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Topics:
General Internal Medicine • Rheumatology • Osteoarthritis • General Rheumatology • General Primary Care
When do you prefer bariatric surgery such as sleeve gastrectomy or gastric bypass over an initial trial of a GLP-1 receptor agonist in patients with severe obesity and painful knee or hip osteoarthritis?
This question is part of our collaboration with ACR Convergence 2025 to preview a session from this year's meeting. This question is inspired by the upcoming session "GLP1 Agonists in Rheumatic Disease and Osteoarthritis: Should We Give Them to Everyone?" by Dr. C. Thomas Appleton and Dr. @Francis Berenbaum.
Answer from: at Community Practice
I believe that this type of decision should be made by obesity specialists and not by rheumatologists. However, we can anticipate that the patient's choice is paramount: some prefer radical options such as surgery, while others cannot bear to hear about it. The decision should only be made through d...
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Answer from: at Community Practice
I do discuss evidence that GLP-1 drugs also reduce inflammation, and there is a suggestion that they reduce OA pain potentially by more than just producing weight loss. I have been advising OA patients with significant obesity to try these drugs (but discuss with PCP as well).