Thursday, April 2, 2020

Impact of Comorbidity and Multiple Sclerosis

Living with one chronic disease, such as multiple sclerosis, can be challenging. Living with more than one chronic disease can make diagnosis and treatment difficult. Living with comorbidity can lead to disability, lower quality of life, delayed diagnosis, increased hospitalization, and increased risk of death for people living with MS.

Some comorbid conditions may be symptoms of MS, such as depression or anxiety, but others are unrelated to MS. Common comorbidities in multiple sclerosis include depression, anxiety, high cholesterol, high blood pressure, gastrointestinal disease, thyroid disease, and chronic lung disease. The subject of comorbidity is a personal one as I actively manage three of these comorbidities in addition to MS.

Mental health and MS

Mood disorders, such as depression, anxiety, and bipolar disorder, are more common in people with MS than in the general population. The prevalence of depression ranges from 36 to 54 percent in people with MS, according to the National MS Society, compared to 16 percent in the general population. Anxiety disorders affect approximately 36 percent with MS while bipolar disorder affects between 6.5 and 13 percent. These estimates are somewhat higher than what was found in a 2015 worldwide literature review and significantly higher than results of a 2018 retrospective analysis of claims data for patients living in the United States. 

Feelings of anxiety or depression may be symptoms of MS, might signal a relapse, or might relate to conditions that were diagnosed before MS. No matter the cause of these symptoms, it is important to discuss what’s going on with your doctors. Mental health conditions can go undiagnosed or untreated. 

Many neurologists are willing to prescription medication for a mood disorder, but others may refer you to a specialist instead. I have worked with a licensed clinical social worker (LCSW) to learn how to deal with various challenges I face related to mental health while medication prescribed by my neurologist helps to alleviate symptoms. 

Cardiovascular disease and MS

In the United States, the most common comorbidities in people with MS, based on claims data from 2006 to 2014, are high cholesterol and high blood pressure which affect between 26 to 30 percent of people with MS. Researchers found that claims for high cholesterol and high blood pressure were 39 and 25 percent, respectively, more likely among male patients compared with female patients with MS. However this contradicts results from a previous study that found hypertension, heart failure, and coronary heart disease were significantly less common in people with MS. 

Treatment of cardiovascular comorbidity is particularly important for people with MS as researchers have determined that high blood pressure and heart disease contribute to advanced brain atrophy and vascular comorbidity is associated with increased risk of disability progression. 

Lifestyle changes can help reduce the risk of heart disease. If you smoke, stop. Exercise and healthy eating can help to control high blood pressure. To lower cholesterol levels, eat a diet high in fiber, but low in cholesterol, saturated fat, and refined sugar. Stay active, increase physical activity, and maintain a healthy weight. If lifestyle changes alone are not enough, your doctor may prescribe medication to help control risk factors for heart disease.

Gastrointestinal disease and MS

In the US claims study mentioned above, gastrointestinal (GI) disease comorbidities were found in the claims of 18 to 21 percent of patients with MS. In general, these diseases were more common among women than men. The gastrointestinal diseases included were celiac disease, constipation, Crohn’s disease, diarrhea, dysphagia (difficulty swallowing), gastroesophageal reflux disease (GERD), irritable bowel syndrome, and ulcerative colitis. 

Several of these GI conditions double as symptoms of MS. If you experience any difficulties with bowel dysfunction, constipation, diarrhea, trouble swallowing, GERD, or other GI symptoms, please talk to your neurologist. You may be referred to a gastroenterologist for evaluation. While there is no single MS diet, some people with MS report that they feel better when they limit sugar and grains from their diet.

Thyroid disease and MS

Thyroid disease comorbidity was documented in 13 to 17 percent of the medical records for MS patients in the US claims database study. A prior systematic review estimated the overall prevalence of thyroid disease comorbidity in MS patients at 6.44 percent, ranging from 0 percent to 16 percent depending upon the specific condition. Examples of thyroid diseases included in the analysis were hypothyroidism, hyperthyroidism, Hashimoto’s thyroiditis, and Grave’s disease. 

Although thyroid disease has been identified as one of the more common comorbidities in people diagnosed with MS, the prevalence of thyroid disease prevalence of thyroid disease in people with MS is similar to that of the general population. Since one MS disease-modifying therapy, Lemtrada (alemtuzumab), is associated with thyroid disease, periodic thyroid function tests are required.

Impact of comorbidity on MS

Living with comorbidity, or having more than one health condition to manage, negatively impacts a person with MS in several ways. It can lead to greater physical disability and quality of life. The person with MS may have more symptoms to deal with which can complicate treatment decisions. Increased risk of death is the ultimate reason to try to reduce comorbidity in people with MS.

What can you do?

If you are coping with MS and one or more additional health conditions, it’s vitally important to seek proper medical treatment and to make healthy lifestyle choices. The choices you can make to improve your chances of living well with MS are very similar to the healthy actions suggested to reduce cardiovascular disease. 

Healthy steps you can take include:
  • Stay physically active and move your body as you can
  • Stay mentally and socially active as well
  • Stop smoking
  • Limit alcohol consumption
  • Focus on eating proper nutrition
  • Eliminate vitamin deficiencies
  • Maintain a healthy weight
    Stay hydrated
  • Get adequate sleep
  • Reduce stress 
  • Take time for yourself 
  • Seek routine medical care to stay on top of your health
(originally published on in 2018)

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