Expert: Jacqueline Jacques, ND - 11/15/2008

Question
I had bypass surgery 7 years ago and have been diagnosed with both osteoarthritis and rheumatoid arthritis which are advancing rapidly.  Is there a correlation between the surgery and autoimmune problems?  Is is safe to be taking NSAIDS, plaquenil and methotrexate or can such a combination accelerate malabsorption?  Are there any rheumatologists in the New York/New Jersey metropolitan area who treat gastric bypass patients?

Answer
Judi,

As I am an nutrition expert, I am really not the best person to answer this question.  I do not know of any research linking weight loss surgery to autoimmune disorders, but I do know that several of the drugs you mention here can have serious side effects both nutritionally and otherwise.  Typically NSAIDS are contraindicated after a gastric bypass.  I would suggest that you start with a consult with your surgeon.  I would also ask him/her for an referral to a rheumatologist - as many WLS patients have arthritis, it would be likely that they already have someone they work with.

Nutritionally for these drugs, I would be most concerned about iron, folic acid and vitamin C.  You are most likely already taking these on a daily basis, but with methotrexate you may need as much as 5mg folic acid to prevent deficiency.  This requires a prescription, and would usually be provided by the rheumatologist.

Please let me know if I can assist further.

In Health,

Dr. Jacques