The incidence and prevalence of comorbid gastrointestinal, musculoskeletal, ocular, pulmonary, and renal disorders in multiple sclerosis: A systematic review

Abstract

Background:As new disease-modifying therapies emerge a better knowledge of the risk of comorbid disease in multiple sclerosis (MS) is needed.Objective:To estimate the incidence and prevalence of comorbid gastrointestinal, musculoskeletal, ocular, pulmonary, and renal disorders in MS.Methods:We systematically reviewed the world literature by searching PUBMED, EMBASE, SCOPUS, the Web of Knowledge, and reference lists of retrieved articles. For selected articles, one reviewer abstracted data using a standardized form. The abstraction was verified by a second reviewer. The quality of all selected studies was assessed. For population-based studies we quantitatively assessed studies using the I2 statistic, and conducted random effects meta-analyses.Results:Study designs were heterogeneous with respect to populations, case definitions, and methods of ascertainment. Incidence of the studied comorbidities was rarely reported. Irritable bowel syndrome and chronic lung disease had a prevalence of more than 10% in the MS population. Irritable bowel syndrome, fibromyalgia, cataracts and glaucoma were more common than expected in the MS population.Conclusion:Although they have been the subject of less study than other comorbidities, irritable bowel syndrome, arthritis, and chronic lung disease are common in the MS population and occur more often than expected when compared to the general population.

Total Hip and Knee Arthroplasty in Patients with Multiple Sclerosis

“…2 Patients with MS are also prone to musculoskeletal comorbidity, with prevalence estimates ranging from 13.7% to 54.3%. 3 Surgical selection in patients with MS who are considering arthroplasty is complicated by general debility, which may interfere with rehabilitation, and by spasticity, which may affect the longevity of the hip or knee prosthesis. 4 Moreover, immunomodulatory and immunosuppressive medications for MS may impair healing and lead to higher infection rates.…”

“…Prevalence estimates of knee replacement in MS range from 1% to 1.5% and of hip replacement, from 0.5% to 1.5%. 3 To our knowledge, a systematic review of outcomes of knee and hip replacements in persons with MS has not been performed. The literature is limited to case reports and case series that focus on adverse events, [4][5][6][7][8] such as a series of four patients with MS with knee replacement, all of whom required repeated operation for aseptic failure or instability.…”

The multiple sclerosis microbiome?

“…However, the cases had longstanding MS (average disease duration =12.8 years), were older than controls (by >7 years) and included more men (32% vs. 14%, respectively). Despite these differences, some findings may be informative while others may be a consequence of physiological changes related to MS. For instance, the methane producing Methanobrevibacter are associated with constipation and irritable bowel syndrome (4), and may indicate underlying bowel dysfunction which is common in MS (5). Future studies could assess gut transit times to help tease out the direction of this relationship.…”

Autoimmune Comorbidities Are Associated with Brain Injury in Multiple Sclerosis

“…[5][6][7][8][9][10][11][12][13][14] Examples of the most frequent comorbidities or secondary disorders that co-occur with MS include thyroid disease, rheumatoid arthritis, psoriasis, cardiovascular disorders, depression and anxiety, diabetes mellitus, chronic lung disease, and irritable bowel syndrome, among others. [4][5][6][8][9][10]14,15 The pathogenesis of these associations with MS is unclear at this time but may be linked to a genetic predisposi-tion, 5,16,17 the presence of a chronic inflammatory condition, 10 environmental factors, 18 and the use of disease-modifying therapy. 19 It has been postulated that CD4ϩ T-cells of the Th1 phenotype, CD8ϩ T-cells, and B-cells play a key role in focal and diffuse destruction of the CNS in patients with MS. 20 The immune deviation of CD 4ϩ T-cells into Th1 and Th2 phenotypes has been the subject of many immunologic and epidemiologic studies in MS. 21,22 In particular, it has been reported that Th1 responses associated with autoimmunity may be attenuated by a Th2 shift.…”