Tuesday, 7 April 2015

Comorbidities: bowel, lung and joints

MSers may have a higher incidence of irritable bowel syndrome, arthritis and lung disease. #MSBlog #MSResearch

"The following meta-analysis is the next in the recently published series of papers by Ruth-Ann Marrie and colleagues. It suggests MSers have a higher incidence of irritable bowel syndrome (IBS), arthritis, and chronic lung disease. The higher incidence of chronic lung disease can be explained by the smoking association with MS; MSers in general are more likely to be smokers than the general population. Smoking increase your chances of developing MS by ~50%."

"Arthritis is more difficult to explain. Rheumatoid arthritis (RA) is less common in MSers simply because the major gene predisposing you to develop RA protects you from getting MS. Arthritis is a non-specific term and includes a large number of different diseases; the association of arthritis and MS would therefore need additional studies to investigate the association in detail."

"Irritable bowel syndrome (IBS) is an interesting co-morbidity. Could it be that initial inexplicable bowel problems, due to MS, get labelled as IBS prior to focal neurological symptoms bring MS to forefront of the clinical diagnosis? IBS is also a bit of a dumping ground when it comes to gastroenterology diagnoses. A large number of problems get labelled as IBS when we can't explain them. The association of IBS with MS is important as problems with bowel function are a significant problem for MSers and impact on quality of life. I spend a significant amount of time managing bowel function in my MS clinics; in particular chronic constipation, intermittent diarrhoea, faecal urgency and intermittent incontinence. The latter is one of the drivers of social isolation, another co-morbidity that is often ignored."

BACKGROUND: As new disease-modifying therapies emerge a better knowledge of the risk of comorbid disease in multiple sclerosis(MS) is needed.

OBJECTIVE: To estimate the incidence and prevalence of comorbid gastrointestinal, musculoskeletal, ocular, pulmonary, and renal disorders in MS.

METHODS: We systematically reviewed the world literature by searching PUBMED, EMBASE, SCOPUS, the Web of Knowledge, and reference lists of retrieved articles. For selected articles, one reviewer abstracted data using a standardized form. The abstraction was verified by a second reviewer. The quality of all selected studies was assessed. For population-based studies we quantitatively assessed studies using the I 2 statistic, and conducted random effects meta-analyses.

RESULTS: Study designs were heterogeneous with respect to populations, case definitions, and methods of ascertainment. Incidence of the studied comorbidities was rarely reported. Irritable bowel syndrome and chronic lung disease had a prevalence of more than 10% in the MS population. Irritable bowel syndrome, fibromyalgia, cataracts and glaucoma were more common than expected in the MS population.

CONCLUSION: Although they have been the subject of less study than other comorbidities, irritable bowel syndrome, arthritis, and chronic lung disease are common in the MS population and occur more often than expected when compared to the general population.

"The following are my slides from the recent NMSS-ECTRIMS comorbidity meeting in Toronto."

"The following is the programme from the NMSS-ECTRIMS comorbidity meeting in Toronto; you may need to see the programme to put my talk into the correct context."

CoI: multiple


  1. The smoking stat doesn´t add up. I never smoked and got MS so this needs to be explained. Also smoking has reduced to c.20% of the population compared with 60% in the 1930s. But MS is now increasing among the population. EBV is the cause. Smoking has a minimal effect.

  2. Had most of these comorbidities, healthy lifestyle never smoked, but having trouble reading this, still waiting for my cataract appointment. I've not got much hope. Oh forgot to mention never been on a DMT in my life.

  3. After my MRI showing MS lesions, my neuro told me I didn't have MS. Then he told me that constipation had nothing to do with MS, I shook my head, left his office and got a referral directly to the MS clinic instead. Delayed my diagnosis by 1.5 years wasting my time with this man while suffering from severe trigeminal neuralgia -- two or more lesions in the pons and a larger lesion in the left medulla. He is still allowed to practise.

  4. Well, I had 26 lesions and trigeminal neuralgia, cognitive problems and balance problems and neurologist said you don't look like you have ms. "You won't probably qualify for drugs and you don't want to be poked and prodded." His receptionist asked me how long have you had it? Well, she showed me the MRI and it stated compatable with MS…………. I made a appointment at ms clinic and 2 days later I was diagnosed by another neurologist………..PPMS. I do have arthritis. My mother smoked heavily and died due to COPD. Please keep your own reports, research, and get second referrals…………… BEST REGARDS

    1. I'm curious -- where are you located? In in British Columbia, Canada.

  5. "Fortunately" my first MRI which was supposed to "rule out" MS just made it blatantly clear that my problem was MS (lots of lesions all over the place). I've learnt the hard way and now get the images copied onto a disc every time I have a scan (how ridiculous is it to wait months to see the neuro and find that he can't access the radiology system to look at your MRI images because his log-in has expired!!!). I also make sure I get a copy of all my blood test results, any Neuro reports sent to my GP, and anything else that relates to my health, and keep my own file. I'm sure the docs must sometimes think I'm a real pain but at least by doing so I don't go to an appointment and find that the filing clerks haven't kept up and critical information isn't in my file yet (and I'm talking about weeks not days for the filing to catch up). Having my own copies of everything also gives me the chance to look up anything I don't understand so that I can make the best use of the limited time at appointments. Accordingly, I strongly recommend that everyone gets and keeps copies of their records. More than once I have gone to an appointment, and taken a spare copy - and ended up with a "Here's one I prepared earlier" scenario - with me giving the specialist a copy of something which should have been on file but wasn't.

    1. I do exactly the same thing as I realized early on that the systems were archaic and inefficient and I'm the only one who really cares.


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