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14-01-2021 | Rheumatology | News | Article

Support for bariatric surgery in obese people with gout

Claire Barnard

medwireNews: Bariatric surgery is associated with a significant decrease in bodyweight and serum uric acid (SUA) levels among people with obesity, with particularly pronounced reductions in those with hyperuricemia and gout, researchers report.

These findings suggest that “[g]out may be considered as an indicator for this surgical treatment in people with severe obesity,” say Jine Lu, from The Second People’s Hospital of Qujing City in China, and colleagues.

The team reviewed data from 147 obese patients with an average age of 36 years who underwent bariatric surgery at the hospital between 2014 and 2019. Overall, mean bodyweight decreased significantly from 95.2 kg at baseline to 64.3 kg at the 1-year follow-up, while mean SUA decreased from 419.0 to 327.9 µmol/L.

Lu and team say that the 55 patients with hyperuricemia and the 25 with gout “tended to have higher body weight and SUA at baseline” and greater reductions in both measures over the 1-year period compared with other patients. Specifically, the average decrease in bodyweight was 31.9 kg in people with hyperuricemia and 38.2 kg in those with gout, compared with 26.8 kg in other patients (from baseline values of 97.7, 108.7, and 88.6 kg, respectively); the average reductions in SUA levels were 99.9 and 163.6 versus 27.2 µmol/L, respectively (from corresponding baseline values of 476.6, 544.3, and 322.0 µmol/L).

All gout patients included in the study had SUA levels above the therapeutic target (360 µmol/L) at baseline, but 40% achieved SUA levels below this target at the 1-year follow-up.

Therefore, bariatric surgery “can dramatically reduce the SUA below the therapeutic target in 12 months,” write the researchers in Rheumatology.

They note that while bodyweight decreased steadily over the study period, average SUA levels “decreased rapidly” from 419.0 to 308.4 µmol/L in the first 7 days after surgery, followed by an increase to 444.8 µmol/L at 1 month and a gradual decrease thereafter.

“[I]t is well known that an effective urate lowering therapy may cause crystals to be shed back to the bloodstream and hence lead to the temporal increase of SUA and trigger acute attacks [and] the flare-up of SUA observed in this study within a month may be related to this mechanism,” speculate the researchers.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

Rheumatology 2021; doi:10.1093/rheumatology/keaa822

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