Effect of bariatric and metabolic surgery on rheumatoid arthritis outcomes: A systematic review

Saoussen Miladi; Yasmine Makhlouf; Hiba Boussaa; Leith Zakraoui; Kawther Ben Abdelghani; Alia Fazaa; Ahmed Laatar

doi:10.1371/journal.pone.0294277

Peer Review History

Original SubmissionSeptember 16, 2023
16 Oct 2023 Decision Letter - Belal Nedal Sabbah, Editor PONE-D-23-29166Effect of bariatric surgery on Rheumatoid Arthritis outcomes: A systematic reviewPLOS ONE Dear Dr. Makhlouf, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ACADEMIC EDITOR: Dear authors, thank you for submitting this manuscript to PLOS One. The reviewers have given comments regarding your manuscript, and I suggest you address each one. Please submit your revised manuscript by Nov 30 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear authors, I read your manuscript carefully. I have few suggestions and questions and I hope addressing them, can increase the quality of your manuscript. 1- Please use the person first language and use "patients with obesity" instead of "obese patient". 2- Please clarify why you did the search for published papers between 2015 and 2022. 3- Please use "bariatric and metabolic surgery (BMS)" instead of bariatric surgery, alone. 4- Please add your searched "Keywords" to the "Search Strategy". 5- As different types of MBS have different effects and outcomes, I recommend to do a subgroup analysis between different types of MBS (sleeve gastrectomy, RYGB,.....) 6- There are other published systematic reviews on effect of BMS on other inflammatory/auto-immune diseases. I recommend to use these published papers at the beginning of discussion part to have a more broad vision on anti-inflammatory role of BMS. - Impact of prior bariatric surgery on outcomes of hospitalized patients with systemic lupus erythematosus: a propensity score-matched analysis of the U.S. nationwide inpatient sample. (doi: 10.1016/j.soard.2023.06.006) - Effect of Metabolic and Bariatric Surgery on the Clinical Course of Multiple Sclerosis in Patients with Severe Obesity: a Systematic Review. (DOI: 10.1007/s11695-023-06633-z) Reviewer #2: Dear author, This manuscript show clinical relevant. I did some comments to improve this manuscript: Introduction: It is recommended to provide more information about Rheumatoid Arthritis (RA) and how it relates to research outcomes. Clarify the research gap. Methods: It is necessary to inform the PROSPERO registration number I suggest adding new MeSH (Medical Subject Headings) terms to the search, such as "Rheumatoid arthritis", "Arthritis", "Inflammatory disease", "Immune-mediated rheumatic disease", "Obesity management", "Gastric bypass", "Gastroplasty." Update your search with these new terms. Specify which software (e.g. Mendeley, Zootero) was used for article and data extraction. Results: If one of the objectives was to examine the effect of bariatric surgery on disease activity, presentation of these data is suggested. Include information about the methodological quality of the studies in the body of the text, as it is relevant to the discussion. Consider creating a table with numerical clinical data (e.g., DAS-28, weight, BMI) before and after surgery to make it easier for readers to understand. Discussion: If the article claims that weight loss resulting from bariatric surgery is associated with improvements in RA outcomes, be sure to present this data clearly and accurately. Dedicate a section to discussing the methodological quality of the included studies. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Mohammad Kermansaravi Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0294277.r001
Revision 1
25 Oct 2023 Author Response Dear Editor, We would like to thank you for allowing us to resubmit a revised copy of this manuscript. We would also like to take this opportunity to express our thanks to the reviewers for the positive feedback and helpful comments for correction. We have revised the manuscript accordingly and provided a point-by-point response below. We hope the revised manuscript will be suitable for publication in your journal. Best regards, The corresponding author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Partly Thank you for your answer ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: N/A Thank you for your answer. Indeed, we did not conduct a metanalyses. ________________________________________ 3. Have the authors made all data underlying the findings in their manuscript fully available? Reviewer #1: No Reviewer #2: No Thank you for your remark. We added the sentence in the declaration section: All the data is fully available without restriction. ________________________________________ 4. Is the manuscript presented in an intelligible fashion and written in standard English? Reviewer #1: Yes Reviewer #2: Yes Thank you for your remark. ________________________________________ 5. Review Comments to the Author Reviewer #1: 1- Please use the person first language and use "patients with obesity" instead of "obese patient". As requested, we replaced obese patients with patients with obesity (Line 67, Line 141, line 11 discussion, Line 66 conclusion) 2- Please clarify why you did the search for published papers between 2015 and 2022. Thank you for your remark. A comprehensive search was conducted from inception until June 16th 2023. However, the included studies were published between 2015 and 2022 (Line 110). 3- Please use "bariatric and metabolic surgery (BMS)" instead of bariatric surgery, alone. As requested, we replaced bariatric surgery with bariatric and metabolic surgery (BMS) in the abstract as well as in the manuscript (Line 49-Line 51-56�63,66, 87,88,93, 111, 112, 128, 139,143, 145, 160, 164, 167, 200, 201, discussion L4,L8,L9,L24, L25, L36, L39, L67). 4- Please add your searched "Keywords" to the "Search Strategy". The keywords used were: “rheumatoid arthritis”, “bariatric surgery”, “Gastric Bypass”, “Gastroplasty”, “Patient Reported Outcome Measures”, "Blood Sedimentation", "C-Reactive Protein", “mortality” and “morbidity”. We added the keywords in the method section (LINE 104� LINE 107). 5- As different types of MBS have different effects and outcomes, I recommend to do a subgroup analysis between different types of MBS (sleeve gastrectomy, RYGB,.....) Thank you for this pertinent remark. Indeed, it would be very interesting to compare the different interventions and outcomes in RA. Unfortunately, it was not possible to perform subgroup analyses in this particular matter as the different procedures were mentioned in the descriptive data and there were no statistical analyses performed to address its relation to patient reported outcomes. Moreover, the primary outcome did not focus on the type of intervention and the design of the study was not performed in that optic. However, this represents a great subject for future trials. 6- There are other published systematic reviews on effect of BMS on other inflammatory/auto-immune diseases. I recommend to use these published papers at the beginning of discussion part to have a more broad vision on anti-inflammatory role of BMS. - Impact of prior bariatric surgery on outcomes of hospitalized patients with systemic lupus erythematosus: a propensity score-matched analysis of the U.S. nationwide inpatient sample. (doi: 10.1016/j.soard.2023.06.006) - Effect of Metabolic and Bariatric Surgery on the Clinical Course of Multiple Sclerosis in Patients with Severe Obesity: a Systematic Review. (DOI: 10.1007/s11695-023-06633-z) Thank you for your pertinent question. As requested, we highlighted the effect of BMS on author inflammatory/auto-immune diseases by adding these references at the beginning of the discussion: « The anti-inflammatory role was investigated in other diseases such as systemic lupus erythematosus and multiple sclerosis. Prior BMS was associated with an improvement in clinical course and in-hospitals outcomes compared to non-surgery (10,11) ». (Line 3-Line 6 discussion) Reviewer #2: Dear author 1- Introduction: It is recommended to provide more information about Rheumatoid Arthritis (RA) and how it relates to research outcomes. Clarify the research gap. As requested, we clarified the research gap by emphasizing the fact that obesity is responsible for maintaining disease activity in RA patients. Moreover, data on the effect of surgical interventions on obesity and patient reported outcomes are lacking in RA. Similarly, RA patients suffering from obesity were less likely to achieve remission or low disease activity (5). Indeed, adipocytokines produced by the adipose tissue maintain an inflammatory state in the synoviocytes which makes it difficult to achieve remission (6). Thus, there is a need for more stringent interventions to reduce weight in this population.(Line 82-86) 2- It is necessary to inform the PROSPERO registration number As requested, we added the registration number at the bottom of the manuscript in declarations. The study is registered (PROSPERO) CRD42023437401. 3-I suggest adding new MeSH (Medical Subject Headings) terms to the search, such as "Rheumatoid arthritis", "Arthritis", "Inflammatory disease", "Immune-mediated rheumatic disease", "Obesity management", "Gastric bypass", "Gastroplasty." Update your search with these new terms. 4-Specify which software (e.g. Mendeley, Zootero) was used for article and data extraction. As requested, we included the different Mesh words. The search was updated accordingly (Fig 1 flow chart). We specified that we used Zotero for article and data extraction. 5-If one of the objectives was to examine the effect of bariatric surgery on disease activity, presentation of these data is suggested. The evaluation of the effect of bariatric surgery on disease activity relied on acute phase reactants (ESR, CRP), disease activity scores: DAS28 ESR, DAS28 CRP, CDAI and ACR. We summarized data before and after surgey in paragraph 1.3.1 Inflammatory markers and disease activity outcomes and in Table 1. 6-Include information about the methodological quality of the studies in the body of the text, as it is relevant to the discussion. The methodological quality of the studies was high according to Newcastle Ottawa Scale (NOS) scale which was added as a supplementary data. Moreover, we added more information and detail about the methodological qualities and limitations of the studies (Line 49-Line 55). 7-Consider creating a table with numerical clinical data (e.g., DAS-28, weight, BMI) before and after surgery to make it easier for readers to understand. Regarding weight and BMI, they were added with disease activity in Table 1 as requested. 8-If the article claims that weight loss resulting from bariatric surgery is associated with improvements in RA outcomes, be sure to present this data clearly and accurately. Dedicate a section to discussing the methodological quality of the included studies. As requested, all the data regarding disease activity outcomes in RA patients was displayed in Table 1 and commented in the 1.3.1 Inflammatory markers and disease activity outcomes to facilitate the comprehension for the readers. A dedicated section discussing the methodological quality of the studies was added as requested (Line 46-Line 55). Attachments Attachment Submitted filename: response to reviewers Plos one.docx https://doi.org/10.1371/journal.pone.0294277.r002
30 Oct 2023 Decision Letter - Belal Nedal Sabbah, Editor Effect of bariatric surgery on Rheumatoid Arthritis outcomes: A systematic review PONE-D-23-29166R1 Dear Dr. Makhlouf, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Belal Nedal Sabbah Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear authors, I read your revised manuscript and your responses. I found all my comments addressed. Thank you for your revised manuscript. Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Mohammad Kermansaravi Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0294277.r003
Formally Accepted
7 Nov 2023 Acceptance Letter - Belal Nedal Sabbah, Editor PONE-D-23-29166R1 Effect of bariatric and metabolic surgery on Rheumatoid Arthritis outcomes: A systematic review Dear Dr. Makhlouf: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Belal Nedal Sabbah Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0294277.r004

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