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Table 1 Basic characteristic and rheumatic disease outcomes after bariatric surgery in selected studies with their main limitations

From: Consequences of bariatric surgery on outcomes in rheumatic diseases

Authors Patients/bariatric surgery/follow-up Rheumatic diseases Outcomes Main limitations
Lalmohamed et al. [6] n = 2079 pts
n = 10,442 controls
60% LAGB, 29% RYGB
2.2 years
Osteoporosis No increase in OP fracture rate Retrospective design
Limited follow-up duration
Zhang et al. [7] (meta-analysis) Five observational trials and one RCT but in pts with T2DM
≠ BS
2.2 to 4.8 years
Osteoporosis Higher risk for any type of fracture in the surgical group
Fracture risk in non-vertebral sites: 1.42; 1.68 in the upper limbs
Mainly retrospective and observational studies
Comparison between only mixed and restrictive procedures
Rousseau et al. [8] n = 9300 pts
n = 38,028 sex-matched obese pts
n = 126,760 non-obese controls
41% LAGB, 27% SG, 9% RYGB, 21% BD
4.4 years
Osteoporosis Postoperative adjusted fracture risk higher in the bariatric group aRR: 1.38
A site-specific effect is suggested
Retrospective nested case control study
Bariatric and obese groups not matched for BMI
Lu et al. [9] (nationwide cohort study) n = 2064 pts
n = 5027 propensity score-matched subjects
14% malabsorptive procedures, 86% restrictive procedures
4.8 years
Osteoporosis Increased risk of fracture adjusted HR 1.21; malabsorptive procedures aHR 1.48 Retrospective design
Data on BMI pre-surgery and post-surgery were not available.
Nakamura et al. [10] n = 258 pts
94% RYGB
7.7 years
Osteoporosis A twofold increased risk of OP fracture Retrospective uncontrolled design on review of medical records
Non-standardized data
Groen et al. [13] (systematic review) 13 studies
n = 2286 pts
n = 1551 non-surgical pts
RYGB and LAGB
3 months to 6 years
Knee complaints in knee osteoarthritis Overall significant improvement in knee pain was seen in 73% out of the used assessments Mainly uncontrolled prospective studies
No RCTs
Limited follow-up duration
Gill et al. [14] (systematic review) 6 studies
n = 2008 pts
n = 1531 controls
RYGB and LAGB
0.5 to 8 years
Knee and hip osteoarthritis BS may benefit obese pts with hip or knee OA.
Evidence that standardization of outcome is lacking
Inability to perform a pooled analysis or a meta-analysis due to lack of randomized controlled study
Sparks et al. [20] n = 53 pts
81% RYGB
12 months and most recent follow-up
Rheumatoid arthritis Decrease in disease activity and serum inflammatory markers
Less RA-related medication use
At 12 months, 6% of pts had moderate/high disease activity vs 57% at baseline
RUD
SSS
Validated measures not collected consistently
Sethi et al. [27] n = 21 pts
91% LAGB
6.1 years
Psoriatic arthritis Decrease in disease severity rating Retrospective uncontrolled database analysis
SSS
Validated measurement not collected consistently
Abstract
Nielsen et al. [31] n = 132 pts
≠ BS
6 to 13 months
Gout Low-quality evidence for gout attacks and achieving serum uric acid targets A meta-analysis was not possible.
The majorities of included studies were uncontrolled.
The lack of rigorous studies is underlined.
Corcelles et al. [32] n = 31pts
74% RYGB
3 years
Systemic lupus erythematosus Decrease in SLE immunosuppression medication requirement RUD
SSS
Saber et al. [36] n = 10 pts
RYGB
24.5 months
Fibromyalgia Decrease in median of pain score and points of tenderness RUD
SSS
Phone interview
Khoueir et al. [43] n = 58 pts
62% RYGB
12 months
Low back pain 44% decrease in axial back pain (VAS) 38 pts completed pre and post-op questionnaire
SSS
Limited follow-up duration
Uncontrolled study
Lidar et al. [44] n = 30 pts
≠ BS
12 months
Low back pain Axial and radicular back pain decreased after surgery (VAS) SSS
Uncontrolled study
Vincent et al. [33] n = 25 pts
72% RYGB
28% LAGB
3 months
Low back pain 54% reduction in mean score change in numeric pain rating scale SSS
Limited follow-up duration
Melissas et al. [42] n = 29 pts
VBG
24 years
Low back pain Improved functional disability scores SSS
Uncontrolled study
  1. BD biliopancreatic diversion, BS bariatric surgery, LAGB laparoscopic adjustable gastric banding, OA osteoarthritis, OP osteoporosis, RA rheumatoid arthritis, RCT randomized controlled trial, RUD retrospective uncontrolled design, RYGB laparoscopic ROUX-en-Y gastric bypass, SG sleeve gastrectomy, SLE systemic lupus erythematosus, SSS small sample size, T2DM type 2 diabetes mellitus, VBG vertical banded gastroplasty