Comorbidity in Multiple Sclerosis

Abstract

Comorbidities in patients with multiple sclerosis (MS) has become an area of increasing interest in the recent years. A comorbidity is defined as any additional disease that coexists in an individual with a given index disease and that is not an obvious complication of the index disease. The aim of this review is to describe the current evidence regarding the range of comorbidities in the population with MS reported in different countries and the current knowledge about the influence of comorbidities on the clinical features and therapeutic challenges in MS. Certain comorbidities are more prevalent in people with MS such as depression, anxiety, cerebro-and cardiovascular diseases, and certain autoimmune disorders such as diabetes, thyroid disease, and inflammatory bowel disease. A previous perception of a trend toward a lower overall risk of cancer in patients with MS appears to be challenged, but there is no evidence on any higher occurrence of malignancies in the population with MS. Comorbidities may modify the clinical presentation of MS, and have implications for treatment choice, adherence, and outcome. Several comorbid conditions are associated with increased disability progression, including diabetes, hypertension, and chronic obstructive pulmonary disease. Comorbidities are common in MS from the time of diagnosis and may account for some of the heterogeneity observed in MS, including diagnostic delay, clinical presentation, degree of disability progression, rate of health care utilization, working ability, employment status, and quality of life. Coexisting diseases and polypharmacy increase the complexity of patient management and poses major challenges, particularly with the increasing number of immunosuppressive disease-modifying therapies.

The Nerves to Conduct a Multiple Sclerosis Crime Investigation

“…For a complex disease like MS, individual drugs have proven to be ineffective for management and treatment and have failed to inhibit MS progression. A multimodal approach may be more effective at addressing complex chronic diseases, including MS and its comorbidities [ 123 ]. Administering a pro-remyelinating drug may not be as efficacious for long-term use without reducing recurring chronic inflammation.…”

“…It is likely that microbiota composition plays an influential role in MS pathogenesis. Correcting intestinal dysbiosis may also improve cognitive behaviour and depression [ 127 ], which is a common symptom of MS [ 123 , 128 ]. Therefore, future treatments should consider how disease-modifying treatments (DMTs) can be combined with therapies targeted at the microbiota.…”

The Nerves to Conduct a Multiple Sclerosis Crime Investigation

“…It is likely that microbiota composition plays an influential role in MS pathogenesis. Correcting intestinal dysbiosis may also improve cognitive behaviour and depression [127], which is a common symptom of MS [123,128]. Therefore, future treatments should consider how disease-modifying treatments (DMTs) can be combined with therapies targeted at the microbiota.…”

A study on prevalence of various mood disorders in patients with multiple sclerosis in South Indian population Chennai, Tamil Nadu

“…6,7 30.5% was observed by Boeschoten and 23.7% by Magyari et al in their systematic review studies. 8,9 Saba Karimi et al reported 47.1% in 87 patients in a cross sectional study. 10 Kessler et al, Kovacs et al and Simpson et al reported that the incidence in women gender are more vulnerable when compared to men at the time of first episode.…”