MS patients often have other chronic medical problems — known as comorbidities — at the time of diagnosis. In a recent study, investigators examined the records of 23,382 Canadian MS patients and 116,638 matched controls to determine how common other chronic conditions are at the time of MS diagnosis.
The results were published last month in Neurology, the official journal of the American Academy of Neurology. The study, led by Dr. Ruth Ann Marrie, found that eight medical conditions including fibromyalgia, inflammatory bowel disease, and epilepsy, are more common in newly diagnosed MS patients than in the non-MS population. Psychiatric comorbidities, specifically depression, anxiety, and bipolar disease are also more common.
Compared with the control group, all comorbidities except hyperlipidemia (high cholesterol) were more common in the MS group. Other studies have found that some other inflammatory conditions, for example rheumatoid arthritis and gout, also have higher rates of comorbidities.
Depression is a recognized comorbidity in established MS. Estimates are that 60 percent of the MS population will experience major depression over the course of the disease. However, in this study, depression and anxiety were also significant at the time of diagnosis, particularly people of the ages 20-44. Depression and anxiety have significant impact on patients’ quality of life, adherence to treatment, and risk of hospitalization.
The investigators also found that there were differences in comorbid conditions among men and women. Women with MS had a higher prevalence of chronic lung disease and men with MS had higher prevalence of hypertension, diabetes, epilepsy and all psychiatric comorbidities that were included in the study. The reasons for these differences are not clear but may be due to hormonal effects.
The presence of comorbidities can affect both the diagnosis and management of MS. This study and previous research all suggest that comorbidities can be associated with delays in MS diagnosis, poorer outcomes and quality of life, greater disability at the time of MS diagnosis, and increased risks of disability progression. People with multiple health problems may have a more difficult disease course. The presence of comorbidities can also influence the selection of disease-modifying treatments. Therefore, it is very important for to properly diagnosis and effective treat these conditions from the outset.
While comorbidities appear to impact the disease course, many questions remain, including whether MS and any of these comorbid conditions have common risk factors or biology. This is an ever-growing area of epidemiological research interest and there are substantial gaps in our knowledge.
“This study highlights the importance of thinking about the impact of all that’s going on in your life, not just your MS,” explains Pat Daily, RMMSC Director of Counseling and Support Services. “It’s important to be attentive to all of those things, talk with your doctor about other health problems that you are having so that they can be properly treated.”