increasingly referred for bariatric surgery. Little is known about their clinical outcomes. Objective Determine whether chronic steroid use is associated with increased morbidity and mortality after stapled bariatric procedures. Setting American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Methods We reviewed all patients who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (RYGB) and were reported to the ACS-NSQIP from 2011 to 2013. Patients were grouped based on type of surgery and history of chronic steroid use. Primary outcome measures were mortality and serious morbidity in the first 30 days. Regression analyses were used to determine predictors of outcome. Results Of 23,798 patients who underwent LSG and 38,184 who underwent RYGB, 385 (1.6%) and 430 (1.1%), respectively, were on chronic steroids. Patients on chronic steroids had a 3.4 times increased likelihood of dying within 30 days (95% CI 1.4–8.1, p=0.007), and two-fold increased odds of serious complications (95% CI 1.2–2.3, p=0.008), regardless of surgery type. In multivariate regression, steroid usage remained an independent predictor of mortality and serious complications. Conclusions In a large, nationally-representative patient database, steroid use independently predicted mortality and serious postoperative complications after stapled bariatric procedures. Surgeons should be cautious about offering stapled bariatric procedures to patients on chronic steroids.

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“…Therefore, it is not surprising that reduction in obesity-induced inflammation after obesity surgery may be beneficial in improving or reversing the severity of IBD [7][8][9][10][11]. Bariatric surgery has also been shown to improve the long-term status and management of other inflammatory diseases such as psoriasis, gout, and systemic lupus erythematosus [17][18][19].…”

Section: Discussionmentioning

confidence: 99%