ClinicSpeak: MS comorbidities and survival

Are you being managed holistically? #ClinicSpeak #MSBlog #MSResearch

"The results from the UK GP database show that mortality in MSers is not only driven by MS-related disability but by comorbidities, for example infections (pneumonia, flu and urinary tract infections), depression, alcohol abuse, smoking, heart disease, cancer and depression. One could argue that many of these comorbidities are linked to having MS and if you didn't have MS they wouldn't be an issue, particularly pneumonia, urinary tract infection and depression.  The MSers who I look after who abuse alcohol tell me that their alcohol abuse is due to them having MS; they find alcohol treats their anxiety. In other words drinking is the way they treat their own depression and anxiety."

"From a clinical perspective it is irrelevant to the management of individual MSer to argue about what came first; MS or the comorbidity. As healthcare professionals looking after people with MS we need an holistic approach to the disease. In other words we need to treat the depression, prevent urinary tract infections and aspiration pneumonia, try and get MSers to stop smoking, treat their other addictions and modify their cardiovascular risk factors to prevent cardiac disease. If possible we should screen for malignancies, particularly if they are on an immunosuppressive therapy, and refer promptly the relevant specialty for treatment when we detect a malignancy. We have to take responsibility for maximising health, in particular brain health of people with MS. The latter is a two-way street and MSers have to engage in the process as well. Self-management is the name of the game in 2015 and the next phase of preventive health care will be developing programmes to nudge patients towards self-management of chronic disease. Prevention is better than cure. It is easier to prevent disability than to treat the consequences of having disability."
"The following is my tube map analogy of the holistic approach to the management of MS; each stop on the map is an issue that needs to be addressed by MSers and their HCPs."

Epub: Jick et al. Epidemiology of multiple sclerosis: results from a large observational study in the UK.J Neurol. 2015 Jun 13.

Background: MS progression to mortality may not be solely determined by the underlying autoimmune process.

Objective: We conducted a study in a large cohort of MS patients with the aim of describing characteristics of MSers and identification of predictors for all-cause mortality in this patient group.

Methods: We performed a retrospective analysis of primary care data from the UK Clinical Practice Research Datalink. Incident MS cases diagnosed between 1993 and 2006 were identified and validated using electronic and original medical records. MSers were followed to identify deaths; hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using Cox proportional regression with age as time-scale. 

Results: In total, 1713 incident MS cases were identified. Following MS diagnosis, frequent comorbidities were infections (80 %), and depression (46 %). Adjusted HRs (95 % CIs) for all-cause mortality were: 2.0 (1.2-3.4) for current smoking; 7.6 (3.2-17.7) for alcohol abuse; 2.7 (1.6-4.5) for pneumonia and influenza; 4.1 (2.7-6.3) for urinary tract infections; 2.2 (1.2-4.2) for heart disease and 4.9 (2.9-8.0) for cancer. 

Conclusions: Our results suggest that MS survival is influenced not only by the underlying autoimmune process, but also by patient comorbidities and lifestyle factors.

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