Bariatric Surgery: A Fix for OA?

By M. Elaine Husni, MD, MPH

Almost 1 in 3 Americans suffers with obesity, and among those with more severe obesity, the prevalence of diabetes can be greater than 25 percent. Obesity remains a substantial but potentially modifiable risk factor for the progression of osteoarthritis (OA), a debilitating disease without a cure. A population-based study reported a significantly increased odds ratio of 13.6 for developing knee OA in individuals with a BMI over 36 kg/m2 compared with controls.

Obesity is considered one of the main modifiable risk factors for OA. Bariatric surgery is currently the only evidence-based approach for massive weight loss in very obese individuals who are refractory to medical therapy. However, there is currently limited literature to evaluate the role of bariatric surgery in obese patients with symptomatic OA.

Our research team included Ankita Satpute, student at Case Western Reserve University School of Medicine, and Cleveland Clinic co-authors Sangeeta Kashyap, MD, staff in the Endocrinology & Metabolism Institute, and Philip Schauer, MD, Director of the Bariatric and Metabolic Institute. We sought to evaluate the long-term effects of significant weight loss on quality of life for obese and diabetic patients with OA. In general, weight loss has been shown to improve pain and function in hip and knee joints with OA.

Quality of life improves for bariatric surgery patients

In this study, 150 subjects with obesity included in the STAMPEDE trial and randomized to receive medical management (n = 50) or bariatric surgery (50 sleeve gastrectomy and 50 Roux-en-Y gastric bypass) were screened for evidence of OA using American College of Rheumatology criteria or radiographic evidence when available. Sixty-seven OA patients were included: 18 medical and 49 surgical. The RAND 36-Item Health Survey 1.0 was administered at baseline and postintervention at one, two and three years to assess quality of life.

At one year following intervention, patients who underwent bariatric surgery lost an average of 57.6 pounds (-9.03 kg/m2 BMI), while those medically managed lost 16.6 pounds (-2.46 kg/m2 BMI). Overall, quality of life improvements were greater in the surgical group compared with the medical group, with statistically significant improvements at one year in the physical component score (P < .05) of the RAND 36 and in three other domains: physical functioning (P < .05), general health (P < .001) and energy/fatigue (P < .001). After three years, only differences in the general health domain remained significant (P < .05).

Bariatric surgery as part of strategy for treating OA

The population of patients with osteoarthritis is growing, yet disease-modifying treatment has remained stagnant for decades. OA continues to negatively impact quality of life. Our findings reveal that bariatric surgery and the resulting massive weight loss have the potential to considerably improve health-related quality of life for patients suffering from OA for up to three years.

This is the first randomized controlled study to demonstrate exciting findings of improved quality of life outcomes in obese and diabetic patients with OA out to three years following bariatric surgery when compared to baseline scores and a medically managed control group. These results emphasize the need to refocus attention on disease prevention through obesity-related risk factor modification rather than symptom management.

Taking these results together, bariatric surgery may seem a radical approach in contrast to available OA treatments, but this study highlights benefits to significant weight loss that can be promising for a subgroup of this population. Bariatric surgery may serve as part of a comprehensive weight management strategy, with marked weight loss leading to improvement in patients with symptomatic OA. However, further research is needed to clarify the underlying mechanisms and define the role of bariatric surgery in this patient population.

Dr. Husni directs both the Arthritis and Musculoskeletal Treatment Center and Cleveland Clinic’s disease-specific biorepositories.