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Musculoskeletal Symptoms Improve After Gastric Bypass


 

CHICAGO — Musculoskeletal symptoms are very common in the morbidly obese, but improve significantly as early as 6 months after gastric bypass surgery, Michele Hooper, M.D., said at the 2004 World Congress on Osteoarthritis.

In a study of 48 consecutive patients, 52% had complete resolution of musculoskeletal symptoms, in weight bearing and non-weight bearing sites, 6 months after surgery. Fibromyalgia symptoms resolved in 90% of patients.

Such benefits may even become more pronounced with time, as weight loss generally plateaus at 24 months and many of the patients were still obese at the time of the study.

While these highly motivated patients may not reflect the general obese population, the benefits seen with weight loss indicate that prevention and treatment of obesity could improve musculoskeletal health and function, said Dr. Hooper of University Hospitals of Cleveland.

She reported on 47 women and one man, mean age 44 years, who were evaluated before and 6 months after laparoscopic or open Roux-en-Y surgery.

The mean weight of the women before surgery was 292 pounds (body mass index 51 kg/m

The percentage of patients with comorbid conditions at baseline decreased after weight loss: hypertension (52% vs. 14%), sleep apnea (46% vs. 14%), depression (33% vs. 14%), gastroesophageal reflux disease (31% vs. 11%), type 2 diabetes (30% vs. 7%), and asthma (30% vs. 7%). Ninety percent of fibromyalgia symptoms resolved.

The dramatic resolution of fibromyalgia symptoms may be due to a decrease in comorbid syndromes, particularly depression, and an increase in physical activity, Dr. Hooper said at the meeting, which was sponsored by the Osteoarthritis Research Society International.

Lower extremity musculoskeletal symptoms improved with weight loss, with the exception of hip and trochanteric bursitis complaints.

Upper extremity symptoms improved, with the exception of epicondylitis.

The proportion of patients affected by symptoms decreased significantly as follows: knee symptoms (75% at baseline vs. 44% after weight loss); ankle/foot (46% vs. 8%); shoulder (40% vs. 27%); lumbar spine (38% vs. 15%); hand (35% vs. 21%); carpal tunnel syndrome (31% vs. 15%); hip joint (23% vs. 15%); trochanteric bursitis (29% vs. 17%); and epicondylitis (13% vs. 4%).

At 6 months, scores on the Western Ontario and McMaster University Osteoarthritis (WOMAC) composite index improved 67% from baseline. WOMAC subscales improved for pain (51%), function (74%), and stiffness (64%).

Short Form-36 Health Survey scores significantly improved in seven of eight domains measured, and the remaining one domain, general health, was close to normal at baseline.

“The WOMAC osteoarthritis index offers significant potential for assessing musculoskeletal outcomes in obese subjects after gastric bypass surgery, and should be explored further,” Dr. Hooper said.

“The SF indicates that obesity is associated with a poor quality of life, which improves significantly after weight loss associated with gastric bypass surgery.”

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