“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.”
Marrie et al. The incidence and prevalence of comorbid gastrointestinal, musculoskeletal, ocular, pulmonary, and renal disorders in multiple sclerosis: A systematic review. Mult Scler. 2015 Mar;21(3):332-341.
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.”