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Weight Loss Surgery May Improve Symptoms of Psoriasis and Psoriatic Arthritis

First-of-its-kind study shows correlation between excessive weight loss and improvement of the two diseases

SAN FRANCISCO— Excessive weight loss aided by bariatric (weight loss) surgery has been linked to improved symptoms in people with psoriasis and psoriatic arthritis, according to new research findings presented this week at the American College of Rheumatology Annual Meeting in San Francisco.

Psoriasis is an autoimmune skin disease in which red patches with silver scales develop on the skin and scalp. Some patients with psoriasis also develop joint inflammation, referred to as psoriatic arthritis. Like psoriasis, psoriatic arthritis symptoms can flare and subside over time. Psoriatic arthritis can affect any joint within the body, either in the extremities or the spine.”

Psoriasis and psoriatic arthritis are chronic diseases, and treatment often requires drug therapies that suppress the immune system and reduce inflammation. Obesity is more prevalent among patients with psoriasis and psoriatic arthritis, and this appears to be related to fat tissue-driven systemic inflammation.

“Recent studies suggest that obesity is a risk factor for the development of psoriasis and psoriatic arthritis and precedes the onset of these conditions in many cases, explains lead investigator in the retrospective study, Soumya M. Reddy, MD; co-director, NYU Psoriatic Arthritis Center; assistant professor of medicine, New York University School of Medicine. “Obesity is thought to drive systemic inflammation because adipose tissue (fat cells) are known to produce pro-inflammatory molecules, known as adipokines, and cytokines. In addition, increased biomechanical stress at the entheses due to obesity is also proposed as another mechanism that may trigger systemic inflammation at this site.”

To ascertain the effects of weight loss from bariatric surgery on psoriasis and psoriatic arthritis, Dr. Reddy and her research team reviewed a database of 9,073 bariatric surgeries performed at one surgical center between 2002 and 2013. From this database, Dr. Reddy’s team identified 128 patients who had a diagnosis of psoriasis prior to having bariatric surgery and contacted them to discuss their history of psoriasis and psoriatic arthritis as well as any changes in their symptoms, treatments and therapies both before and after their surgery.

Of the 128 patients contacted, 86 agreed to participate in the study. Sixty-two percent of these participants were women with an average age of 46.5 years. Ninety-one percent underwent laparoscopic adjustable gastric banding (specifically, Realize-C Band ™, LAPBAND System APS™, and LAPBAND System APL™) and their average weight at the time of surgery was 288 pounds. While all patients had been diagnosed with psoriasis prior to their surgeries, 21 participants had also been diagnosed with psoriatic arthritis prior to surgery, giving Dr. Reddy’s team the opportunity to look at both conditions within their study.

The researchers followed up with each study participant at an average of six years after their surgery. They were looking for a five-point reduction in symptoms based on a zero-to-10 scale. On average, at the time of follow up, participants achieved an excess weight loss (%EWL) of 46.2 percent, and most reported improvements in their symptoms.

“When asked to compare their symptoms before surgery to their symptoms one year and after, 55 percent of participants with psoriasis, and 62 percent with psoriatic arthritis, reported improvements in their symptoms to our team, explains Dr. Reddy.”

Specifically, participants with psoriasis dropped from an average of 5.6 to 4.4 on the ten-point scale, and those with psoriatic arthritis dropped from 6.4 to 4.5. The results were even more significant for those who reported their symptoms to be greater than five before surgery; on average, they moved from 8.2 to 4.8. And, those who were diagnosed later in life — 37 years old, on average — fared better than those who had been diagnosed earlier.

“Our study suggests a relationship of surgical weight loss and subjective improvements in psoriasis and psoriatic arthritis; it does not demonstrate a causal link, and further prospective studies are required to confirm these findings,” Dr. Reddy says of the findings and next steps.

Although more research needs to be conducted, Dr. Reddy recommends rheumatologists include conversations and action plans to maintain a healthy weight for their patients with psoriatic arthritis. “It is important to undertake healthy choices for diet and exercise for weight management,” she says. “Recent studies show that weight loss may improve a person’s response to medications for psoriasis and psoriatic arthritis and increase the chances of achieving a minimal disease activity state. While we do not have enough information yet to make clear recommendations for medication or surgical interventions for weight loss at this time, there is enough literature that points to the need to have conversations about weight management with our patients now. At our NYU Psoriatic Arthritis Center, we take a multidisciplinary approach to these issues, and patients are referred to a dedicated nutritionist on site when appropriate.”

Jocelyn Givens
During Annual Meeting: Newsroom – 415-978-3605 or 415-978-3604
Office – 404-633-3777 ext. 810
jgivens@rheumatology.org

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About the American College of Rheumatology

Headquartered in Atlanta, Ga., the American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to Advance Rheumatology! In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.

About the ACR/ARHP Annual Meeting

The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. For more information about the meeting, visit www.acrannualmeeting.org or join the conversation on Twitter by using the official #ACR15 hashtag.

About the Rheumatology Research Foundation

The Rheumatology Research Foundation is the largest private funding source of rheumatology research and training programs in the U.S.  Established in 1985, the Foundation is focused on advancing patient care and accelerating discoveries in rheumatic diseases. For more information, visit www.rheumresearch.org.