Evaluating the long-term safety and disease-modifying potential of metabolic surgery in patients with rheumatoid arthritis: a TriNetX cohort study.

BACKGROUND

Obesity and rheumatoid arthritis (RA) are chronic, often coexisting conditions that compound clinical complexity. Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity, but its long-term safety and impact on RA disease control are not well defined.

OBJECTIVES

To evaluate the long-term safety (≤5 years) and potential disease-modifying effects of MBS in patients with RA.

SETTING

Multicenter, retrospective cohort study using the TriNetX global federated health research network across multiple healthcare institutions worldwide.

METHODS

Adults (≥18 years) who underwent MBS between 2010 and 2024 were identified. Three cohorts were created: RA with MBS, RA without MBS, and MBS without RA. Propensity score matching was performed using demographic and comorbidities. Primary outcomes included long-term safety, nutritional complications, and RA disease-modifying indicators such as medication use and inflammatory markers.

RESULTS

One thousand nine-hundred thirty-one patients with RA who underwent MBS were matched 1:1 with controls. Patients with RA experienced higher nutritional complications including vitamin D (52.4% versus 42.7%), B12 (18.0% versus 14.0%), and iron deficiency (11.5% versus 8.5%). Sleeve gastrectomy was associated with fewer complications than Roux-en-Y gastric bypass. Postoperatively, patients with RA showed significant reductions in use of corticosteroids (34.3% versus 53.6%), tumor necrosis factor inhibitors (6.3% versus 14.5%), and disease-modifying antirheumatic drugs (9.7% versus 31.6%), along with lower inflammatory makers levels. Five-year mortality was lower in the RA surgical group (1.8% versus 3.8%).

CONCLUSIONS

MBS in patients with RA is associated with improved disease control and reduced mortality, though higher nutritional risks warrant careful postoperative monitoring and multidisciplinary care.