Research Decoder: Comorbidities

hA comorbidity is a chronic medical condition that occurs alongside an existing one. For example, someone diagnosed with both multiple sclerosis and hypertension would be said to have two comorbid conditions. Comorbidities are of paramount concern to clinicians and other care providers, since they can often interact with MS in unpredictable ways, in turn complicating the course or treatment of MS, impacting quality of life and influencing disease progression. A proper understanding of the types and frequencies of comorbidities among people living with MS is a crucial step in figuring out the optimal treatment and management plan that suits each individual. Comprehensive and accurate information on the population patterns of comorbidities is also indispensable for designing proper research studies in order to account for any complicating factors that could end up skewing the results.

An international initiative aimed at cataloguing the various types and frequencies of comorbidities in people living with MS, called the MS Comorbidities Project and led by the International Advisory Committee on Clinical Trials in MS, released a seven-part, systematic review of comorbidities in MS earlier this year. The reviews were co-authored by leading MS epidemiologist and neurologist Dr. Ruth Ann Marrie (supported by an MS Society Donald Paty Career Development Award) and a team of international colleagues, and together make up the most exhaustive overview of the MS comorbidity landscape to date. The reviews were broken up across six different categories of comorbid conditions: 1) sleep disorders and seizure disorders; 2) cardiac, cerebrovascular, and peripheral vascular disease; 3) psychiatric disorders; 4) autoimmune disease; 5) gastrointestinal, musculoskeletal, ocular, pulmonary, and renal disorders, and; 5) cancer.

The review came up with some highly important findings. Firstly, the five most common comorbidities found among people living with MS were depression, anxiety, hypertension, hypercholesterolemia and chronic lung disease. The most common autoimmune diseases in particular included thyroid disease and psoriasis. Strikingly, the authors found that some conditions, such as meningiomas and urinary system cancers, were more common in the MS population compared to the general population, whereas pancreatic, ovarian, prostate and testicular cancers were less common. Together, these findings show that there is an urgent need to include routine screening for certain comorbidities as a part of standard MS management.

Of course, there are many challenges to overcome when conducting a systematic literature review like this one; for instance, study designs and reporting methodologies can differ significantly from one study to another, and variable quality between studies can complicate matters further. One aim of the MS Comorbidities Project is to help standardize the design and quality of studies going forward.

Recently, Dr. Marrie and colleagues published an MS Society-funded study where they asked: do comorbid conditions affect health and survival in people living with MS? This question was driven by the observation that while people with MS are living longer now than ever before, their lifespans in general continue to be lower than people in the general population. They found that people with MS who had comorbidities such as depression, anxiety, diabetes, heart disease and chronic lung disease had an increased risk of dying at a younger age than people without these conditions; however, people without MS had a similar increased risk of shorter lifespan if they had the same medical conditions. Nonetheless, these results highlight the need to understand and treat these conditions in tandem with the management of MS. You can read the details of the study in our recent MS Update.

Do you have any comorbid conditions that exist alongside your MS? Share your story in the comments below.

References

Marrie RA et al. (2015). A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: Overview. Mult Scler. 21(3): 263-81.

Marrie RA et al. (2015). Effect of comorbidity on mortality in multiple sclerosis. Neurology. [Epub ahead of print]

Image credits: © Cornelius20 | Dreamstime.com – Brain Maze Photo

10 thoughts on “Research Decoder: Comorbidities

  1. Lori Batchelor

    I used to have chronic cerebrospinal venous insufficiency but your failure to support my right to even be tested for it in Canada showed me how hypocritical the Society is when it comes to quality of life and I don’t trust your caring about any comorbidities being treated in tandem with the management of MS!

    Reply
  2. SANDRA MAE WATTS

    Hi Dr Lee. I never thought of myself as having comorbidities, but at 59 now, I do have musculosketal issues, nystagmus, and am osteoporotic. So of course I am now taking medications for those, as well as my DMT for MS.

    Reply
  3. Lori Batchelor

    I tried posting before but it doesn’t seem to have worked so I’ll try again. I had CCSVI as a comorbidity.

    I wonder if the statement “Nonetheless, these results highlight the need to understand and treat these conditions in tandem with the management of MS.” in Karen Lee’s Blog about the study “Effect of comorbidity on mortality in multiple sclerosis” will mean that people with MS in Canada will now at least be able to be tested for Chronic Cerebrospinal Venous Insufficiency (CCSVI) and then treated for it if it is found?

    I found this statement in the study interesting:
    “The most common causes of death in the MS population were diseases of the nervous system and diseases of the circulatory system.”
    CCSVI is a problem in the circulatory system–I hope this study will finally encourage the MS Society of Canada to fight for the right for people with MS to be tested/treated so that if they are affected they may regain proper blood flow in their circulatory system!
    Lori Batchelor

    Reply
  4. Tanya Henderson

    I have been diagnosed with MS since 1989. In 2013 I was diagnosed diabetic (type 2) and just recently with osteoarthritis. This was a very interesting read. Thank you.

    Reply
  5. Danielle Avery

    I live with MS, Bipolar disorder and Hashimoto’s Thyroiditis. While it’s not always a barrel of laughs, with help, support and stress management, I’m doing quite well.
    xo

    Reply
    1. drkarenlee Post author

      Hi Danielle,

      It’s great to hear that you’re doing well and have a great support system.

      Dr. K

      Reply
  6. Candice Cronin

    I live with MS and Fibromyalgia. Starting to learn how to distinguish what symptoms are coming from which condition. Slowly Starting to get things under control

    Reply
    1. drkarenlee Post author

      Hi Candice,

      I’m so glad to hear that you’re taking control of your MS and comorbidities.

      Dr. K

      Reply
  7. Angela

    I have MS and also have asthma, hypertension, depression, anxiety and sleep disorder. Result, a long list of pills and supplements to try and keep it all in order. I also keep having to be screened for breast cancer and colon cancer because of concerning results but no positive diagnosis. That’s the worst part.

    Reply

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