Bariatric surgery associated with improved psoriasis, psoriatic arthritis

Researchers have shown for the first time that there might be an association between excess weight loss post bariatric surgery and symptomatic improvement in cases of severe psoriasis.

In the study, NYU Langone Medical Center researchers analyzed a database of 9,073 bariatric surgeries performed at between 2002 and 2013. Of those, 128 patients had preoperative psoriasis diagnoses. Eighty-six (67%) of patients from that group completed the study, and 21 (24%), of those also had preoperative diagnoses of psoriatic arthritis.

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A mean 6.1 years after surgery, 55% of psoriasis and 62% of psoriatic arthritis patients reported subjective improvement of the disease, according to the study.

The researchers found that overall psoriasis disease severity fell, on a 0-to-10 scale, from 5.6 before surgery to 4.4 one year after surgery. The reported decrease in psoriatic arthritis was from 6.4 prior to surgery to 4.5 one year after. The improvements were more pronounced among those with severe psoriasis and severe psoriatic arthritis.

Their analysis of patients with severe disease revealed excess weight loss was associated with greater improvements in psoriasis and higher excess weight loss at one year was associated with a trend in psoriatic arthritis improvement, according to the study.

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The improvements were most pronounced among patients with more severe disease at the time of surgery and among those who were diagnosed at older ages.

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What’s the link?

The researchers say fat tissue-driven systemic inflammation might increase the risks for the development of psoriasis and psoriatic arthritis. And excess weight loss may reduce inflammation and pain triggered in the body by extreme excesses of fat tissue, according to an NYU Langone press release on the study.

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“Factors such as older age at diagnosis of psoriasis and severity of psoriasis may be used to identify patients with a greater likelihood of improvement. Despite study limitations, we show for the first time an improvement in [psoriatic arthritis] after bariatric surgery and a possible association with surgical [excess weight loss]. Larger prospective studies are needed to further define the true effect of surgical weight loss on psoriasis and [psoriatic arthritis],” the researchers wrote.

Recent literature supports an association between psoriasis and obesity, so it makes sense to hypothesize that weight reduction may decrease psoriasis and psoriatic arthritis symptoms, Roger S. Ho, M.D., M.P.H., assistant professor of dermatology at NYU Langone Medical Center said to Dermatology Times.

“There are some small-scale, randomized-control trials that have shown that nonpharmacologic, nonsurgical weight loss interventions may improve a patient’s psoriasis, and I think this study adds to the theme that weight reduction may benefit a patient’s psoriasis symptoms,” Dr. Ho says. “I think this study, being a case-series, serves as a great springboard for future, larger-scale, longitudinal and controlled studies examining whether surgical weight loss interventions, bariatric surgeries in this case, reduce psoriasis and psoriatic arthritis symptoms and improve a psoriasis patient’s quality of life.”

Dermatologists should consider recommending lifestyle modifications for weight reduction in obese patients who have psoriasis, according to Dr. Ho.

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“However, I think it is still premature to recommend bariatric surgery as a treatment modality for psoriasis patients until larger-scale, randomized-controlled studies comparing different weight loss interventions (such as lifestyle modification, pharmacologic approach or surgical interventions) against no weight loss intervention support such a recommendation,” the dermatologist said.

The researchers presented their findings in November 2015 at the 2015 American College of Rheumatology (ACR) and the Association for Rheumatology Health Professional (ARHP) Annual Meeting in San Francisco.

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