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Cheng T, Mao X, Hao L. Multiple sclerosis is associated with adverse outcomes following hip and knee arthroplasty: A systematic review and meta-analysis of observational studies. Mult Scler Relat Disord 2023; 79:104956. [PMID: 37660457 DOI: 10.1016/j.msard.2023.104956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/05/2023] [Accepted: 08/20/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The association of multiple sclerosis (MS) with joint diseases has been established. However, the impact of MS on postoperative outcomes following total joint arthroplasty (TJA) remains controversial. Therefore, a systematic review of the literature is warranted to ascertain the relationship between MS and adverse outcomes post-TJA. METHODS A systematic literature search of PubMed, Embase, Scopus, and the Cochrane Library from inception to 1 March 2023 was conducted to identify observational studies comparing post-TJA outcomes in MS and non-MS patients. Two investigators independently screened titles, abstracts, and full-text articles for eligibility. A random-effects model was used to calculate odds ratios (OR), mean differences (MD), and corresponding 95% confidence intervals (CI). RESULTS Seven retrospective cohort studies published between 2018 and 2022 met the inclusion criteria. Patients with MS had a higher risk of medical, surgical, and overall complications than patients without MS. Similarly, the MS group was more likely to experience an extended hospital stay, non-home discharge, and revision surgery compared to the control group. Joint infection and implant instability were also more common in patients with MS. CONCLUSION Although TJA may benefit MS patients, current evidence suggests that their postoperative outcomes may be inferior to those of non-MS patients. Thus, orthopaedic surgeons should inform MS patients of potential risks and perform preoperative optimization individually when considering elective arthroplasty.
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Affiliation(s)
- Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.600 Yishan Road, Shanghai 200233, The People's Republic of China.
| | - Xin Mao
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.600 Yishan Road, Shanghai 200233, The People's Republic of China
| | - Liang Hao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, No.1 Minde Road, Nanchang 330006, The People's Republic of China.
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2
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López-Pingarrón L, Almeida H, Soria-Aznar M, Reyes-Gonzales MC, Rodríguez-Moratinos AB, Muñoz-Hoyos A, García JJ. Interstitial Cells of Cajal and Enteric Nervous System in Gastrointestinal and Neurological Pathology, Relation to Oxidative Stress. Curr Issues Mol Biol 2023; 45:3552-3572. [PMID: 37185756 PMCID: PMC10136929 DOI: 10.3390/cimb45040232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
The enteric nervous system (ENS) is organized into two plexuses-submucosal and myenteric-which regulate smooth muscle contraction, secretion, and blood flow along the gastrointestinal tract under the influence of the rest of the autonomic nervous system (ANS). Interstitial cells of Cajal (ICCs) are mainly located in the submucosa between the two muscle layers and at the intramuscular level. They communicate with neurons of the enteric nerve plexuses and smooth muscle fibers and generate slow waves that contribute to the control of gastrointestinal motility. They are also involved in enteric neurotransmission and exhibit mechanoreceptor activity. A close relationship appears to exist between oxidative stress and gastrointestinal diseases, in which ICCs can play a prominent role. Thus, gastrointestinal motility disorders in patients with neurological diseases may have a common ENS and central nervous system (CNS) nexus. In fact, the deleterious effects of free radicals could affect the fine interactions between ICCs and the ENS, as well as between the ENS and the CNS. In this review, we discuss possible disturbances in enteric neurotransmission and ICC function that may cause anomalous motility in the gut.
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Affiliation(s)
- Laura López-Pingarrón
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Henrique Almeida
- i3S-Instituto de Investigação e Inovação em Saúde, Porto University, 4200-135 Porto, Portugal
- Department of Biomedicine, Faculty of Medicine, Porto University, 4200-319 Porto, Portugal
- Department of Obstetrics and Gynecology, Hospital-CUF Porto, 4100-180 Porto, Portugal
| | - Marisol Soria-Aznar
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Marcos C Reyes-Gonzales
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | | | - Antonio Muñoz-Hoyos
- Department of Pediatrics, Faculty of Medicine, University of Granada, 18016 Granada, Spain
| | - Joaquín J García
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
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Hovanesian J, Singh IP, Bauskar A, Vantipalli S, Ozden RG, Goldstein MH. Identifying and addressing common contributors to nonadherence with ophthalmic medical therapy. Curr Opin Ophthalmol 2023; 34:S1-S13. [PMID: 36951648 DOI: 10.1097/icu.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
PURPOSE OF REVIEW To discuss common reasons for nonadherence and review existing and emerging options to reduce nonadherence with ocular medical therapy and optimize therapeutic outcomes. RECENT FINDINGS Nonadherence can arise from patient-related issues (e.g. physical, cognitive) and healthcare-related issues (e.g. cost, access to care). Multiple strategies have been developed and evaluated to overcome these barriers to adherence. Identifying nonadherence and its cause(s) facilitates the development of strategies to overcome it. SUMMARY Many common causes of nonadherence can be mitigated through a variety of strategies presented.
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Affiliation(s)
| | - I Paul Singh
- The Eye Centers of Racine and Kenosha, Racine, Wisconsin
| | - Aditi Bauskar
- Ocular Therapeutix, Inc., Bedford, Massachusetts USA
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Jahromi SR, Martami F, Morad Soltani K, Togha M. Migraine and obesity: what is the real direction of their association? Expert Rev Neurother 2023; 23:75-84. [PMID: 36714917 DOI: 10.1080/14737175.2023.2173575] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION In recent decades, studies have addressed the issue of how migraine and obesity are related and have suggested obesity as a risk factor for migraine headache. However, the exact direction of this relationship remains under debate. In this review, the authors summarize the evidence that have suggested migraine as a risk factor for obesity and overweightness. AREAS COVERED This article reviews the results of the previous research published on PubMed and Scopus databases (from 2000 to 2020) concerning the association between migraine and obesity to determine the actual direction of their association. Special attention has been given to the common mechanistic pathways involved in the pathophysiology of migraine and obesity. EXPERT OPINION The majority of research conducted thus far has considered obesity as a risk factor for migraine. However, because of the cross-sectional design of available research, we cannot be certain of the proposed direction of this association. There is evidence supporting the hypothesis that obesity can serve as a consequence of migraine through the effects of neuropeptides, inflammatory mediators, adipokines, gut microbiota and modifications in eating behavior and lifestyle. However, the real direction of the relationship between migraine and obesity should be further investigated in large prospective studies.
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Affiliation(s)
- Soodeh Razeghi Jahromi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Martami
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Morad Soltani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Togha
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Alugba G, Urhi A, Olateju IV, Onyemarin H, Uzzi C, Oshiba-Fowode T, Obomanu E, Popoola HA, Okoronkwo EJ, Ukenenye E, Asaolu G, Oladunjoye AF, Oladunjoye O. Renal diseases associated with multiple sclerosis: A narrative review. Medicine (Baltimore) 2022; 101:e31959. [PMID: 36482579 PMCID: PMC9726425 DOI: 10.1097/md.0000000000031959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The mechanisms of renal pathology in multiple sclerosis (MS) can be related to the disease itself or its treatment. Although kidney disease can be associated with MS, not much has been reported in the literature; hence, our study aimed to describe the prevalence and types of renal diseases and discuss their prognosis in patients with MS. A literature search (2012-2022) was performed using the Scale for the Assessment of Narrative Review Articles. The databases searched included MEDLINE (PubMed) and EMBASE. Fourteen articles from these databases met the inclusion criteria. The inclusion criteria were as follows: publications with full-text access. Articles published in English. Original articles related to renal diseases in MS. The prevalence of renal diseases in MS from the articles obtained ranged from 0.74% to 2.49%. Interferon beta (IFN-β)-associated glomerulonephritis was common among the reviewed articles. Significant improvement and resolution of the pathology were observed after the discontinuation of the offending medication. Renal symptoms in 2 out of 4 cases with renal thrombotic microangiopathy (TMA) induced by interferon-beta progressed to chronic kidney disease, even after the drug was stopped. Other studied renal pathologies included nephrolithiasis secondary to urinary retention and urinary catheter use in patients with MS.
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Affiliation(s)
- Gabriel Alugba
- Delta State University, Abraka, Nigeria
- * Correspondence: Gabriel Alugba, Delta State University, P.M.B 1 Abraka, Delta State, Nigeria (e-mail: )
| | | | | | | | | | | | - Elvis Obomanu
- Department of Medicine, University of Portharcourt, Choba, Nigeria
| | | | | | - Emmanuel Ukenenye
- Medical Council of Jamaica, University of the West Indies, Kingston, Jamaica
| | - Gideon Asaolu
- Medical Council of Jamaica, University of the West Indies, Kingston, Jamaica
| | | | - Olubunmi Oladunjoye
- Department of General Internal Medicine, Baylor College of Medicine, Houston, TX, USA
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Steinle AM, Nian H, Pennings JS, Bydon M, Asher A, Archer KR, Gardocki RJ, Zuckerman SL, Stephens BF, Abtahi AM. Complications, readmissions, reoperations and patient-reported outcomes in patients with multiple sclerosis undergoing elective spine surgery - a propensity matched analysis. Spine J 2022; 22:1820-1829. [PMID: 35779839 DOI: 10.1016/j.spinee.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/05/2022] [Accepted: 06/16/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Multiple sclerosis (MS) is an autoimmune, neurodegenerative disease that can lead to significant functional disability. Improving treatment regimens have extended life expectancy and led to an increase in the number of elective spine surgeries for degenerative conditions in the MS population. Recent literature has reported mixed results regarding the efficacy of elective spine surgery for patients with MS. There is also a paucity of literature comparing postoperative patient reported outcomes (PROs) and reoperation rates between patients with and without MS. PURPOSE To determine if patients with MS have worse PROs and higher complication, readmission and reoperation rates after elective spine surgery compared with patients without neurodegenerative conditions when adjusting for baseline covariates through propensity matching. STUDY DESIGN/SETTING Retrospective review of prospectively collected data from the Quality Outcomes Database (QOD), a national, longitudinal, multicenter spine outcomes registry. PATIENT SAMPLE For the lumbar cohort, 312 patients with MS and 46,738 patients without MS were included. The cervical myelopathy cohort included 91 patients with MS and 6,426 patients without MS. The cervical radiculopathy cohort consisted of 103 patients with MS and 13,751 patients without MS. OUTCOME MEASURES 1) complication rates, 2) readmission rates, 3) reoperation rates, and 4) PROs at 3- and 12-months including ODI/NDI, NRS back/neck/arm/leg pain, mJOA scores and patient satisfaction ratings. METHODS Data from the QOD was queried for patients with surgeries occurring between 04/2013-01/2019. Three surgical groups were included: 1) Elective lumbar surgery, 2) Elective cervical surgery for myelopathy, 3) Elective cervical surgery for radiculopathy. Patients with any neurodegenerative condition other than MS were excluded. Patients without MS were propensity matched against patients with MS in a 5 to 1 ratio without replacement based on ASA grade, arthrodesis, surgical approach, number of operated levels, age, and baseline ODI/NDI, NRS leg/arm pain, NRS back/neck pain, and EQ-5D. Multivariable regressions with cluster-robust standard errors were used to estimate average effect of how the outcome would change if the MS patient didn't have the disease. The mean difference was used for continuous outcomes and the risk difference was used for binary outcomes. RESULTS For the lumbar cohort, no differences were found between the 2 groups at 3 or 12 months in any of the outcome measures. For the myelopathy cohort, patients with MS patients had a lower rate of reoperation at 12 months (risk difference=-0.036, p=.007) and worse 3-month mJOA scores (mean difference=-1.044, p=.004) compared with patients without MS. For the radiculopathy cohort, patients with MS had a lower rate of reoperation at 3 months (risk difference=-0.019, p=.018) and 12 months (risk difference=-0.029, p=.007) compared with those without MS. CONCLUSIONS Patients with MS had similar PROs compared with patients without MS when adjusting for baseline covariates through propensity matching, except for 3-month mJOA scores in the myelopathy cohort. Reoperation rates were found to be lower in patients with MS undergoing elective cervical surgery for both myelopathy and radiculopathy. These results suggest that when analyzed independently, a diagnosis of MS does not significantly impact complication, readmission and reoperation rates or PROs, and therefore should not represent a major contraindication to elective spine surgery. Surgical decisions in this patient population should be made based on careful consideration of patient factors including other comorbidities as well as baseline patient functional status.
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Affiliation(s)
- Anthony M Steinle
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA
| | - Hui Nian
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave Ste 1100, Nashville, TN 37203, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, 200 First St SW Floor 8. Rochester, MN 55905, USA
| | - Anthony Asher
- Neuroscience Institute, Atrium Health and Department of Neurosurgery, Carolinas Medical Center, Charlotte, North Carolina; Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, 1021 Morehead Medical Dr, Charlotte, NC 28204, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA; Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, 3401 West End Ave Suite 380, Nashville, TN 37203, USA
| | - Raymond J Gardocki
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN 37212, USA
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN 37212, USA
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN 37212, USA.
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Spirin N, Kiselev D, Baranova N, Karpova M. Nociceptive and mixed pains in patients with multiple sclerosis. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:44-51. [DOI: 10.17116/jnevro202212207244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zhao RZ, Zhang GX, Zhang WT, Yu WJ, Du L, Toledo MC, Olivera Leal IR, O'Farrill ZL, Izquierdo G. Ocular manifestations of multiple sclerosis in patients from three countries: A Web-based survey. Eur J Ophthalmol 2021; 32:2975-2981. [PMID: 34939452 DOI: 10.1177/11206721211069457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study evaluates the epidemiological characteristics, ophthalmological manifestations, and different therapeutic options available for patients with multiple sclerosis (MS) in China, Spain, and Cuba. METHODS A self-designed questionnaire was used to conduct a comparable descriptive cross-sectional study on patients with MS. The survey included patients' demographic data, ocular manifestations related to MS, and treatment methodology followed in the three countries. The online survey was designed using the Wenjuanxing survey platform, and a survey link was circulated through WhatsApp, WeChat, and emails. Quantitative data were expressed as mean and standard deviation, the Kruskal-Wallis test was used for non-parametric variables. Qualitative data were expressed as numerical and percentage. The chi-square test (χ2) was used to compare the group's response categories. The statistical difference was considered significant when p < 0.05. RESULTS The female-to-male ratio in all the three countries was 2-3:1, and relapsing-remitting MS (RRMS) was the most frequent in all three countries. Vision loss was slow and progressive in half of the patients from the three countries, with no significant differences (p = 0.524). A higher percentage of steroid treatment was observed in Chinese patients in comparison with the patients from other two countries (p < 0.001), and a similar trend was seen in the use of traditional medicines. Almost one-third of patients who did not receive any treatment recovered spontaneously in all the three countries (p = 0.097). CONCLUSIONS MS occurs more frequently in the relapsing-remitting clinical form and there is a clear female predominance. The first ocular crisis or clinical debut of MS is characterized by slow and progressive visual impairment, increasing and adding to other ocular manifestations during its evolutionary course. Spontaneous recovery of vision after an attack of optic neuritis in the course of MS is possible.
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Affiliation(s)
- Run-Ze Zhao
- Department of Ophthalmology, Eye Institute of PLA, 66352Xijing Hospital, Fourth Military Medical University, Shaanxi, The People of Republic of China.,Department of Ophthalmology, 113046Hermanos Ameijeiras Hospital, Havana, Cuba
| | - Guo-Xun Zhang
- Department of Neurology, 105849Yan'an University, Shaanxi, The People of Republic of China.,Multiple Sclerosis Unit, Neurology Service, 222071Vithas Nisa Hospital, Seville, Spain
| | - Wen-Ting Zhang
- Institute of Biomedicine of Seville, IBIS (University of Seville, HUVR, Government of Andalusia, CSIC), Spain; Department of Medical Biochemistry and Molecular Biology and Immunology, 16778University of Seville, 41009, Spain
| | - Wen-Jin Yu
- Department of Neurology, Xijing Hospital,Fourth Military Medicine University, Shaanxi, The People of Republic of China
| | - Lu Du
- Department of Ophthalmology, Eye Institute of PLA, 66352Xijing Hospital, Fourth Military Medical University, Shaanxi, The People of Republic of China
| | | | - I R Olivera Leal
- Department of Neurology, Hermanos Ameijeiras Hospital, Havana, Cuba
| | | | - G Izquierdo
- Multiple Sclerosis Unit, Neurology Service, 222071Vithas Nisa Hospital, Seville, Spain
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Bhattacharjee S, Yegezu Z, Kollecas K, Duhrkopf K, Hashemi L, Greene N. Influence of Comorbidities on Healthcare Expenditures and Perceived Physical and Mental Health Status Among Adults with Multiple Sclerosis: A Propensity Score-Matched US National-Level Study. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:377-394. [PMID: 34017188 PMCID: PMC8129918 DOI: 10.2147/ceor.s305154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/30/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the effect of comorbidities on healthcare expenditures and perceived physical and mental health status among adults with multiple sclerosis (MS) compared to propensity score-matched non-MS controls. Methods A retrospective, cross-sectional, matched cohort study was conducted using Medical Expenditure Panel Survey (2005–2015) data. The base study sample consisted of adults (age ≥18 years) who were alive and had positive total healthcare expenditures during the survey calendar year. Adults with MS were propensity-matched (1:1) to non-MS controls based on age, gender, and race/ethnicity using greedy matching algorithm. Healthcare expenditures consisted of total and subtypes of expenditures. Health status consisted of perceived physical and mental health status. Comorbidities were identified using ICD-9-CM and Clinical Classification System codes. Ordinary least squares regression and multinomial logistic regression were used to analyze the healthcare expenditures and health status variables, respectively. Results Final study sample consisted of 541 adults in each MS and non-MS control groups after propensity score matching. After adjusting for potential confounders, individuals with MS had greater total and subtypes of expenditures compared to non-MS controls, and several comorbidities (eg, depression, hypertension) were significantly associated with increased healthcare expenditures. Yearly average total expenditures (expressed in 2018 US$) were significantly (p<0.001) higher for adults with MS ($29,396) than propensity score-matched non-MS adults ($7875). Moreover, after adjusting for all individual-level factors, adults with MS experienced 363% (p<0.001) higher total expenditures compared to propensity score-matched non-MS controls. Individuals with MS were more likely to report poorer physical and good mental health status compared to propensity score-matched non-MS controls, and several comorbidities (eg, anxiety, depression) were significant independent predictors of poorer health status. For example, adults with MS were four times more likely (OR: 4.10, 95% CI: 2.42–6.96) to report fair/poor physical health status compared to excellent/very good physical health status compared with non-MS controls. Adults with MS were 42% (OR: 1.42, 95% CI: 1.01–1.99) more likely than propensity score-matched non-MS controls to report good rather than very good or excellent mental health status. However, there was no difference between adults with MS and propensity score-matched non-MS controls in terms of reporting fair or poor than very good or excellent mental health status. Conclusion Findings from this study indicate substantial economic and health status burdens among adults with MS at the US national-level that are significantly influenced by comorbidities.
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Affiliation(s)
- Sandipan Bhattacharjee
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Zufan Yegezu
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | - Kristin Kollecas
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
| | - Kevin Duhrkopf
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
| | - Lobat Hashemi
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
| | - Nupur Greene
- Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USA
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10
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Declemy A, Haddad R, Chesnel C, Charlanes A, Le Breton F, Sheikh Ismael S, Amarenco G. Prevalence of comorbidities in multiple sclerosis patients with neurogenic bladder. Prog Urol 2021; 31:732-738. [PMID: 33941463 DOI: 10.1016/j.purol.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/11/2020] [Accepted: 10/30/2020] [Indexed: 01/22/2023]
Abstract
AIMS The aim of this study was to define the prevalence of comorbidities among multiple sclerosis patients with lower urinary tract symptoms. METHODS A retrospective study of data collected prospectively from January 2000 to March 2016 was carried out using a database. Comorbidities were divided into several classes according to the International Classification of Diseases (ICD-10). RESULTS One hundred and fifty-five patients were included. All had a neurogenic bladder with 150 (96%) overactive bladder. EDSS score was≥6 in 44 patients (28%). Comorbidities were present in 79 (50,9%) and the most frequent ones were cardiovascular (14,2%), endocrinological (10,3%), urological (8,4%), abdominal (7,7%). Overweight (BMI≥25) was observed in 63 (40%). A strict relationship was found for BMI and stress urinary incontinence (P<0.001) as well as voiding dysfunction (P=0.003) without significant association for BMI and overactive bladder. CONCLUSION Prevalence of comorbidities is important in MS (more than 50%). A significant association is found between overweight, stress urinary incontinence and voiding dysfunction. Knowledge of these comorbidities in MS is important since the presence of these urinary symptoms not related to neurogenic bladder must lead to a specific treatment. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- A Declemy
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France.
| | - R Haddad
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - C Chesnel
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - A Charlanes
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - F Le Breton
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - S Sheikh Ismael
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - G Amarenco
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
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11
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Change and onset-type differences in the prevalence of comorbidities in people with multiple sclerosis. J Neurol 2020; 268:602-612. [PMID: 32880720 DOI: 10.1007/s00415-020-10194-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Little is known about the change in prevalence of comorbidities during the disease course of people with multiple sclerosis (MS) and whether the prevalences vary by MS onset type. OBJECTIVE To calculate the change in prevalence of comorbidities between symptom onset and the time of study, to compare the prevalences of comorbidities with those in the Australian population at the time of study and to examine onset-type differences. METHODS Comorbidity data from 1518 participants of the Australian MS Longitudinal Study and Australian population comparator data (2014-2015 National Health Survey) were used. The change in prevalence between time points and prevalence ratios (PR) at the time of study (crude, age and sex adjusted, and stratified by onset type) was calculated. RESULTS Comorbidities were common, and those with the largest increases in prevalence between MS symptom onset and the time of study were depression (+ 26.9%), anxiety (+ 23.1%), hypertension (+ 21.9%), elevated cholesterol (+ 16.3%), osteoarthritis (+ 17.1%), eye diseases (+ 11.6%), osteoporosis (+ 10.9%) and cancer (+ 10.3%). Compared to the general population and after age and sex adjustment, participants had a significantly higher prevalence for 14/19 comorbidities at the time of study. The associations were strongest for anaemia, cancer (both PR > 4.00), anxiety, depression, migraine (all PR > 3.00), psoriasis and epilepsy (both PR > 2.00). No significant differences were seen by onset type. CONCLUSION Comorbidities are common at MS symptom onset and increase with MS duration. Having MS may thus contribute to accrual of comorbidities. This emphasises the importance of optimal screening for and management of comorbidities in early MS and throughout the disease course.
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Magyari M, Sorensen PS. Comorbidity in Multiple Sclerosis. Front Neurol 2020; 11:851. [PMID: 32973654 PMCID: PMC7473304 DOI: 10.3389/fneur.2020.00851] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 07/07/2020] [Indexed: 01/09/2023] Open
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.
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Affiliation(s)
- Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Neurology, The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Per Soelberg Sorensen
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Denmark
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Hauer L, Perneczky J, Sellner J. A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications. J Neurol 2020; 268:4066-4077. [PMID: 32719975 PMCID: PMC8505322 DOI: 10.1007/s00415-020-10107-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system which is associated with numerous comorbidities. These include cardiovascular disease, psychiatric and neurologic disturbances, restless leg syndrome, migraine, cancer, autoimmune diseases, and metabolic disorders. Comorbid disease is an important consideration for clinicians treating patients with MS; early presentation of comorbidities can obscure or delay MS diagnosis, as well as significantly impacting the disease course. Improved understanding of comorbidities and their emergence in MS populations is important for improving the quality of life and optimizing treatment for patients. Therefore, we evaluated published studies reporting epidemiologic data on comorbidities and their associated impact on disease progression in patients with MS (PwMS). The prevalence of neurologic, cardiovascular, metabolic, and autoimmune comorbidities was elevated in PwMS in general, and furthermore, this adversely affected a broad range of outcomes. Compared with PwMS, cancer rates in people without MS or the general population were lower, which should prompt further studies into the mechanisms of both diseases. Studies were under-represented in many regions owing to the latitudinal gradient of MS and possible underfunding of studies.
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Affiliation(s)
- Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Julian Perneczky
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstrase 67, 2130, Mistelbach, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstrase 67, 2130, Mistelbach, Austria. .,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. .,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
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Smith KA, Burkill S, Hiyoshi A, Olsson T, Bahmanyar S, Wormser D, Geissbühler Y, Moore A, Kharat V, Montgomery S. Comorbid disease burden among MS patients 1968-2012: A Swedish register-based cohort study. Mult Scler 2020; 27:268-280. [PMID: 32162580 PMCID: PMC7820574 DOI: 10.1177/1352458520910497] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: People with multiple sclerosis (pwMS) have increased comorbid disease (CMD) risk. Most previous studies have not considered overall CMD burden. Objective: To describe lifetime CMD burden among pwMS. Methods: PwMS identified using Swedish registers between 1968 and 2012 (n = 25,476) were matched by sex, age, and county of residence with general-population comparators (n = 251,170). Prevalence, prevalence ratios (PRs), survival functions, and hazard ratios by MS status, age, and time period compared seven CMD: autoimmune, cardiovascular, depression, diabetes, respiratory, renal, and seizures. Results: The magnitude of the PRs for each CMD and age group decreased across time, with higher PRs in earlier time periods. Before 1990, younger age groups had higher PRs, and after 1990, older age groups had higher PRs. Male pwMS had higher burden compared with females. Overall, renal, respiratory, and seizures had the highest PRs. Before 2001, 50% of pwMS received a first/additional CMD diagnosis 20 years prior to people without MS, which reduced to 4 years after 2001. PwMS had four times higher rates of first/additional diagnoses in earlier time periods, which reduced to less than two times higher in recent time periods compared to people without MS. Conclusion: Swedish pwMS have increased CMD burden compared with the general population, but this has reduced over time.
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Affiliation(s)
- Kelsi A Smith
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden/Department of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sarah Burkill
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden/Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden/Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Shahram Bahmanyar
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden/Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden/Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Scott Montgomery
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden/Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden/Department of Epidemiology and Public Health, University College London, London, UK
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Harding K, Zhu F, Alotaibi M, Duggan T, Tremlett H, Kingwell E. Multiple cause of death analysis in multiple sclerosis: A population-based study. Neurology 2020; 94:e820-e829. [PMID: 31932517 DOI: 10.1212/wnl.0000000000008907] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/08/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To gain a better understanding of the complex patterns of causes that contribute to death due to multiple sclerosis (MS) by assessing the relationship between MS and other causes of death listed on death certificates. METHODS Multiple cause of death data for all adult deaths (aged ≥18 years) in British Columbia, Canada, between 1986 and 2013 were accessed. All causes, as listed on the death certificate, whether underlying or contributing, were considered "any mention" causes. The associations between mention of MS on the death certificate and mention of other causes of death were examined by logistic regression, adjusted for age, sex, and calendar year (Bonferroni-corrected α level = 0.002). Findings were also sex-stratified. RESULTS Among 771,288 deaths, MS was mentioned on 2,153 certificates. If MS was mentioned (versus not mentioned), there was a greater chance that specific conditions contributed to the death: respiratory infection (adjusted odds ratio [aOR], 3.03 [95% confidence interval (CI), 2.73-3.36]), aspiration pneumonia (aOR, 7.15 [95% CI, 6.23-8.22]), urinary tract infection (UTI) (aOR, 10.2 [95% CI, 8.7-12.0]), other infection including sepsis (aOR, 1.34 [95% CI, 1.15-1.56]), and skin disease (aOR, 5.06 [95% CI, 3.96-6.46]). Sex differences existed for urinary tract infection (men: aOR, 14.9 [95% CI, 11.5-19.3]; women: aOR, 8.00 [95% CI, 6.53-9.81]) and chronic respiratory disease (men = aOR, 1.36 [95% CI, 1.14-1.63]; women = aOR, 0.97 [95% CI, 0.84-1.13]). CONCLUSIONS Deaths attributed to MS were commonly caused by infection (especially respiratory and urinary tract-related); conditions associated with advanced disability and immobility, such as aspiration pneumonia; and chronic respiratory disease in men. All are potentially modifiable; interventions that reduce the frequency or severity of these complications could improve survival in MS.
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Affiliation(s)
- Katharine Harding
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia
| | - Feng Zhu
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia
| | - Thomas Duggan
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia
| | - Helen Tremlett
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia
| | - Elaine Kingwell
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia.
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Zarei S, Maldonado I, Franqui-Dominguez L, Rubi C, Rosa YT, Diaz-Marty C, Coronado G, Nieves MCR, Akhlaghipour G, Chinea A. Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients. Surg Neurol Int 2019; 10:200. [PMID: 31768280 PMCID: PMC6826276 DOI: 10.25259/sni_252_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are limited data on multiple sclerosis (MS) patients in underserved groups, including Puerto Rico. In this study, we analyzed the characteristic of MS symptoms and number of relapses in Puerto Rican patients. We then compare these characteristics with MS patients from the US. The number of MS relapses is highly correlated with the treatment onset and adherence. Patients in Puerto Rico have been experiencing lengthy treatment delay. We will discuss the possible causes of such delay and its impact on MS prognosis. METHODS This retrospective cohort study consisted of the evaluation of 325 medical records from MS patients attending the Caribbean Neurological Center from 2014 to 2019. We gathered symptoms and comorbidities data as binary objects. The treatment delay was calculated based on the mean value of days between diagnosis and treatment onset for these groups of patients. RESULTS We found that on average, the treatment delay for MS patients in Puerto Rico (PR) to receive their medication was 120 days. The most common MS subtype was relapsing-remitting 72.8%, with a mean of 1.684 relapses per year. Initial symptoms were sensory 54%, visual 33.1%, motor 28.8%, coordination 23.2%, fatigue 9.7%, memory 7.3%, depression 6.5%, urinary 4.9%, gastrointestinal 2.4%, and sexual dysfunction 1.6%. The most common comorbidities were hypertension 18.4%, asthma 13.6%, and thyroid disease 12.8%. When we compared the comorbidities between the two populations, immune thrombocytopenia had the highest percent change with the value of almost 200% (0.001% of US patient vs. 0.8% of Puerto Rican MS patients). CONCLUSION Patients from Puerto Rico had a 33% higher relapse rate compared to the one reported for MS patients in the US. This higher rate may be related to the long delay in receiving their medications. They also had a higher rate of complex comorbidities such as immune thrombocytopenia or thyroid disease. Our findings provide a proof of concept that delay in receiving medications can increase the number of relapses and complex comorbidities among MS patients.
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Affiliation(s)
- Sara Zarei
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Irvin Maldonado
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | | | - Yanibel Tapia Rosa
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Cristina Diaz-Marty
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Guadalupe Coronado
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
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Wylezinski LS, Gray JD, Polk JB, Harmata AJ, Spurlock CF. Illuminating an Invisible Epidemic: A Systemic Review of the Clinical and Economic Benefits of Early Diagnosis and Treatment in Inflammatory Disease and Related Syndromes. J Clin Med 2019; 8:E493. [PMID: 30979036 PMCID: PMC6518102 DOI: 10.3390/jcm8040493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
Healthcare expenditures in the United States are growing at an alarming level with the Centers for Medicare and Medicaid Services (CMS) projecting that they will reach $5.7 trillion per year by 2026. Inflammatory diseases and related syndromes are growing in prevalence among Western societies. This growing population that affects close to 60 million people in the U.S. places a significant burden on the healthcare system. Characterized by relatively slow development, these diseases and syndromes prove challenging to diagnose, leading to delayed treatment against the backdrop of inevitable disability progression. Patients require healthcare attention but are initially hidden from clinician's view by the seemingly generalized, non-specific symptoms. It is imperative to identify and manage these underlying conditions to slow disease progression and reduce the likelihood that costly comorbidities will develop. Enhanced diagnostic criteria coupled with additional technological innovation to identify inflammatory conditions earlier is necessary and in the best interest of all healthcare stakeholders. The current total cost to the U.S. healthcare system is at least $90B dollars annually. Through unique analysis of financial cost drivers, this review identifies opportunities to improve clinical outcomes and help control these disease-related costs by 20% or more.
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Affiliation(s)
- Lukasz S Wylezinski
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- IQuity, Inc., Nashville, TN 37203, USA.
| | | | | | | | - Charles F Spurlock
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- IQuity, Inc., Nashville, TN 37203, USA.
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Multi-drug use among patients with multiple sclerosis: A cross-sectional study of associations to clinicodemographic factors. Sci Rep 2019; 9:3743. [PMID: 30842515 PMCID: PMC6403326 DOI: 10.1038/s41598-019-40283-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/13/2019] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) is the most prevalent immune-mediated disease affecting the central nervous system. A treatment strategy with multiple therapies is a frequent clinical scenario. Unmonitored multi-drug use can lead to adverse outcomes, higher health care costs and medication non-adherence. The primary aim of this study was to evaluate the frequency of polypharmacy and related clinicodemographic factors in a single-center MS patient cohort. Furthermore, medication aspects of therapy management were examined. After the patients agreed to participate in the study, data were collected through patient interviews, patient records and clinical investigations. Subsequently, a statistical data analysis regarding various medication subgroups and polypharmacy (use of at least five drugs) was performed. Polypharmacy was observed in 56.5% of the patients (N = 306). High degrees of disability (odds ratio [OR] = 1.385), comorbidities (OR = 4.879) and inpatient treatment (OR = 5.146) were associated with a significantly higher risk of polypharmacy (p ≤ 0.001). Among patients with polypharmacy, disease-modifying drugs, antihypertensives, gastrointestinal drugs, thrombosis prophylactics, osteoporosis medications and sedatives were frequently used. In summary, polypharmacy plays a large role in MS patients, especially in those with higher degrees of disability, those with comorbidities and those treated in an inpatient setting.
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Toward a Shared-Care Model of Relapsing-Remitting Multiple Sclerosis: Role of the Primary Care Practitioner. Can J Neurol Sci 2019; 45:304-312. [PMID: 29756588 DOI: 10.1017/cjn.2018.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The objective of this study was to develop a shared-care model to enable primary-care physicians to participate more fully in meeting the complex, multidisciplinary healthcare needs of patients with multiple sclerosis (MS). DESIGN The design consisted of development of consensus recommendations and a shared-care algorithm. PARTICIPANTS A working group of 11 Canadian neurologists involved in the management of patients with MS were included in this study. MAIN MESSAGE The clinical management of patients with multiple sclerosis is increasing in complexity as new disease-modifying therapies (DMTs) become available, and ongoing safety monitoring is required. A shared-care model that includes primary care physicians is needed. Primary care physicians can assist in the early detection of MS of individuals presenting with neurological symptoms. Additional key roles for family physicians are health promotion, symptom management, and safety and relapse monitoring of DMT-treated patients. General principles of health promotion include counseling MS patients on maintaining a healthy lifestyle; performing standard screening measures; and identifying and treating comorbidities. Of particular importance are depression and anxiety, which occur in >20% of MS patients. Standard work-ups and treatments are needed for common MS-related symptoms, such as fatigue, pain, bladder dysfunction, sexual dysfunction, spasticity, and sleep disorders. Ongoing safety monitoring is required for patients receiving specific DMTs. Multiple sclerosis medications are generally contraindicated during pregnancy, and patients should be counseled to practice effective contraception. CONCLUSIONS Multiple sclerosis is a complex, disabling illness, which, similar to other chronic diseases, requires ongoing multidisciplinary care to meet the evolving needs of patients throughout the clinical course. Family physicians can play an invaluable role in maintaining general health, managing MS-related symptoms and comorbidities, monitoring for treatment-related adverse effects and MS relapses, and coordinating allied health services to ensure continuity of care to meet the complex and evolving needs of MS patients through the disease course. RÉSUMÉ: Élaborer un modèle de soins partagés dans les cas de sclérose en plaques récurrente-rémittente. Objectif: Élaborer un modèle de soins partagés afin de permettre aux médecins de première ligne de mieux répondre aux besoins complexes et multidisciplinaires de patients atteints de la sclérose en plaques (SP). Conception : Recommandations résultant d'un consensus et élaboration d'un algorithme en matière de soins partagés. PARTICIPANTS Un groupe de travail formé de onze neurologues canadiens impliqués dans la prise en charge de patients atteints de la SP. Message-clé : La prise en charge clinique de patients atteints de la SP est de plus en plus complexe dans la mesure où des médicaments modificateurs de l'évolution de la maladie (MMSP) deviennent accessibles et où un suivi permanent en matière de sécurité est nécessaire. Soulignons aussi qu'un modèle de soins partagés incluant les médecins de première ligne est nécessaire. Ces professionnels peuvent permettre un dépistage plus rapide de la SP chez des individus présentant des symptômes neurologiques. Ils peuvent aussi jouer un rôle de premier plan en matière de promotion de la santé, de soulagement des symptômes et de suivi de patients traités avec des MMSP en ce qui a trait à leur sécurité et à de possibles rechutes. Parmi les principes généraux de promotion de la santé, on peut inclure les suivants : offrir aux patients atteints de la SP des conseils leur permettant de maintenir de saines habitudes de vie ; adopter des mesures de dépistage standards ; identifier et traiter les comorbidités. À cet égard, l'anxiété et la dépression sont d'une importance particulière et sont fréquemment signalées (> 20 %) chez les patients atteints de SP. Des démarches d'investigation et des traitements standards sont nécessaires dans le cas des symptômes courants reliés à la SP, par exemple de la fatigue, des douleurs, une dysfonction vésicale, des dysfonctions sexuelles, de la spasticité et des troubles du sommeil. On l'a dit, un suivi permanent s'impose dans le cas de patients bénéficiant d'un traitement spécifique avec des MMSP. Les médicaments associés à la SP sont généralement contre-indiqués durant la grossesse de sorte qu'on devrait conseiller aux patients d'adopter des méthodes de contraception efficaces. CONCLUSIONS La SP est une maladie complexe et invalidante qui, à l'instar d'autres maladies chroniques, exige des soins multidisciplinaires continus afin de répondre, en lien avec un tableau clinique précis, aux besoins en constante évolution des patients. Les médecins de première ligne peuvent jouer un rôle irremplaçable à plusieurs égards : dans le maintien d'une bonne santé ; le suivi et le soulagement des symptômes et des comorbidités reliés à la SP ; le suivi des rechutes et des effets indésirables associés aux traitements. N'oublions pas non plus la coordination des services paramédicaux afin d'assurer, durant l'évolution de la SP, une continuité des soins répondant aux besoins complexes et en constante évolution des patients atteints de cette maladie.
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Hill E, Abboud H, Briggs FBS. Prevalence of asthma in multiple sclerosis: A United States population-based study. Mult Scler Relat Disord 2018; 28:69-74. [PMID: 30557818 DOI: 10.1016/j.msard.2018.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) and asthma are complex multifactorial diseases which adversely impact daily functioning. However, the prevalence of asthma in those with MS is not clear. The objective of this study is to characterize the prevalence of asthma in those with MS, with considerations for age, gender, and race. METHODS We conducted a U.S. population-based, cross-sectional study of electronic health record information for 56.6 million Americans available in the IBM® Explorys EPM: Explore database. We evaluated the prevalence of asthma in MS (N = 141,880) and non-MS (N = 56,416,790) cohorts, stratifying by age, gender, and race (All, White Americans, and African Americans). RESULTS The prevalence of asthma was significantly greater among those with MS than the general population across age, gender, and racial subpopulations. Adjusting for age and gender, asthma was three times more common in MS. In the MS cohort, the prevalence of asthma had a U-shaped distribution with respect to age, with the greatest asthma prevalence among the young and the elderly (> 20% prevalence among those <30 or ≥80 years; prevalence range: 15 to 30%); this significantly differed from the fairly uniform distribution observed in the non-MS cohort (prevalence range: 4 to 9%). These patterns were relatively consistent when stratifying by gender and race. CONCLUSION Asthma is significantly more common in those with MS than in the general population - particularly in the young and elderly - irrespective of gender and race. The results add to the growing MS comorbidity literature, and emphasizes the need for comorbidity management as a part of comprehensive MS patient care.
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Affiliation(s)
- Eddie Hill
- Neuroimmunological Disorders Gene-Environment Epidemiology Laboratory, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Hesham Abboud
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Farren B S Briggs
- Neuroimmunological Disorders Gene-Environment Epidemiology Laboratory, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Gutman JM, Kim K, Schwarzkopf R, Kister I. Total Hip and Knee Arthroplasty in Patients with Multiple Sclerosis. Int J MS Care 2018; 20:244-250. [PMID: 30374255 DOI: 10.7224/1537-2073.2017-093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Hip and knee replacements for osteoarthritis are established procedures for improving joint pain and function, yet their safety in patients with multiple sclerosis (MS) is unknown. Patients with MS face unique surgical challenges due to underlying neurologic dysfunction. Current literature on arthroplasty in MS is limited to case reports focusing on adverse events. Methods Of 40 identified patients who underwent hip or knee replacement, 30 had sufficient data for inclusion. We reviewed their medical records and recorded reasons for surgery, age at surgery, MS characteristics, surgical complications, and ambulatory aid status before and after surgery. We supplemented medical record review with questionnaires regarding preoperative and postoperative pain and satisfaction with surgical outcomes. Results Median follow-up was 26 months. Complications of surgery were reported in ten patients (33%), mostly mild and self-limited, although four patients (13%) required repeated operation. Six patients (20%) reported improvements in ambulatory aid use compared with presurgery baseline, ten (33%) worsened, and 14 (47%) were unchanged. In 20 patients who completed the questionnaire, mean ± SD joint pain scores (on 0-10 scale) decreased from 8.6 ± 2.0 preoperatively to 2.9 ± 2.4 postoperatively (P < .001). Five patients (25%) were free of joint pain at last follow-up. Conclusions These results suggest that pain reduction is a realistic outcome of total knee or hip arthroplasty in people with MS and that improved functional gait outcomes are possible in some patients. Prospective, multicenter, collaborative studies are needed to optimize selection and improve outcomes in people with MS considering arthroplasty.
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Fitzcharles MA, Perrot S, Häuser W. Comorbid fibromyalgia: A qualitative review of prevalence and importance. Eur J Pain 2018; 22:1565-1576. [PMID: 29802812 DOI: 10.1002/ejp.1252] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2018] [Indexed: 12/11/2022]
Abstract
Fibromyalgia (FM) may be an unrecognized cause of suffering for persons with an array of medical conditions. This is especially true for illness that is characterized by pain of any nature. Once believed to be a unique diagnosis, FM is recently reported to occur concomitantly with various rheumatic diseases, and importantly adversely impacts global health status. However, there is increasing report of FM associated with other diseases that are not defined by chronic pain. This qualitative review examines the evidence for comorbid FM in illness, and where available the effect of FM on the primary disease. Other than for musculoskeletal disorders, the published literature reporting an association of FM with illness is limited with scanty reports for some neurological, gastrointestinal, mental health and other overlapping pain conditions. Comorbid FM adversely affects both health status and outcome for rheumatic diseases, but with limited study in other diseases. When unrecognized, comorbid FM may be mistaken as poor control of the primary disease, leading to incorrect treatment decisions. FM may be a neglected condition that pervades many conditions and may contribute to the burden of illness. Physicians should be alert to the possibility of comorbid FM, and symptoms of FM should be specifically addressed. SIGNIFICANCE Comorbid fibromyalgia (FM) in other medical conditions is largely unrecognized. When reported as accompanying rheumatic diseases, FM adversely affects global health status. With limited reports of comorbid FM with other conditions, neglect to diagnose comorbid FM may misdirect treatments.
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Affiliation(s)
- M-A Fitzcharles
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - S Perrot
- Pain Center, Cochin Hospital, Paris Descartes University, France
| | - W Häuser
- Department Internal Medicine I, Klinikum Saarbrücken, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Germany
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Gyllensten H, Wiberg M, Alexanderson K, Norlund A, Friberg E, Hillert J, Ernstsson O, Tinghög P. Costs of illness of multiple sclerosis in Sweden: a population-based register study of people of working age. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:435-446. [PMID: 28488184 PMCID: PMC5978901 DOI: 10.1007/s10198-017-0894-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 04/21/2017] [Indexed: 05/15/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) causes work disability and healthcare resource use, but little is known about the distribution of the associated costs to society. OBJECTIVES We estimated the cost of illness (COI) of working-aged individuals with MS, from the societal perspective, overall and in different groups. METHODS A population-based study was conducted, using data linked from several nationwide registers, on 14,077 individuals with MS, aged 20-64 years and living in Sweden. Prevalence-based direct and indirect costs in 2010 were calculated, including costs for prescription drug use, specialized healthcare, sick leave, and disability pension. RESULTS The estimated COI of all the MS patients were SEK 3950 million, of which 75% were indirect costs. MS was the main diagnosis for resource use, causing 38% of healthcare costs and 67% of indirect costs. The distribution of costs was skewed, in which less than 25% of the patients accounted for half the total COI. CONCLUSIONS Indirect costs contributed to approximately 75% of the estimated overall COI of MS patients of working age in Sweden. MS was the main diagnosis for more than half of the estimated COI in this patient group. Further studies are needed to gain knowledge on development of costs over time during the MS disease course.
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Affiliation(s)
- Hanna Gyllensten
- Department of Clinical Neuroscience, Karolinska Institutet, Berzelius Väg 3, Floor 6, SE-171 77, Stockholm, Sweden.
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.
| | - Michael Wiberg
- Department of Clinical Neuroscience, Karolinska Institutet, Berzelius Väg 3, Floor 6, SE-171 77, Stockholm, Sweden
- Department of analysis and prognosis, Swedish Social Insurance Agency, SE-126 37, Stockholm, Sweden
| | - Kristina Alexanderson
- Department of Clinical Neuroscience, Karolinska Institutet, Berzelius Väg 3, Floor 6, SE-171 77, Stockholm, Sweden
| | - Anders Norlund
- Department of Clinical Neuroscience, Karolinska Institutet, Berzelius Väg 3, Floor 6, SE-171 77, Stockholm, Sweden
| | - Emilie Friberg
- Department of Clinical Neuroscience, Karolinska Institutet, Berzelius Väg 3, Floor 6, SE-171 77, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Berzelius Väg 3, Floor 6, SE-171 77, Stockholm, Sweden
| | - Olivia Ernstsson
- Department of Clinical Neuroscience, Karolinska Institutet, Berzelius Väg 3, Floor 6, SE-171 77, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Petter Tinghög
- Department of Clinical Neuroscience, Karolinska Institutet, Berzelius Väg 3, Floor 6, SE-171 77, Stockholm, Sweden
- Red Cross University College, Teknikringen 1, SE-114 28, Stockholm, Sweden
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Hoehne A, James ML, Alam IS, Ronald JA, Schneider B, D'Souza A, Witney TH, Andrews LE, Cropper HC, Behera D, Gowrishankar G, Ding Z, Wyss-Coray T, Chin FT, Biswal S, Gambhir SS. [ 18F]FSPG-PET reveals increased cystine/glutamate antiporter (xc-) activity in a mouse model of multiple sclerosis. J Neuroinflammation 2018; 15:55. [PMID: 29471880 PMCID: PMC5822551 DOI: 10.1186/s12974-018-1080-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/24/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The cystine/glutamate antiporter (xc-) has been implicated in several neurological disorders and, specifically, in multiple sclerosis (MS) as a mediator of glutamate excitotoxicity and proinflammatory immune responses. We aimed to evaluate an xc-specific positron emission tomography (PET) radiotracer, (4S)-4-(3-[18F]fluoropropyl)-L-glutamate ([18F]FSPG), for its ability to allow non-invasive monitoring of xc- activity in a mouse model of MS. METHODS Experimental autoimmune encephalomyelitis (EAE) was induced in C57BL/6 mice by subcutaneous injection of myelin oligodendrocyte glycoprotein (MOG35-55) peptide in complete Freund's adjuvant (CFA) followed by pertussis toxin. Control mice received CFA emulsion and pertussis toxin without MOG peptide, while a separate cohort of naïve mice received no treatment. PET studies were performed to investigate the kinetics and distribution of [18F]FSPG in naïve, control, pre-symptomatic, and symptomatic EAE mice, compared to 18F-fluorodeoxyglucose ([18F]FDG). After final PET scans, each mouse was perfused and radioactivity in dissected tissues was measured using a gamma counter. Central nervous system (CNS) tissues were further analyzed using ex vivo autoradiography or western blot. [18F]FSPG uptake in human monocytes, and T cells pre- and post-activation was investigated in vitro. RESULTS [18F]FSPG was found to be more sensitive than [18F]FDG at detecting pathological changes in the spinal cord and brain of EAE mice. Even before clinical signs of disease, a small but significant increase in [18F]FSPG signal was observed in the spinal cord of EAE mice compared to controls. This increase in PET signal became more pronounced in symptomatic EAE mice and was confirmed by ex vivo biodistribution and autoradiography. Likewise, in the brain of symptomatic EAE mice, [18F]FSPG uptake was significantly higher than controls, with the largest changes observed in the cerebellum. Western blot analyses of CNS tissues revealed a significant correlation between light chain of xc- (xCT) protein levels, the subunit of xc- credited with its transporter activity, and [18F]FSPG-PET signal. In vitro [18F]FSPG uptake studies suggest that both activated monocytes and T cells contribute to the observed in vivo PET signal. CONCLUSION These data highlight the promise of [18F]FSPG-PET as a technique to provide insights into neuroimmune interactions in MS and the in vivo role of xc- in the development and progression of this disease, thus warranting further investigation.
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Affiliation(s)
- Aileen Hoehne
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Michelle L James
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Israt S Alam
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - John A Ronald
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Bernadette Schneider
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Aloma D'Souza
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Timothy H Witney
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Lauren E Andrews
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Haley C Cropper
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Deepak Behera
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Gayatri Gowrishankar
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Zhaoqing Ding
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Frederick T Chin
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Sandip Biswal
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Sanjiv S Gambhir
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA, 94305, USA. .,Department of Bioengineering, Department of Materials Science & Engineering, Stanford University, Stanford, CA, 94305, USA.
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Laroni A, Signori A, Maniscalco GT, Lanzillo R, Russo CV, Binello E, Lo Fermo S, Repice A, Annovazzi P, Bonavita S, Clerico M, Baroncini D, Prosperini L, La Gioia S, Rossi S, Cocco E, Frau J, Torri Clerici V, Signoriello E, Sartori A, Zarbo IR, Rasia S, Cordioli C, Cerqua R, Di Sapio A, Lavorgna L, Pontecorvo S, Barrilà C, Saccà F, Frigeni B, Esposito S, Ippolito D, Gallo F, Sormani MP. Assessing association of comorbidities with treatment choice and persistence in MS. Neurology 2017; 89:2222-2229. [DOI: 10.1212/wnl.0000000000004686] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/24/2017] [Indexed: 01/09/2023] Open
Abstract
Objective:To assess whether the presence of concomitant diseases at multiple sclerosis (MS) diagnosis is associated with the choice and the treatment persistence in an Italian MS cohort.Methods:We included newly diagnosed patients (2010–2016) followed in 20 MS centers and collected demographic and clinical data. We evaluated baseline factors related to the presence of comorbidities and the association between comorbidities and the clinical course of MS and the time to the first treatment switch.Results:The study cohort included 2,076 patients. Data on comorbidities were available for 1,877/2,076 patients (90.4%). A total of 449/1,877 (23.9%) patients had at least 1 comorbidity at MS diagnosis. Age at diagnosis (odds ratio 1.05, 95% confidence interval [CI] 1.04–1.06; p < 0.001) was the only baseline factor independently related to the presence of comorbidities. Comorbidities were not significantly associated with the choice of the first disease-modifying treatment, but were significantly associated with higher risk to switch from the first treatment due to intolerance (hazard ratio 1.42, CI 1.07–1.87; p = 0.014). Association of comorbidities with risk of switching for intolerance was significantly heterogeneous among treatments (interferon β, glatiramer acetate, natalizumab, or fingolimod; interaction test, p = 0.04).Conclusions:Comorbidities at diagnosis should be taken into account at the first treatment choice because they are associated with lower persistence on treatment.
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Diagnostic confounders of chronic widespread pain: not always fibromyalgia. Pain Rep 2017; 2:e598. [PMID: 29392213 PMCID: PMC5741304 DOI: 10.1097/pr9.0000000000000598] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 12/11/2022] Open
Abstract
Although chronic widespread pain is the defining feature of fibromyalgia, a myriad of other conditions may present with similar pain complaint leading to misdiagnosis. Conditions that may mimic fibromyalgia may be categorized as musculoskeletal, neurological, endocrine/metabolic, psychiatric/psychological, and medication related. In this review, we examine these various conditions that should be considered in a differential diagnosis and provide direction that will help the clinician differentiate these conditions from fibromyalgia. Introduction: Chronic widespread pain (CWP) is the defining feature of fibromyalgia (FM), a worldwide prevalent condition. Chronic widespread pain is, however, not pathognomonic of FM, and other conditions may present similarly with CWP, requiring consideration of a differential diagnosis. Objectives: To conduct a literature search to identify medical conditions that may mimic FM and have highlighted features that may differentiate these various conditions from FM. Methods: A comprehensive literature search from 1990 through September 2016 was conducted to identify conditions characterized by CWP. Results: Conditions that may mimic FM may be categorized as musculoskeletal, neurological, endocrine/metabolic, psychiatric/psychological, and medication related. Characteristics pertaining to the most commonly identified confounding diagnoses within each category are discussed; clues to enable clinical differentiation from FM are presented; and steps towards a diagnostic algorithm for mimicking conditions are presented. Conclusion: Although the most likely reason for a complaint of CWP is FM, this pain complaint can be a harbinger of illness other than FM, prompting consideration of a differential diagnosis. This review should sensitize physicians to a broad spectrum of conditions that can mimic FM.
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Tremlett H, Waubant E. The multiple sclerosis microbiome? ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:53. [PMID: 28251132 DOI: 10.21037/atm.2017.01.63] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Helen Tremlett
- Medicine (Neurology) and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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28
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Marrie RA, Patten S, Tremlett H, Svenson LW, Wolfson C, Yu BN, Elliott L, Profetto-McGrath J, Warren S, Leung S, Jette N, Bhan V, Fisk JD. Chronic lung disease and multiple sclerosis: Incidence, prevalence, and temporal trends. Mult Scler Relat Disord 2016; 8:86-92. [PMID: 27456880 DOI: 10.1016/j.msard.2016.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/07/2016] [Accepted: 05/10/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVES We aimed to estimate the incidence and prevalence of chronic lung disease (CLD), including asthma and chronic obstructive pulmonary disease, in the MS population versus a matched cohort from the general population. METHODS We used population-based administrative data from four Canadian provinces to identify 44,452 persons with MS and 220,849 age-, sex- and geographically-matched controls aged 20 years and older. We employed a validated case definition to estimate the incidence and prevalence of CLD over the period 1995-2005, and used Poisson regression to assess temporal trends. RESULTS In 2005, the crude incidence of CLD per 100,000 persons was 806 (95%CI: 701-911) in the MS population, and 757 in the matched population (95%CI: 712-803). In 2005, the crude prevalence of CLD was 13.5% (95%CI: 13.1-14.0%) in the MS population, and 12.4% (95%CI: 12.3-12.6%) in the matched population. Among persons aged 20-44 years, the average annual incidence of CLD was higher in the MS population than in the matched population (RR 1.15; 95%CI: 1.02-1.30), but did not differ between populations for those aged ≥45 years. The incidence of CLD was stable, but the prevalence of CLD increased 60% over the study period. CONCLUSION CLD is relatively common in the MS population. The incidence of CLD has been stable over time, but the prevalence of CLD has increased. Among persons aged 20-44 years, CLD is more common in the MS population than in a matched population. Given the prevalence of CLD in the MS population, further attention to the effects of CLD on outcomes in MS and approaches to mitigating those effects are warranted.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Scott Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Helen Tremlett
- Department of Medicine (Neurology) and Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Lawrence W Svenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Surveillance and Assessment Branch, Alberta Ministry of Health, Edmonton, Canada; School of Public Health, University of Alberta, Edmonton, Canada
| | - Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - B Nancy Yu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Public Health, Manitoba Health Healthy Living and Seniors, Winnipeg, Canada
| | - Lawrence Elliott
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Sharon Warren
- Faculty of Rehabilitation Medicine, University of Alberta, Canada
| | - Stella Leung
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nathalie Jette
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Virender Bhan
- Department of Medicine, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Canada
| | - John D Fisk
- Nova Scotia Health Authority, Canada; Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
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Veldhuijzen van Zanten JJ, Pilutti LA, Duda JL, Motl RW. Sedentary behaviour in people with multiple sclerosis: Is it time to stand up against MS? Mult Scler 2016; 22:1250-6. [PMID: 27072688 DOI: 10.1177/1352458516644340] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/18/2016] [Indexed: 01/14/2023]
Abstract
Historically, people with multiple sclerosis (MS) have been considered sedentary, although the actual scientific study of sedentary behaviour in MS did not originate until 2011. Sedentary behaviour, which is conceptually distinct from physical inactivity, is defined as any waking activity characterised by an energy expenditure ⩽ 1.5 metabolic equivalents and in a sitting or reclining posture. In the general population, the volume of sitting time is associated with increased risks of morbidity and mortality, independent of physical activity, and has been suggested to carry a greater risk of mortality than smoking behaviour. There are many symptoms of MS (e.g. mobility disability and fatigue) that could increase the prevalence of sedentary behaviour, and sedentary behaviour may have considerable implications for the development of comorbid conditions prevalent in MS. This review provides a summary of the rates, correlates, consequences and interventions attempting to reduce sedentary behaviour in MS. We provide a research agenda that guides future research on sedentary behaviour in MS. This paper provides a clarion call that it is time to 'stand up against MS'.
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Affiliation(s)
| | - Lara A Pilutti
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Eclectic Ocular Comorbidities and Systemic Diseases with Eye Involvement: A Review. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6215745. [PMID: 27051666 PMCID: PMC4808667 DOI: 10.1155/2016/6215745] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/01/2016] [Accepted: 02/01/2016] [Indexed: 02/07/2023]
Abstract
Coexistence of several ocular diseases is more frequent than suspected. In spite of the refractive errors, one or more of the following can be detected simultaneously: glaucoma, cataracts, uveitis, age-related macular degeneration, and dry eyes. In addition, as people age, ocular comorbidities are much more usually seen. Specific diseases are openly acknowledged to affect the eyes and vision, such as diabetes mellitus, hypertension blood pressure, arthritis, hyperthyroidism, neurodegenerative disorders, hematologic malignancies, and/or systemic infections. Recent advances in early diagnosis and therapy of the ophthalmic pathologies have reinforced patient options to prevent visual impairment and blindness. Because of this, it is essential not to overlook sight-threatening conditions such as the ocular comorbidities and/or the eye involvement in the context of systemic disorders. Moreover, the important role of the multidisciplinary cooperation to improve and sustain management of patients affected with eclectic ocular comorbidities and/or systemic disorders with eye repercussion is specifically addressed. This review intends to shed light on these topics to help in making opportune diagnosis and appropriately managing the affected patients.
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Marrie RA, Patten SB, Tremlett H, Wolfson C, Warren S, Svenson LW, Jette N, Fisk J. Sex differences in comorbidity at diagnosis of multiple sclerosis: A population-based study. Neurology 2016; 86:1279-1286. [PMID: 26962066 PMCID: PMC4826338 DOI: 10.1212/wnl.0000000000002481] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 11/16/2015] [Indexed: 01/16/2023] Open
Abstract
Objective: To determine the prevalence of comorbidity in the multiple sclerosis (MS) population at the time of MS diagnosis. We also compared the prevalence of comorbidity in the MS population to that in a matched cohort from the general population. Methods: Using population-based administrative health data from 4 Canadian provinces, we identified 23,382 incident MS cases and 116,638 age-, sex-, and geographically matched controls. We estimated the prevalence of hypertension, diabetes, hyperlipidemia, heart disease, chronic lung disease, epilepsy, fibromyalgia, inflammatory bowel disease, depression, anxiety, bipolar disorder, and schizophrenia at MS diagnosis using validated case definitions. We compared the populations using rate ratios. Results: Of the MS cases, 16,803 (71.9%) were female. The most prevalent comorbidity was depression (19.1%). Compared to the matched population, all comorbidities except hyperlipidemia were more common in the MS population. Relative to the matched populations, the prevalence of hypertension was 16% higher for women with MS and 48% higher for men with MS, thus there was a disproportionately higher prevalence of hypertension in men with MS than women. Men with MS also had a disproportionately higher prevalence than women with MS for diabetes, epilepsy, depression, and anxiety. Conclusions: Comorbidity is more common than expected in MS, even around the time of diagnosis. The prevalence of psychiatric comorbidity is particularly high and highlights the need for clinical attention to this issue. The observed sex-specific differences in the burden of comorbidity in MS, which differ from those in the matched population, warrant further investigation.
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Affiliation(s)
- Ruth Ann Marrie
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba; Department of Community Health Sciences (S.B.P., L.W.S., N.J.), Institute for Public Health (N.J.), Department of Clinical Neurosciences (N.J.), and Hotchkiss Brain Institute (N.J.), University of Calgary; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.) and School of Public Health (L.W.S.), University of Alberta, Edmonton; Surveillance and Assessment (L.W.S.), Alberta Health, Edmonton; and Departments of Psychiatry and Medicine (J.F.), Dalhousie University, Halifax, Canada.
| | - Scott B Patten
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba; Department of Community Health Sciences (S.B.P., L.W.S., N.J.), Institute for Public Health (N.J.), Department of Clinical Neurosciences (N.J.), and Hotchkiss Brain Institute (N.J.), University of Calgary; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.) and School of Public Health (L.W.S.), University of Alberta, Edmonton; Surveillance and Assessment (L.W.S.), Alberta Health, Edmonton; and Departments of Psychiatry and Medicine (J.F.), Dalhousie University, Halifax, Canada
| | - Helen Tremlett
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba; Department of Community Health Sciences (S.B.P., L.W.S., N.J.), Institute for Public Health (N.J.), Department of Clinical Neurosciences (N.J.), and Hotchkiss Brain Institute (N.J.), University of Calgary; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.) and School of Public Health (L.W.S.), University of Alberta, Edmonton; Surveillance and Assessment (L.W.S.), Alberta Health, Edmonton; and Departments of Psychiatry and Medicine (J.F.), Dalhousie University, Halifax, Canada
| | - Christina Wolfson
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba; Department of Community Health Sciences (S.B.P., L.W.S., N.J.), Institute for Public Health (N.J.), Department of Clinical Neurosciences (N.J.), and Hotchkiss Brain Institute (N.J.), University of Calgary; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.) and School of Public Health (L.W.S.), University of Alberta, Edmonton; Surveillance and Assessment (L.W.S.), Alberta Health, Edmonton; and Departments of Psychiatry and Medicine (J.F.), Dalhousie University, Halifax, Canada
| | - Sharon Warren
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba; Department of Community Health Sciences (S.B.P., L.W.S., N.J.), Institute for Public Health (N.J.), Department of Clinical Neurosciences (N.J.), and Hotchkiss Brain Institute (N.J.), University of Calgary; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.) and School of Public Health (L.W.S.), University of Alberta, Edmonton; Surveillance and Assessment (L.W.S.), Alberta Health, Edmonton; and Departments of Psychiatry and Medicine (J.F.), Dalhousie University, Halifax, Canada
| | - Lawrence W Svenson
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba; Department of Community Health Sciences (S.B.P., L.W.S., N.J.), Institute for Public Health (N.J.), Department of Clinical Neurosciences (N.J.), and Hotchkiss Brain Institute (N.J.), University of Calgary; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.) and School of Public Health (L.W.S.), University of Alberta, Edmonton; Surveillance and Assessment (L.W.S.), Alberta Health, Edmonton; and Departments of Psychiatry and Medicine (J.F.), Dalhousie University, Halifax, Canada
| | - Nathalie Jette
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba; Department of Community Health Sciences (S.B.P., L.W.S., N.J.), Institute for Public Health (N.J.), Department of Clinical Neurosciences (N.J.), and Hotchkiss Brain Institute (N.J.), University of Calgary; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.) and School of Public Health (L.W.S.), University of Alberta, Edmonton; Surveillance and Assessment (L.W.S.), Alberta Health, Edmonton; and Departments of Psychiatry and Medicine (J.F.), Dalhousie University, Halifax, Canada
| | - John Fisk
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba; Department of Community Health Sciences (S.B.P., L.W.S., N.J.), Institute for Public Health (N.J.), Department of Clinical Neurosciences (N.J.), and Hotchkiss Brain Institute (N.J.), University of Calgary; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.) and School of Public Health (L.W.S.), University of Alberta, Edmonton; Surveillance and Assessment (L.W.S.), Alberta Health, Edmonton; and Departments of Psychiatry and Medicine (J.F.), Dalhousie University, Halifax, Canada
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Zivadinov R, Raj B, Ramanathan M, Teter B, Durfee J, Dwyer MG, Bergsland N, Kolb C, Hojnacki D, Benedict RH, Weinstock-Guttman B. Autoimmune Comorbidities Are Associated with Brain Injury in Multiple Sclerosis. AJNR Am J Neuroradiol 2016; 37:1010-6. [PMID: 26892983 DOI: 10.3174/ajnr.a4681] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/25/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE The effect of comorbidities on disease severity in MS has not been extensively characterized. We determined the association of comorbidities with MR imaging disease severity outcomes in MS. MATERIALS AND METHODS Demographic and clinical history of 9 autoimmune comorbidities confirmed by retrospective chart review and quantitative MR imaging data were obtained in 815 patients with MS. The patients were categorized on the basis of the presence/absence of total and specific comorbidities. We analyzed the MR imaging findings, adjusting for key covariates and correcting for multiple comparisons. RESULTS Two hundred forty-one (29.6%) study subjects presented with comorbidities. Thyroid disease had the highest frequency (n = 97, 11.9%), followed by asthma (n = 41, 5%), type 2 diabetes mellitus (n = 40, 4.9%), psoriasis (n = 33, 4%), and rheumatoid arthritis (n = 22, 2.7%). Patients with MS with comorbidities showed decreased whole-brain and cortical volumes (P < .001), gray matter volume and magnetization transfer ratio of normal-appearing brain tissue (P < .01), and magnetization transfer ratio of gray matter (P < .05). Psoriasis, thyroid disease, and type 2 diabetes mellitus comorbidities were associated with decreased whole-brain, cortical, and gray matter volumes (P < .05). Psoriasis was associated with a decreased magnetization transfer ratio of normal-appearing brain tissue (P < .05), while type 2 diabetes mellitus was associated with increased mean diffusivity (P < .01). CONCLUSIONS The presence of comorbidities in patients with MS is associated with brain injury on MR imaging. Psoriasis, thyroid disease, and type 2 diabetes mellitus comorbidities were associated with more severe nonconventional MR imaging outcomes.
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Affiliation(s)
- R Zivadinov
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center MR Imaging Clinical Translational Research Center (R.Z.)
| | - B Raj
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center
| | - M Ramanathan
- Department of Pharmaceutical Sciences (M.R.), School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York
| | - B Teter
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - J Durfee
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center
| | - M G Dwyer
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center
| | - N Bergsland
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center Magnetic Resonance Laboratory (N.B.), IRCCS Don Gnocchi Foundation, Milan, Italy
| | - C Kolb
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - D Hojnacki
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - R H Benedict
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - B Weinstock-Guttman
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
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Marck CH, Neate SL, Taylor KL, Weiland TJ, Jelinek GA. Prevalence of Comorbidities, Overweight and Obesity in an International Sample of People with Multiple Sclerosis and Associations with Modifiable Lifestyle Factors. PLoS One 2016; 11:e0148573. [PMID: 26849357 PMCID: PMC4743906 DOI: 10.1371/journal.pone.0148573] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/19/2016] [Indexed: 11/29/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic neurological disorder, often affecting young people. Comorbid disorders such as depression, anxiety and hypertension are common and can affect disease course, treatment, and quality of life (QOL) of people with MS (PwMS). The associations between comorbidities, body mass index (BMI) and health outcomes are not well studied in MS, although research shows most PwMS are overweight. Most data on the prevalence of comorbidities and obesity in PwMS comes from North American populations. This study describes the prevalence of comorbidities, overweight and obesity and associations with modifiable factors in an international sample of PwMS recruited online through social media, MS societies and websites. The online survey consisted of validated and researcher-devised instruments to assess self-reported health outcomes and lifestyle behaviors. Of the 2399 respondents, 22.5% were overweight, 19.4% were obese and 67.2% reported at least one comorbidity, with back pain (36.2%), depression (31.7%), anxiety (29.1%) and arthritis (13.7%) most prevalent and most limiting in daily activities. Obesity and most comorbid disorders were significantly more prevalent in North America. Obese participants were more likely to have comorbidities, especially diabetes (OR 4.8) and high blood pressure (OR 4.5) but also depression (OR 2.2). Being overweight, obese, or a former, or current smoker was associated with an increase in the number of comorbidities; while healthy diet, physical activity (borderline significant) and moderate alcohol consumption were associated with decreased number of comorbidities. Increasing number of comorbidities was related to worse QOL, increased odds of disability and prior relapse. Obese PwMS had higher odds of disability and lower QOL. The associations between BMI, comorbidities and health outcomes are likely to be bi-directional and associated with lifestyle behaviors. Preventing and treating comorbid disorders and obesity in PwMS is warranted, and advice regarding healthy and risky lifestyle may assist in improving health outcomes.
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Affiliation(s)
- Claudia Helena Marck
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sandra Leanne Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Keryn Louise Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Tracey Joy Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - George Alexander Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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34
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Heine M, Wens I, Langeskov-Christensen M, Verschuren O, Eijnde BO, Kwakkel G, Dalgas U. Cardiopulmonary fitness is related to disease severity in multiple sclerosis. Mult Scler 2015; 22:231-8. [PMID: 26014607 DOI: 10.1177/1352458515581437] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND In persons with MS (pwMS), a lower cardiopulmonary fitness has been associated with a higher risk for secondary disorders, decreased functional capacity, symptom worsening and reduced health-related quality of life. OBJECTIVE To investigate the association between disease severity and cardiopulmonary fitness. METHODS Data from cardiopulmonary exercise tests, previously conducted in three different countries, were pooled. The association between disease severity (Expanded Disability Status Scale (EDSS)) and cardiopulmonary fitness (peak oxygen uptake (VO2peak)) was adjusted for age, sex and the country of origin. RESULTS The combined sample comprised 116 ambulant pwMS having a mean (± SD) EDSS score of 2.7 ± 1.3. There was a significant correlation (r = -0.418, p < .01) between VO2peak and EDSS. A multiple regression model (R(2) = 0.520, p < .01) was constructed to describe VO2peak (mL∙kg(-1)∙min(-1)); VO2peak = 36.622 - 5.433 (Sex (1=men)) - 0.124 (Age) - 2.082 (EDSS) + 2.737 (Belgium) + 8.674 (Denmark). CONCLUSION There was a significant association between disease severity and cardiopulmonary fitness. The close relation between cardiopulmonary fitness and chronic conditions associated with physical inactivity, suggest a progressive increase in risk of secondary health conditions in pwMS.
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Affiliation(s)
- Martin Heine
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Inez Wens
- Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Bert O Eijnde
- Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands
| | - Ulrik Dalgas
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
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Marrie RA, Cohen J, Stuve O, Trojano M, Sørensen PS, Reingold S, Cutter G, Reider N. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler 2015; 21:263-81. [PMID: 25623244 PMCID: PMC4361468 DOI: 10.1177/1352458514564491] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Comorbidity is an area of increasing interest in multiple sclerosis (MS). Objective: The objective of this review is to estimate the incidence and prevalence of comorbidity in people with MS and assess the quality of included studies. Methods: We searched the PubMed, SCOPUS, EMBASE and Web of Knowledge databases, conference proceedings, and reference lists of retrieved articles. Two reviewers independently screened abstracts. One reviewer abstracted data using a standardized form and the abstraction was verified by a second reviewer. We assessed study quality using a standardized approach. We quantitatively assessed population-based studies using the I2 statistic, and conducted random-effects meta-analyses. Results: We included 249 articles. Study designs were variable with respect to source populations, case definitions, methods of ascertainment and approaches to reporting findings. Prevalence was reported more frequently than incidence; estimates for prevalence and incidence varied substantially for all conditions. Heterogeneity was high. Conclusion: This review highlights substantial gaps in the epidemiological knowledge of comorbidity in MS worldwide. Little is known about comorbidity in Central or South America, Asia or Africa. Findings in North America and Europe are inconsistent. Future studies should report age-, sex- and ethnicity-specific estimates of incidence and prevalence, and standardize findings to a common population.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Health Sciences Center, Canada
| | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Nadia Reider
- Department of Internal Medicine, University of Manitoba, Canada
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