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Cristina Maglio Group

Cristina Maglio is a resident physician in Rheumatology with research time within Wallenberg Centre.

Obesity is a burden for western countries and its prevalence is dramatically increasing in the last decades. Overweight and obesity increase the risk of developing several diseases that impair quality of life and lead to increased mortality. Obesity is known to be associated with a low-grade systemic inflammatory state and it has been hypothesized that obesity-related inflammation may be implicated in the pathogenesis of rheumatic inflammation. Moreover, obesity is a risk factor for various rheumatic diseases including gout, psoriatic arthritis and rheumatoid arthritis. Several obesity-related comorbidities improve after weight loss. Bariatric surgery is the most effective treatment to achieve weight loss and to lower the risk of developing several diseases including type 2 diabetes, cardiovascular disease and cancer.

Aim of this research project is to study the effect of bariatric surgery-induced weight loss on the risk of developing rheumatic diseases in obese subjects. To answer this research question, we will exploit the potential of the Swedish Obesity Subjects (SOS) study. The SOS study is a large trial started in the 80’s which includes participants from all over Sweden and its headquarters is set at the University of Gothenburg. The study aims to investigate the effect the effect of bariatric surgery on obesity-associated morbidity and mortality compared to conventional treatment. The trial includes 4047 individuals who have been followed-up for up to 25 years. Prof. Lena Carlsson is the current leader of the SOS study.

Previous results

Gout is an inflammatory arthritis caused by monosodium urate crystal deposition in the joints and its precursor is hyperuricemia (i.e. high serum uric acid levels). We have recently shown that bariatric surgery decreases the incidence of gout up to 25 years of follow up in obese participants of the SOS study (Maglio C et al, Annals of the Rheumatic Diseases 2016). Furthermore, we have shown that obese subjects undergoing bariatric surgery have lower serum uric acid levels and a lower chance to develop hyperuricemia during follow up.

Bariatric surgery and the risk of psoriatic arthritis and rheumatoid arthritis

Obesity is a risk factor for both psoriatic arthritis and rheumatoid arthritis. Psoriatic arthritis is characterized by chronic joint and soft tissue inflammation and affects up to one third of subjects with cutaneous psoriasis. A retrospective study has recently shown that gastric bypass, a common type of bariatric procedure, reduces the incidence of psoriasis and psoriatic arthritis (Egeberg A et al, JAMA Surg 2016). Rheumatoid arthritis is a common rheumatic disorder that affects primarily the joints. A recent study in a small cohort of obese patients with rheumatoid arthritis shows that disease activity and serum inflammatory markers are significantly reduced after bariatric surgery-induced weight loss (Sparks JA et al, Arthritis Care Res 2015). We hypothesize that obese subjects undergoing bariatric surgery have a lower risk of developing psoriatic arthritis and rheumatoid arthritis during follow up. By screening of the Swedish National Patient Register, we will identify all cases of incident psoriatic arthritis or rheumatoid arthritis occurred during follow up in participants of the SOS study. The incidence of psoriatic arthritis and rheumatoid arthritis will be then compared between the control and surgery group.

We also aim to study the interaction between bariatric surgery and genetic background on the risk of developing psoriatic arthritis and rheumatoid arthritis in obese individuals. Genetic predisposition plays an important role in the development of both conditions. Although several genome wide association studies have identified a plethora of genetic variants associated with an increased risk for psoriatic arthritis or rheumatoid arthritis, the contribution of those variants in the pathogenesis of those conditions in obese subjects is unknown. Moreover, the interaction between voluntarily weight loss and those genetic variants on the risk of developing rheumatic diseases has never been studied. We hypothesize that bariatric surgery interacts with the genetic background and diminish the natural risk conferred by genetic variants commonly associated with an increased risk for psoriatic arthritis and rheumatoid arthritis.

Finally, we aim to study the effect of bariatric surgery on the natural history of psoriatic arthritis and rheumatoid arthritis. Only participants of the SOS study who developed psoriatic arthritis and rheumatoid arthritis during a 25-year follow up will be included in the analyses. Disease progression and treatment response will be assessed by a multiple approach including review of the medical records, screening of the Swedish Rheumatology Quality (SRQ) Register and of the Swedish Prescribed Drug Registry as well as measurement of serum factors. We hypothesize that obese subjects with a diagnosis of inflammatory arthritis who have undergone bariatric surgery have a milder disease, a better response to treatment and lower pain and disability compared to obese subjects suffering from the same conditions.

We Are Seeking Outstanding Researchers

Contact Information

Cristina Maglio

cristina.maglio@vgregion.se

Page Manager: Pontus Sundén|Last update: 5/12/2017
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