The obese patient: what can you do?

Episode overview

The TAPAS (Talks About Patients and Science) is a digital medical education series focusing on the inflammatory burden of psoriasis and psoriatic arthritis, including multidisciplinary topics beyond dermatology and rheumatology. It is in an innovative bite-sized format to deliver a concise, central message.

Understanding how low-grade of inflammation contributes to disease and avoiding disease exacerbations by medication are critical for the management of psoriasis and PsA. How can you better strategize treatment choices for patients with obesity in your own clinical practice? Watch these videos to find out.

The conversation is spread over five parts:

1. Adipocytes: more than just fat cells
2. Obesity: the chicken or the egg?
3. The weight of the problem in the clinic
4. Biologics and obese patients, where are we?
5. Conclusion and prelude to “leaky gut”

Faculty

Podcast co-hosts:

Professor Diamant Thaçi
Director and Full Professor at the Institute and Comprehensive Center for Inflammation Medicine at the University of Lübeck in Lübeck, Germany.

Dr Richard Smith
Consultant Rheumatologist at Salisbury NHS Foundation Trust in Salisbury, Wiltshire, UK, and visiting consultant to King Edward Memorial Hospital in Port Stanley in the Falkland Islands.

Part 1: Adipocytes: more than just fat cells 
Understanding of adipocytes changed substantially in recent years. Can fat cells take on the role of the immune system? Which cytokines are specific for adipocytes? Watch this video to learn about this complex but important questions.

References:
Bernhard S, et al. J Innate Immun. 2021;13(4):225-41.
Cerman AA, et al. Br J Dermatol. 2008;159(4):820-6.
Hillyer JF. Dev Comp Immunol. 2016;58:102-18.
https://www.ecologycenter.us/flea-species/ecology-of-reproduction-and-preimaginal-development.html
Liu R, Nikolajczyk S. Front Immunol. 2019;10:1587.
Lu H-L, et al. World J Gastroenterol. 2006;12(11):1747-51.
Procaccini C, et al. Front Immunol. 2013;4:332.
Skowronek P, et al. Insects. 2021;12(6):547.
Touyz RM. Circ Res. 2005;97(12):1216-9.
Wong Y, et al. Front Immunol. 2019;10:1507.
Zhu K-J, et al. Clin Exp Dermatol. 2013;38(5):478-83.

Part 2: Obesity: the chicken or the egg?
Is there a genetic link between psoriasis and obesity? Can bariatric surgery or gastric bypass reduce the risk of developing psoriasis? This video will give you some insights.

References:
Debédat J, et al. Curr Obes Rep. 2019;8:229-42.
Egeberg A, et al. JAMA Surg. 2017;152:344-9.
Faurschou A, et al. Med Hypotheses. 2011;77:1098-101.
Kaeley GS, et al. Semin Arthritis Rheum. 2018;48:35-43.
Kumthekar A, Odgie A. Rheumatol Ther. 2020;7:447-56.
Lønnberg AS, et al. JAMA Dermatol. 2016;152:761-7.
Maglio C, et al. Obesity (Silver Spring). 2017;25:2068-73.

Part 3: The weight of the problem in the clinic
Obese or overweight patients don’t all respond to biologic treatments the same way. Listen to Prof. Thaçi’s take on this topic.

References:
Armstrong A, et al. Dermatol Ther (Heidelb). 2022;12:1055-64.
Bellinato F, et al. J Endocrinol Invest. 2022;45:1277-88.
Boehncke WH, et al. Exp Dermatol. 2011;20:303-7.
Husted JA, et al. Arthritis Care Res (Hoboken). 2011;63:1729-35.
Ji Y-Z, Liu S-R. Biosci Rep. 2019;39:BSR20193266.
Kumthekar A, Odgie A. Rheumatol Ther. 2020;7:447-56.
Pirro F, et al. Clin Drug Investig. 2021;41:917-25.
Singh S, et al. PLoS One. 2018;13:e0195123.
Wong Y, et al. Front Immunol. 2019;10:1507.
Wu JJ, et al. J Eur Acad Dermatol Venereol. 2022;36:797-806.

Part 4: Biologics and obese patients, where are we?
How does body weight impact treatment decisions? What do the clinical data tell us? Tune in to find out Dr Smith’s opinion on this topic.

References:
Björnsson ES, et al. Clin Gastroenterol Hepatol. 2015;13(3):602-8.
Curtis JR, et al. Ann Rheum Dis. 2010;69(1):43-7.
Dirven L, et al. Clin Rheumatol. 2013;32(5):585-90.
Højgaard P, et al. Rheumatology (Oxford). 2016;55(12):2191-9.
Lebwohl MG, et al. J Am Acad Dermatol. 2021;84(2):398-407.
Merola J, et al. Poster presented at AAD 2022; P33055.
Ritchlin CT, et al. RMD Open. 2022;8(1):e002195.
Singh S, et al. PLoS One. 2018;13(5):e0195123.
Ternant D, et al. Clin Pharmacokinet. 2015;54(11):1107-23.

Part 5: Conclusion and prelude to “leaky gut”
Losing weight is difficult. Are there “golden rules” that can help these patients with their lifestyle changes? Curious about how our experts motivate their patients? Watch the discussion between the speakers here, and get a sneaky peek for the next episode.

References:
Forsyth C, et al. Rheumatol Int. 2018;38(5):737-47.