Comorbidities common in MS


REPORT FROM THE 67TH AMERICAN ACADEMY OF NEUROLOGY (AAN) ANNUAL MEETING – WASHINGTON DC, APRIL 18-25, 2015 – Two Canadian studies presented at AAN 2015 focused on the common problem of comorbidities in patients with multiple sclerosis. Pain and fatigue were examined using the Health Utilities Index pain attribute score and the Fatigue Impact Scale for Daily Use (DFIS) in 949 consecutive patients recruited from four MS centres (Fiest et al. AAN 2015; abstract P1.114).

Mean aged was 48.6 years; and 72.4% had a relapsing-remitting course. Patients with one or more comorbidities were more likely to report that pain disrupted normal daily activities, and had higher fatigue scores. Pain was most disruptive among MS patients with comorbid irritable bowel syndrome, rheumatoid arthritis, and fibromyalgia. Fatigue was worse in patients with anxiety, depression and fibromyalgia.

A separate study examined records for MS patients and for the general population in the province of Manitoba for the period 1984-2011 (Marrie et al. AAN 2015; abstract P1.115). Median survival was 83.4 years in the general population and 75.9 years in the MS population. Comorbid conditions independently associated with reduced survival were diabetes, heart disease, depression, anxiety, bipolar disorder and chronic lung disease. Survival was improved in patients with comorbid migraine or autoimmune thyroid disease. Overall, 52% of deaths were attributed to non-MS causes, an indicator of the need to evaluate and manage comorbid medical conditions in MS patients.

In addition, a phenome-wide association study examined health records for 4,118 MS patients from centres in the U.S. to determine phenotypes associated with worse MS severity, as determined by the MS Severity Score (MSSS) (Zongqi et al. AAN 2015; abstract P1.118). The strongest associations with MS severity were functional bladder disorders, spasm, osteoporosis, skin ulcers, psychiatric conditions, and fatigue. Other comorbidities associated with MS severity were cardiovascular disorders (notably cardiac arrhythmia), type 2 diabetes, and metabolic disorders.

Guest Reviewer: Dr. Daniel Selchen, Head of Neurology, St. Michael’s Hospital, Toronto, Canada

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