Expert: John Pilcher, MD - 1/27/2012

Question
I am 37 years old and I was just diagnosed with RA.  I have been considering having VSG for the last year and have decided to go through with it.  My doctor doesn't even want to discuss this option with me.  I am 5'2 and 200 lbs.  I suffer from High Blood Pressure, GERD, and I have a hiatal hernia.  I am overall miserable with very low energy.  It has been very hard to exercise because of the RA so I am limited on what I can do.  Because of all the co-morbids and overall poor quality of health.  I figure if I can loose weight it will help my symptoms over all.  My concern is my body's healing process, I know any surgery is a risk but will RA cause my body to attack the staple site and cause me not to heal properly after surgery.  Am I at higher risk of catching pneumonia after surgery?

Answer
Shawn,
First of all, you are absolutely correct that surgical weight loss will lead to a significant reduction in your RA symptoms. It is not expected that a Sleeve will 'cure' RA, but there is a strong correlation between obesity and an elevated inflammatory state throughout the body; this means that significant weight reduction should realistically lead to decreased severity of RA symptoms.

Sleeve should help your hypertension and energy level. Most surgeons do repair hiatal hernias at the time of Sleeve surgery. The impact of Sleeve on GERD is uncertain; Sleeve does not seem to worsen reflux but it does not really make it better.

The interaction of the RA and surgical recovery is interesting. I am not aware of any cases where RA or any other autoimmune disease has created a reaction against the staples. However, a number of meds that are commonly used for RA treatment do interfere with healing and with the body's natural ability to fight infection. In other words, medications may increase the risk of leak or pneumonia or other infection, and some meds should be reduced or held for an extended period of time (if possible) to avoid a risk increase. The exact management of meds should be coordinated with your surgeon and your rheumatologist, but some common meds that cause concern for surgeons include steroids such as prednisone, and targeted immuned meds such as Remicaide, Enbrel, Humira, and Rituxan.

Best of luck to you!