Unfair as it seems, MS doesn’t keep
other disorders away. It’s possible to have MS and “something else” at the same
time. A new international initiative is being launched to understand how common
it is for people with MS to have other conditions and how these other
conditions may impact the course and treatment of an individual’s MS. The first
stage of this project is now published, in preparation for an international
scientific workshop jointly supported by the National MS Society and the
European Committee for Treatment and Research in MS (ECTRIMS) to focus
attention on comorbidities and determining next steps to finding solutions for
people with MS.
Background: In scientific terms, having two chronic
medical conditions at once is called “comorbidity.” There is growing recognition
that comorbidities may complicate the diagnosis of MS and also influence
disease progression, as well as an individual’s wellness and quality of
life. In addition MS some other disorders may have risk factors in
common. For these reasons, the MS Comorbidities Project is seeking to
characterize the types and frequencies of comorbidities in MS in advance of a
scientific meeting to map out next steps for research strategies to address
this gap area. This project is being undertaken by the International Advisory Committee on Clinical Trials in MS,
a committee comprised of international leaders in MS research and clinical care
that is jointly supported by the National MS Society and ECTRIMS.
The first phase of this project was a
systematic review of existing published studies related to specific medical
conditions in people who have MS. Ruth Ann Marrie, MD, PhD (University of
Manitoba) and colleagues* in Denmark, Italy and the U.S., now report
their findings in seven papers published in the MS Journal. (Read overview and companion papers;
no subscription is needed.) The review was supported in part by the National MS
Society (U.S.A.) and a Don Paty Career Development Award from the MS Society of
Canada.
Review Results: The authors identified more than 7,000
studies on a variety of comorbidities and MS, and narrowed these down,
completing a full-text review of 249 studies that were conducted between 1905
and 2012. Most were conducted in North America or Europe, leading the authors
to comment that little is known about comorbidities that occur with MS in
Central or South America, Asia, or Africa. In addition, the quality and design
of the studies were so variable that it was difficult to compare results.
Nevertheless, their extensive research yielded these highlights, among many
others:
• The five most prevalent disorders occurring alongside MS were depression, anxiety, high blood pressure, high cholesterol, and chronic lung disease.
• The most prevalent autoimmune diseases occurring with MS were thyroid disease and psoriasis.
• The types of cancer that occurred most often in people with MS were cervical, breast, and digestive system cancers. There appeared to be a higher than expected risk of meningiomas and urinary system cancers, and a lower than expected risk of pancreatic, ovarian, prostate and testicular cancer, compared to the general population.
• Some disorders were found more often than expected by the investigators based on previous research, such as heart disease, congestive heart failure, stroke, arthritis, inflammatory bowel disease, irritable bowel syndrome, seizure disorders, bipolar disorder, sleep disorders, and alcohol abuse.
• The five most prevalent disorders occurring alongside MS were depression, anxiety, high blood pressure, high cholesterol, and chronic lung disease.
• The most prevalent autoimmune diseases occurring with MS were thyroid disease and psoriasis.
• The types of cancer that occurred most often in people with MS were cervical, breast, and digestive system cancers. There appeared to be a higher than expected risk of meningiomas and urinary system cancers, and a lower than expected risk of pancreatic, ovarian, prostate and testicular cancer, compared to the general population.
• Some disorders were found more often than expected by the investigators based on previous research, such as heart disease, congestive heart failure, stroke, arthritis, inflammatory bowel disease, irritable bowel syndrome, seizure disorders, bipolar disorder, sleep disorders, and alcohol abuse.
Comment: The authors suggest that further work
is necessary to develop data sources that examine MS comorbidities worldwide,
and that are specific to individuals of different ages, genders, and
ethnicities. They also conclude that efforts should be coordinated so that
methodologies are similar and results can be compared.
To this end, the Society and ECTRIMS
are convening a workshop that will move this research forward. The
International Advisory Committee on Clinical Trials in MS and other experts in
MS research will meet in spring 2015 to discuss next research steps, such as
available data that may facilitate further research and which comorbidities
demand more immediate focus.
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