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Liu Q, Jiang Y, Frisell T, Stridh P, Shchetynsky K, Alfredsson L, Kockum I, Manouchehrinia A, Jiang X. Shared aetiology underlying multiple sclerosis and other immune mediated inflammatory diseases: Swedish familial co-aggregation and large-scale genetic correlation analyses. J Autoimmun 2024; 148:103294. [PMID: 39084084 DOI: 10.1016/j.jaut.2024.103294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 06/22/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND While multiple sclerosis (MS) affects less than 1 % of the general population, immune mediated inflammatory diseases (IMIDs) collectively influence 5-10 % of the population. Understanding familial co-aggregation of MS and other IMIDs carries important clinical and public health implications that will enable early detection and personalized treatment. OBJECTIVE To estimate the familial association between MS and other IMIDs and to quantify their shared genetic basis. DESIGN Register-based multi-generational nested case-control familial co-aggregation study and genetic correlation study. SETTING Sweden. PARTICIPANTS 24,995 individuals with MS matched with 253,870 controls and 1,283,502 first-degree relatives (mothers, fathers, full siblings, and offspring) for familial co-aggregation analysis; population of European ancestry for genetic correlation analysis. MEASUREMENTS Logistic regressions with adjustment for covariates were used to estimate the odds ratios (ORs) of developing MS in individuals with first-degree relatives diagnosed with IMIDs compared to those without such family history. Pairwise genome-wide genetic correlations were estimated with linkage-disequilibrium score regression. RESULTS We observed an OR for familial co-aggregation of MS of 1.09 (95 % confidence interval (95%CI) = 1.07-1.11) in families with IMIDs history compared to families without. The association remained broadly consistent after stratification by sex concordance of relative pairs and by kinships. 18 IMID subtypes showed a familial association with MS, 7 of which including other acute widespread myelin destruction, encephalitis or myelitis or encephalomyelitis, inflammatory bowel disease, autoimmune thyroid diseases, systemic lupus erythematosus, other inflammatory system diseases, and sarcoidosis withstood multiple correction. Genetic correlations further revealed a shared genetic basis between 7 IMID subtypes with MS. CONCLUSION We demonstrated a modest familial co-aggregation of MS with several IMIDs, and such association is likely due to shared genetic factors.
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Affiliation(s)
- Qianwen Liu
- Departement of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Yuan Jiang
- Departement of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Pernilla Stridh
- Departement of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | | | - Lars Alfredsson
- Departement of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Ingrid Kockum
- Departement of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Ali Manouchehrinia
- Departement of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
| | - Xia Jiang
- Departement of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
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Binzer S, Hillert J, Manouchehrinia A. Concomitant autoimmunity and risk of multiple sclerosis disability worsening. Mult Scler Relat Disord 2024; 87:105637. [PMID: 38761694 DOI: 10.1016/j.msard.2024.105637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Few studies have examined the effect of concomitant autoimmune diseases on multiple sclerosis (MS) disability worsening. We set out to examine whether concomitant Crohn's Disease (CD), Ulcerative Colitis (UC), or Type 1 Diabetes (T1D) affect MS disability worsening in a nationwide cohort of MS patients as defined by reaching expanded disability scale status (EDSS) scores 3.0, 4.0 and 6.0. METHODS Patients with MS onset between January 2004 and January 2019 were identified from the Swedish MS registry and the Swedish National Patient Register. Kaplan-Meier analysis was used to estimate the median time to reach sustained disability milestones. Adjusted Cox proportional hazard regression models were used to calculate the risk of reaching disability milestones among persons with and without CD, UC, or T1D. RESULTS Out of 8972 persons with MS, 88 (1.0 %) had T1D, 47 (0.8 %) had UC, and 78 (0.9 %) had CD. There was a significantly higher risk of disability progression, for persons with MS and T1D for reaching EDSS 6.0, hazard ratio (HR) = 2.21 (95 % confidence interval (CI) = 1.48 -3.31) and persons with MS and comorbid CD for reaching EDSS 3.0, HR = 2.30 (95 %CI = 1.74-3.04) and 4.0, HR = 1.59 (95 %CI = 1.09-2.32), and persons with MS and comorbid UC for reaching EDSS 3.0 HR = 1.57 (95 %CI = 1.15-2.14). As defined by Charlson's comorbidity index, the co-existence of other co-morbidities conferred a significant increase in the risk of reaching all endpoints, with HR ranging from 1.23 to 1.62. CONCLUSION Comorbidity is associated with a significantly increased risk of reaching disability end-points, and T1D, CD, and UC increase the risk further. Thus, there appears to be a need for increased vigilance of comorbidites in persons with MS in order to optimise the long-term outcome of MS.
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Affiliation(s)
- Stefanie Binzer
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Kolding Hospital, Department of Neurology, Kolding, Denmark.
| | - Jan Hillert
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ali Manouchehrinia
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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3
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Zong J, Yang Y, Wang H, Zhang H, Yang X, Yang X. The two-directional prospective association between inflammatory bowel disease and neurodegenerative disorders: a systematic review and meta-analysis based on longitudinal studies. Front Immunol 2024; 15:1325908. [PMID: 38720896 PMCID: PMC11076839 DOI: 10.3389/fimmu.2024.1325908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Objective Previous studies reported possible connections between inflammatory bowel disease (IBD) and several neurodegenerative disorders. However, the comprehensive relationships between IBD and various neurodegenerative disorders were not summarized. We executed a meta-analysis of longitudinal studies to provide an estimate of the strength of the two-directional prospective association between IBD and neurodegenerative disorders. Methods We accomplished a thorough bibliographic search of PubMed, Web of Science, Embase, PsycINFO, and Cochrane Library databases until June 2023 to locate relevant longitudinal studies. The extracted data were then analyzed via meta-analysis using either a fixed or random effects model. Results The final analysis encompassed 27 studies. Individuals with IBD faced an increased risk of developing four neurodegenerative disorders than the general public, namely, Alzheimer's disease (hazard ratio[HR] = 1.35, 95% confidence interval [CI]: 1.03-1.77, P=0.031), dementia (HR =1.24, 95% CI: 1.13-1.36, P<0.001), multiple sclerosis (HR =2.07, 95% CI:1.42-3.02, P<0.001) and Parkinson's disease (HR =1.23, 95% CI:1.10-1.38, P<0.001). Two articles reported an increased incidence of amyotrophic lateral sclerosis or multiple system atrophy in IBD patients. Three studies investigated the prospective association between multiple sclerosis and IBD, revealing an elevated risk of the latter in patients with the former. (HR=1.87, 95% CI:1.66-2.10, P<0.001). Interpretation These findings verified the two-directional relationship between the brain-gut axis, specifically demonstrating a heightened risk of various neurodegenerative diseases among IBD patients. It may be profitable to prepare screening strategies for IBD patients to find neurodegenerative diseases during the long-term course of treatment for IBD with a view to potential earlier diagnosis and treatment of neurodegenerative diseases, reducing public health and social burden. Systematic Review Registration PROSPERO (CRD42023437553).
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Affiliation(s)
- Jiahao Zong
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yue Yang
- Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Huipeng Zhang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaorong Yang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Clinical Epidemiology Unit, Clinical Research Center of Shandong University, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaoyun Yang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Shandong, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Clinical Epidemiology Unit, Clinical Research Center of Shandong University, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Zhou H, Qi Y, Xu Y, Qi X, Qi H. Reverse causation between multiple sclerosis and psoriasis: a genetic correlation and Mendelian randomization study. Sci Rep 2024; 14:8845. [PMID: 38632254 PMCID: PMC11024188 DOI: 10.1038/s41598-024-58182-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
Observational studies have found a potential bidirectional positive association between multiple sclerosis and psoriasis, but these studies are susceptible to confounding factors. We examined the directionality of causation using Mendelian randomization and estimated the genetic correlation using the linkage disequilibrium score. We performed Mendelian randomization analysis using large-scale genome-wide association studies datasets from the International Multiple Sclerosis Genetics Consortium (IMSGC, 115,803 individuals of European ancestry) and FinnGen (252,323 individuals of European ancestry). We selected several Mendelian randomization methods including causal analysis using summary effect (CAUSE), inverse variance-weighted (IVW), and pleiotropy-robust methods. According to CAUSE and IVW the genetic liability to MS reduces the risk of psoriasis (CAUSE odds ratio [OR] 0.93, p = 0.045; IVW OR 0.93, p = 2.51 × 10-20), and vice versa (CAUSE OR 0.72, p = 0.001; IVW OR 0.71, p = 4.80 × 10-26). Pleiotropy-robust methods show the same results, with all p-values < 0.05. The linkage disequilibrium score showed no genetic correlation between psoriasis and MS (rg = - 0.071, p = 0.2852). In summary, there is genetic evidence that MS reduces the risk of psoriasis, and vice versa.
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Affiliation(s)
- Hao Zhou
- Peking University Shenzhen Hospital Clinical College, Anhui Medical University, Shenzhen, 518036, China
- The Fifth Clinical Medical College, Anhui Medical University, Hefei, 230000, China
- Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Yajie Qi
- Peking University Shenzhen Hospital Clinical College, Anhui Medical University, Shenzhen, 518036, China
- The Fifth Clinical Medical College, Anhui Medical University, Hefei, 230000, China
- Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Yingxin Xu
- Peking University Shenzhen Hospital Clinical College, Anhui Medical University, Shenzhen, 518036, China
- The Fifth Clinical Medical College, Anhui Medical University, Hefei, 230000, China
- Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Xiaoyi Qi
- Medical College, Shantou University, Shantou, 515000, China
| | - Hui Qi
- Peking University Shenzhen Hospital Clinical College, Anhui Medical University, Shenzhen, 518036, China.
- The Fifth Clinical Medical College, Anhui Medical University, Hefei, 230000, China.
- Peking University Shenzhen Hospital, Shenzhen, 518036, China.
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5
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Nociti V, Romozzi M. Multiple Sclerosis and Autoimmune Comorbidities. J Pers Med 2022; 12:jpm12111828. [PMID: 36579555 PMCID: PMC9698878 DOI: 10.3390/jpm12111828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/17/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system characterized by broad inter- and intraindividual heterogeneity and different prognoses. Multisystem comorbidities are frequent features in people with MS (PwMS) and can affect treatment choices, quality of life, disability and mortality. In this scenario, autoimmune comorbidities play a cardinal role for several reasons, such as the implication on MS pathogenesis, diagnostic delay, disease activity, disability progression, brain atrophy, and treatment choice. However, the impact of an autoimmune comorbid condition on MS is not fully elucidated. This review aims to summarize the currently available data on the incidence and prevalence of autoimmune diseases in PwMS, the possible effect of this association on clinical and neuroradiological MS course and its impact on treatment choice.
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Affiliation(s)
- Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Marina Romozzi
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, 00168 Rome, Italy
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Wang X, Wan J, Wang M, Zhang Y, Wu K, Yang F. Multiple sclerosis and inflammatory bowel disease: A systematic review and meta-analysis. Ann Clin Transl Neurol 2022; 9:132-140. [PMID: 35092169 PMCID: PMC8862424 DOI: 10.1002/acn3.51495] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/23/2021] [Accepted: 12/15/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) and inflammatory bowel disease (IBD) are two autoimmune diseases that seriously affect patients' quality of life. Previous studies have established an association between MS and IBD, including Crohn's disease (CD) and ulcerative colitis (UC), but the results were inconsistent. The aim of this study was to quantify the prevalences of and the association between MS and IBD. METHODS The PubMed, Web of Science, and Embase databases were searched through November 2020 for studies reporting data on MS among patients with IBD and vice versa. The main outcomes were the proportion of MS in patients with IBD and vice versa, as well as the association (risk ratio [RR]) of IBD in MS and that of MS in IBD. RESULTS Based on the analysis of 17 studies, the prevalence of MS in patients with IBD was 0.2% (95% CI 0.1-0.4%), while the prevalence of IBD in patients with MS was 0.6% (95% CI 0.4-0.9%). Patients with MS had a higher prevalence of IBD than controls (RR = 1.53, 95% CI 1.38-1.70, p < 0.00001). There was a similarly high risk of developing CD (RR 1.41, 95% CI 1.14-1.74, p = 0.001) or UC (RR 1.42, 95% CI 1.17-1.71, p = 0.0003) in patients with MS (p for subgroup differences: 0.97). Patients with IBD had a higher prevalence of MS than controls (RR = 1.91, 95% CI 1.06-3.45, p = 0.03). CONCLUSIONS Clinicians should be aware of the increased risk of IBD or MS comorbidity during the diagnostic process. Systematic diagnosis and management at an earlier stage are suggested.
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Affiliation(s)
- Xuan Wang
- Department of Neurology, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Jian Wan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'anChina
| | - Min Wang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'anChina
| | - Yujie Zhang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'anChina
- Department of Histology and Embryology, School of Basic MedicineXi'an Medical UniversityXi'anChina
| | - Kaichun Wu
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'anChina
| | - Fang Yang
- Department of Neurology, Xijing HospitalFourth Military Medical UniversityXi'anChina
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Lindahl H, Bryceson YT. Neuroinflammation Associated With Inborn Errors of Immunity. Front Immunol 2022; 12:827815. [PMID: 35126383 PMCID: PMC8807658 DOI: 10.3389/fimmu.2021.827815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 01/16/2023] Open
Abstract
The advent of high-throughput sequencing has facilitated genotype-phenotype correlations in congenital diseases. This has provided molecular diagnosis and benefited patient management but has also revealed substantial phenotypic heterogeneity. Although distinct neuroinflammatory diseases are scarce among the several thousands of established congenital diseases, elements of neuroinflammation are increasingly recognized in a substantial proportion of inborn errors of immunity, where it may even dominate the clinical picture at initial presentation. Although each disease entity is rare, they collectively can constitute a significant proportion of neuropediatric patients in tertiary care and may occasionally also explain adult neurology patients. We focus this review on the signs and symptoms of neuroinflammation that have been reported in association with established pathogenic variants in immune genes and suggest the following subdivision based on proposed underlying mechanisms: autoinflammatory disorders, tolerance defects, and immunodeficiency disorders. The large group of autoinflammatory disorders is further subdivided into IL-1β-mediated disorders, NF-κB dysregulation, type I interferonopathies, and hemophagocytic syndromes. We delineate emerging pathogenic themes underlying neuroinflammation in monogenic diseases and describe the breadth of the clinical spectrum to support decisions to screen for a genetic diagnosis and encourage further research on a neglected phenomenon.
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Affiliation(s)
- Hannes Lindahl
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Yenan T. Bryceson
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Brogelmann Research Laboratory, Department of Clinical Sciences, University of Bergen, Bergen, Norway
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Ajdacic-Gross V, Steinemann N, Horváth G, Rodgers S, Kaufmann M, Xu Y, Kamm CP, Kesselring J, Manjaly ZM, Zecca C, Calabrese P, Puhan MA, von Wyl V. Onset Symptom Clusters in Multiple Sclerosis: Characteristics, Comorbidities, and Risk Factors. Front Neurol 2021; 12:693440. [PMID: 34295301 PMCID: PMC8290323 DOI: 10.3389/fneur.2021.693440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Multiple sclerosis (MS) symptoms are expected to aggregate in specific patterns across different stages of the disease. Here, we studied the clustering of onset symptoms and examined their characteristics, comorbidity patterns and associations with potential risk factors. Methods: Data stem from the Swiss Multiple Sclerosis Registry, a prospective study including 2,063 participants by November 2019. MS onset symptoms were clustered using latent class analysis (LCA). The latent classes were further examined using information on socio-demographic characteristics, MS-related features, potential risk factors, and comorbid diseases. Results: The LCA model with six classes (frequencies ranging from 12 to 24%) was selected for further analyses. The latent classes comprised a multiple symptoms class with high probabilities across several symptoms, contrasting with two classes with solitary onset symptoms: vision problems and paresthesia. Two gait classes emerged between these extremes: the gait-balance class and the gait-paralysis class. The last class was the fatigue-weakness-class, also accompanied by depression symptoms, memory, and gastro-intestinal problems. There was a moderate variation by sex and by MS types. The multiple symptoms class yielded increased comorbidity with other autoimmune disorders. Similar to the fatigue-weakness class, the multiple symptoms class showed associations with angina, skin diseases, migraine, and lifetime prevalence of smoking. Mononucleosis was more frequently reported in the fatigue-weakness and the paresthesia class. Familial aggregation did not differ among the classes. Conclusions: Clustering of MS onset symptoms provides new perspectives on the heterogeneity of MS. The clusters comprise different potential risk factors and comorbidities. They point toward different risk mechanisms.
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Affiliation(s)
- Vladeta Ajdacic-Gross
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Nina Steinemann
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Gábor Horváth
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Stephanie Rodgers
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Kaufmann
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Yanhua Xu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.,Neurocentre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Valens, Switzerland
| | - Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Chiara Zecca
- Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Milo A Puhan
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Swiss MS Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Berkovich R, Yakupova A, Eskenazi J, Carlson NG, Steinman L. Improvement of Comorbid Psoriasis in Patients With MS Treated With Natalizumab. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/2/e961. [PMID: 33589543 PMCID: PMC8057059 DOI: 10.1212/nxi.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/08/2020] [Indexed: 12/01/2022]
Abstract
Objective To present observations on administration of natalizumab to 18 patients with the comorbid MS and psoriasis, who represented a full subset of patients with such comorbidity within the patient records available. Methods A retrospective analysis of patient records was performed. Patient histories were gathered and included date of diagnosis of MS and psoriasis, MS disease-modifying therapies (DMTs), Expanded Disability Status Scale (EDSS), reason for DMT switch, and effects on MS and psoriasis status. Results On initiation of natalizumab, all 18 patients had a complete cessation of MS disease activity (within 2–8 months) with significant patient-reported improvement of psoriasis (within 1–5 months). This improvement was independent of previous MS therapy and led to 15 of 18 patients needing no additional treatment for MS and psoriasis (remaining 3 patients continued to use topical treatments for psoriasis). Conclusions In this cohort of 18 patients with comorbid MS and psoriasis, beneficial results on both diseases were observed after initiation of therapy with natalizumab.
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Affiliation(s)
- Regina Berkovich
- From the LA County and University of Southern California General Hospital and Clinic (R.B.), Los Angeles; Kazan State Medical University (A.Y.), Russia; UCLA (J.E.), Los Angeles, CA; GRECC, VA Salt Lake, University of Utah (N.C.), Salt Lake City; and Stanford University (L.S.), Palo Alto, CA.
| | - Aida Yakupova
- From the LA County and University of Southern California General Hospital and Clinic (R.B.), Los Angeles; Kazan State Medical University (A.Y.), Russia; UCLA (J.E.), Los Angeles, CA; GRECC, VA Salt Lake, University of Utah (N.C.), Salt Lake City; and Stanford University (L.S.), Palo Alto, CA
| | - Jonathan Eskenazi
- From the LA County and University of Southern California General Hospital and Clinic (R.B.), Los Angeles; Kazan State Medical University (A.Y.), Russia; UCLA (J.E.), Los Angeles, CA; GRECC, VA Salt Lake, University of Utah (N.C.), Salt Lake City; and Stanford University (L.S.), Palo Alto, CA
| | - Noel G Carlson
- From the LA County and University of Southern California General Hospital and Clinic (R.B.), Los Angeles; Kazan State Medical University (A.Y.), Russia; UCLA (J.E.), Los Angeles, CA; GRECC, VA Salt Lake, University of Utah (N.C.), Salt Lake City; and Stanford University (L.S.), Palo Alto, CA
| | - Lawrence Steinman
- From the LA County and University of Southern California General Hospital and Clinic (R.B.), Los Angeles; Kazan State Medical University (A.Y.), Russia; UCLA (J.E.), Los Angeles, CA; GRECC, VA Salt Lake, University of Utah (N.C.), Salt Lake City; and Stanford University (L.S.), Palo Alto, CA
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10
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Castelo-Branco A, Chiesa F, Bengtsson CE, Lee S, Minton NN, Niemcryk S, Lindholm A, Rosenlund M, Piehl F, Montgomery S. Non-infectious comorbidity in patients with multiple sclerosis: A national cohort study in Sweden. Mult Scler J Exp Transl Clin 2020; 6:2055217320947761. [PMID: 32864156 PMCID: PMC7430080 DOI: 10.1177/2055217320947761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background Comorbidity is of significant concern in multiple sclerosis (MS). Few population-based studies have reported conditions occurring in MS after diagnosis, especially in contemporary cohorts. Objective To explore incident comorbidity, mortality and hospitalizations in MS, stratified by age and sex. Methods In a Swedish population-based cohort study 6602 incident MS patients (aged ≥18 years) and 61,828 matched MS-free individuals were identified between 1 January 2008 and 31 December 2016, using national registers. Incidence rates (IRs) and incidence rate ratios (IRRs) with 95% CI were calculated for each outcome. Results IRs of cardiovascular disease (CVD) were higher among MS patients than MS-free individuals, (major adverse CVD: IRR 1.42; 95% CI 1.12–1.82; hemorrhagic/ischemic stroke: 1.46; 1.05–2.02; transient ischemic attack: 1.65; 1.09–2.50; heart failure: 1.55; 1.15–2.10); venous thromboembolism: 1.42; 1.14–1.77). MS patients also had higher risks of several non-CVDs such as autoimmune conditions (IRR 3.83; 3.01–4.87), bowel dysfunction (2.16; 1.86–2.50), depression (2.38; 2.11–2.68), and fractures (1.32; 1.19–1.47), as well as being hospitalized and to suffer from CVD-related deaths ((1.91; 1.00–3.65), particularly in females (3.57; 1.58–8.06)). Conclusion MS-patients experience a notable comorbidity burden which emphasizes the need for integrated disease management in order to improve patient care and long-term outcomes of MS.
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Affiliation(s)
- Anna Castelo-Branco
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital and Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Flaminia Chiesa
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital and Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Sally Lee
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital and Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Neil N Minton
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital and Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Steve Niemcryk
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital and Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Mats Rosenlund
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital and Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
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11
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Castelo-Branco A, Chiesa F, Conte S, Bengtsson C, Lee S, Minton N, Niemcryk S, Lindholm A, Rosenlund M, Piehl F, Montgomery S. Infections in patients with multiple sclerosis: A national cohort study in Sweden. Mult Scler Relat Disord 2020; 45:102420. [PMID: 32736217 DOI: 10.1016/j.msard.2020.102420] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) patients have an increased risk of infections, but few population-based studies have reported infections occurring in MS in the years immediately after diagnosis. OBJECTIVE To explore incident infections in MS, stratified by age and sex. METHODS In a Swedish population-based cohort study 6602 incident MS patients (aged ≥18 years), matched at diagnosis with 61,828 matched MS-free individuals were identified between 1st January 2008 and 31st December 2016, using national registers. Incidence rates (IR) and incidence rate ratios (IRR) with 95% CI were calculated for each outcome. RESULTS The IRRs were 2.54 (95% CI 2.28-2.83) for first serious infection and 1.61 (1.52-1.71) for first non-serious infection. Compared with MS-free individuals, MS patients had higher IRs for skin, respiratory/throat infections, pneumonia/influenza, bacterial, viral, and fungal infections, with the highest IRR observed for urinary tract/kidney infections (2.44; 2.24-2.66). The cumulative incidence for most of these infections was higher among MS patients than MS-free individuals, both 0 to <5 and 5 to <9 years after index date. CONCLUSION The burden of infections around the time of MS diagnosis and subsequent infection risk, underscore the need for careful considerations regarding the risk-benefit across different disease-modifying therapies.
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Affiliation(s)
| | - Flaminia Chiesa
- Real-world Insights, IQVIA Nordics, Pyramidvägen 7, 169 56 Solna, Sweden
| | - Simona Conte
- Real-world Insights, IQVIA Nordics, Pyramidvägen 7, 169 56 Solna, Sweden
| | - Camilla Bengtsson
- Real-world Insights, IQVIA Nordics, Pyramidvägen 7, 169 56 Solna, Sweden.
| | - Sally Lee
- Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, United States
| | - Neil Minton
- Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, United States
| | - Steve Niemcryk
- Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, United States
| | - Anders Lindholm
- Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, United States
| | - Mats Rosenlund
- Department of Learning, Informatics, Management and Ethics (LIME), Tomtebodavägen 18a, 171 65 Solna, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Stockholm Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital and Örebro University, Fakultetsgatan 1, 701 82 Örebro, Sweden; Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom
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12
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Murley C, Karampampa K, Alexanderson K, Hillert J, Friberg E. Diagnosis-specific sickness absence and disability pension before and after multiple sclerosis diagnosis: An 8-year nationwide longitudinal cohort study with matched references. Mult Scler Relat Disord 2020; 42:102077. [PMID: 32353754 DOI: 10.1016/j.msard.2020.102077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) typically onsets when of working age and may reduce work capacity. Previous studies have examined the risk of sickness absence (SA) and disability pension (DP) among MS patients, however, limited knowledge is available on whether MS patients have an excess risk for SA/DP when compared with the general population in Sweden. Moreover, no information exists on the actual diagnoses for SA and DP among MS patients and whether the patterns of SA/DP diagnoses differs to those without MS. We aimed to explore diagnosis-specific SA and DP among working-aged MS patients both before and after MS diagnosis, in comparison to the levels and distributions of SA and DP diagnoses of a matched reference group and analyze the risk of diagnosis-specific DP. MATERIALS AND METHODS Longitudinal Swedish register data of the 2567 MS patients diagnosed with MS in 2009-2012 when aged 25-59 and 10,268 population-based matched references (matched on sex, age, educational level, type of living area, and country of birth) were analysed regarding annual diagnosis-specific SA and DP in the four years before and four years after MS diagnosis. Annual differences in the mean numbers of SA and/or DP net days were calculated with 95% confidence intervals (CI). Hazard ratios (HR) with 95% CI from Cox proportional hazard models were used to compare risks for new all-cause and diagnosis-specific DP after MS diagnosis among the MS patients and references. RESULTS The mean SA/DP net days/year increased among MS patients over follow-up, due to both MS and other diagnoses. During follow-up, around 50% of MS patients had some SA/DP compared to 20% of references. The mean days of SA/DP among the MS patients compared to references increased from 10.3 more days (95% CI: 6.6-14.2) four years prior to MS diagnosis to 68.9 days (62.8-75.1) 4 years after MS diagnosis. Although most new DP among MS patients were due to MS, 15% were not. The adjusted HR for all-cause DP was 23.1 (18.1-29.5). MS patients also had higher risks of new DP due to all diagnoses except MS (HR 3.4; 2.4-4.8), musculoskeletal (HR 2.6; 1.1-6.0) and mental (HR 2.0; 1.1-3.6) diagnoses compared with references. CONCLUSION MS patients had higher levels of SA/DP days/year than the references, already 4 years before the MS diagnosis, and increasingly so thereafter. The excess of SA/DP prior to MS diagnosis could be related to MS onset. However, the excess of SA/DP days were not all due to MS diagnoses, even after being diagnosed with MS. MS patients had a higher risk of having a new DP after being diagnosed with MS in total, but also for diagnoses other than MS.
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Affiliation(s)
- Chantelle Murley
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Korinna Karampampa
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Jan Hillert
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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13
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Psoriasis in family members of patients with multiple sclerosis. Mult Scler Relat Disord 2019; 36:101421. [PMID: 31610402 DOI: 10.1016/j.msard.2019.101421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/28/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND It has been noted both anecdotally and in a selection of studies that the incidence of multiple sclerosis (MS) and psoriasis may be related, however the nature of that association is unclear. Clustering among families of multiple autoimmune diseases may be linked to genetic factors. Whether family members of those with MS are at increased risk of psoriasis is not well established. METHODS A systematic review and meta-analysis was performed according to recommended PRISMA guidelines. Data from studies assessing the proportion or effect size of psoriasis cases reported for families or relatives of MS cases versus families or relatives of control cases without MS were extracted and meta-analysed. RESULTS From a pooled unadjusted meta-analysis of 5 studies that met criteria, we found that family members of MS patients were at increased risk of psoriasis (OR 1.45 95% CI 1.07, 1.97). CONCLUSION Family members of those with MS may be at greater risk of developing psoriasis.
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14
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Shepard CJ, Cline SG, Hinds D, Jahanbakhsh S, Prokop JW. Breakdown of multiple sclerosis genetics to identify an integrated disease network and potential variant mechanisms. Physiol Genomics 2019; 51:562-577. [PMID: 31482761 DOI: 10.1152/physiolgenomics.00120.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Genetics of multiple sclerosis (MS) are highly polygenic with few insights into mechanistic associations with pathology. In this study, we assessed MS genetics through linkage disequilibrium and missense variant interpretation to yield a MS gene network. This network of 96 genes was taken through pathway analysis, tissue expression profiles, single cell expression segregation, expression quantitative trait loci (eQTLs), genome annotations, transcription factor (TF) binding profiles, structural genome looping, and overlap with additional associated genetic traits. This work revealed immune system dysfunction, nerve cell myelination, energetic control, transcriptional regulation, and variants that overlap multiple autoimmune disorders. Tissue-specific expression and eQTLs of MS genes implicate multiple immune cell types including macrophages, neutrophils, and T cells, while the genes in neural cell types enrich for oligodendrocyte and myelin sheath biology. There are eQTLs in linkage with lead MS variants in 25 genes including the multitissue eQTL, rs9271640, for HLA-DRB1/DRB5. Using multiple functional genomic databases, we identified noncoding variants that disrupt TF binding for GABPA, CTCF, EGR1, YY1, SPI1, CLOCK, ARNTL, BACH1, and GFI1. Overall, this paper suggests multiple genetic mechanisms for MS associated variants while highlighting the importance of a systems biology and network approach when elucidating intersections of the immune and nervous system.
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Affiliation(s)
- C Joy Shepard
- Department of Biology, Athens State University, Athens, Alabama.,Graduate Biomedical Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sara G Cline
- Department of Biology, Athens State University, Athens, Alabama
| | - David Hinds
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama.,Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan
| | - Seyedehameneh Jahanbakhsh
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan
| | - Jeremy W Prokop
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan.,Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan
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15
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Association of Multiple Sclerosis with Psoriasis: A Systematic Review and Meta-Analysis of Observational Studies. Am J Clin Dermatol 2019; 20:201-208. [PMID: 30361954 DOI: 10.1007/s40257-018-0399-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous studies have reported the occurrence of psoriasis together with multiple sclerosis (MS). Although similar predisposing genes and pathomechanisms have been hypothesized, the relationship between the two remains obscure. OBJECTIVE The aim of this systematic review and meta-analysis was to investigate the association between psoriasis and MS. METHODS We searched MEDLINE, Embase, and CENTRAL in July 2018 for case-control, cross-sectional, or cohort studies that examined either the odds or risk of psoriasis in subjects with multiple sclerosis. The risk of bias of included studies was assessed using the Newcastle-Ottawa Scale. A random-effects model meta-analysis was used to calculate the odds ratio (OR) for case-control/cross-sectional studies and hazard ratio (HR) for cohort studies. RESULTS We included 10 publications that reported a total of 11 studies (5 case-control, 4 cross-sectional and 2 cohort studies). The case-control and cross-sectional studies included 18,456 MS patients and 870,149 controls, while the two cohort studies involved 25,187 MS patients and 227,225 controls in total. Three studies were rated with a high risk of bias in comparability, non-response rate, and selection of controls. MS was associated with increased odds (OR 1.29; 95% confidence interval [CI] 1.14-1.45) and risk for psoriasis (HR 1.92; 95% CI 1.32-2.80). CONCLUSION Patients with MS display both increased prevalence and incidence of psoriasis.
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16
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Lifestyle and Environmental Factors in Multiple Sclerosis. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a028944. [PMID: 29735578 DOI: 10.1101/cshperspect.a028944] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lifestyle and environmental factors potently influence the risk of multiple sclerosis (MS), because genetic predisposition only explains a fraction of the risk increase. There is strong evidence for associations of Epstein-Barr virus (EBV) infection, smoking, sun exposure/vitamin D, and adolescent obesity to risk of MS. There is also circumstantial evidence on organic solvents and shift work, all associate with greater risk, although certain factors like nicotine, alcohol, and a high coffee consumption associate with a reduced risk. Certain factors, smoking, EBV infection, and obesity interact with human leukocyte antigen (HLA) risk genes, arguing for a pathogenic pathway involving adaptive immunity. There is a potential for prevention, in particular for people at greater risk such as relatives of individuals with MS. All of the described factors for MS may influence adaptive and/or innate immunity, as has been argued for MS risk gene variants.
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17
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Greer JM, Broadley S, Pender MP. Reactivity to Novel Autoantigens in Patients with Coexisting Central Nervous System Demyelinating Disease and Autoimmune Thyroid Disease. Front Immunol 2017; 8:514. [PMID: 28533776 PMCID: PMC5420580 DOI: 10.3389/fimmu.2017.00514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Abstract
Several lines of evidence suggest a definite and unique link between CNS demyelinating diseases and autoimmune thyroid disease (AITD). The aim of the current study was to systematically compare the clinical and laboratory features of patients with coexistent AITD and CNS demyelinating disease with those of patients with just CNS demyelinating disease. Forty-four patients with coexisting CNS demyelinating disease and AITD were identified and their clinical and radiological features were recorded. Blood and DNA were collected and tested for HLA type and for the response of T cells and antibodies to a variety of antigens. Patients with multiple sclerosis (MS) without AITD and healthy individuals were included as controls. Patients with coexisting AITD and CNS demyelinating disease were almost exclusively female (43/44) and had prominent spinal cord involvement as the main neurological finding. The HLA molecules carried by individuals with CNS demyelinating disease and AITD differed from both other MS patients and healthy individuals. Furthermore, patients with both CNS disease and AITD showed less T cell reactivity than patients with MS alone to myelin proteolipid protein, but, compared to other groups, showed elevated levels of T cell reactivity to the calcitonin gene-related peptide, which is present in both the CNS and the thyroid, and elevated levels of T cell and antibody to the leucine-rich repeat-containing G-protein coupled receptor 4 (LGR4), a molecule that is expressed in the brainstem and spinal cord, and which is a homolog of the thyroid-stimulating hormone receptor. We suggest that reactivity of autoreactive immune cells in these patients against antigens present in both the thyroid and the spinal cord is a potential mechanism underlying the pattern of lesion development in the CNS in patients with coexisting AITD and MS and might indicate a novel mechanism of disease pathogenesis in these patients.
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Affiliation(s)
- Judith M Greer
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Simon Broadley
- School of Medicine, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Michael P Pender
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
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18
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Goncharova ZA, Sizyakina LP, Belovolova RA, Megeryan VA. [Comorbid autoimmune pathology in patients treated with disease modifying drugs]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 116:53-60. [PMID: 28139612 DOI: 10.17116/jnevro201611610253-60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Because of intensive growth of the prevalence of multiple sclerosis (MS) and other autoimmune diseases (AID) during the last years, the comorbidity of MS and AID is not a rarity. In this literature review, the development of comorbid AID in patients with MS is considered to be the probable complication of disease modifying therapy with drugs of different groups. The authors present the own data on the prevalence of comorbid autoimmune pathology in patients with MS treated with disease modifying drugs.
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Affiliation(s)
| | - L P Sizyakina
- The Research Institute of Clinical Immunology of Rostov State Medical University, Rostov-on-Don, Russia
| | - R A Belovolova
- The Research Institute of Clinical Immunology of Rostov State Medical University, Rostov-on-Don, Russia
| | - V A Megeryan
- Rostov State Medical University, Rostov-on-Don, Russia
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19
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Interactions between genetic, lifestyle and environmental risk factors for multiple sclerosis. Nat Rev Neurol 2016; 13:25-36. [PMID: 27934854 DOI: 10.1038/nrneurol.2016.187] [Citation(s) in RCA: 653] [Impact Index Per Article: 81.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Genetic predisposition to multiple sclerosis (MS) only explains a fraction of the disease risk; lifestyle and environmental factors are key contributors to the risk of MS. Importantly, these nongenetic factors can influence pathogenetic pathways, and some of them can be modified. Besides established MS-associated risk factors - high latitude, female sex, smoking, low vitamin D levels caused by insufficient sun exposure and/or dietary intake, and Epstein-Barr virus (EBV) infection - strong evidence now supports obesity during adolescence as a factor increasing MS risk. Organic solvents and shift work have also been reported to confer increased risk of the disease, whereas factors such as use of nicotine or alcohol, cytomegalovirus infection and a high coffee consumption are associated with a reduced risk. Certain factors - smoking, EBV infection and obesity - interact with HLA risk genes, pointing at a pathogenetic pathway involving adaptive immunity. All of the described risk factors for MS can influence adaptive and/or innate immunity, which is thought to be the main pathway modulated by MS risk alleles. Unlike genetic risk factors, many environmental and lifestyle factors can be modified, with potential for prevention, particularly for people at the greatest risk, such as relatives of individuals with MS. Here, we review recent data on environmental and lifestyle factors, with a focus on gene-environment interactions.
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20
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Multiple sclerosis and inflammatory bowel diseases: a systematic review and meta-analysis. J Neurol 2016; 264:254-259. [PMID: 27878439 DOI: 10.1007/s00415-016-8340-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/08/2016] [Indexed: 12/13/2022]
Abstract
The association between multiple sclerosis (MS) and inflammatory bowel disease (IBD) has been suggested, apart from their common epidemiological and immunological patterns, also due to observations of increased incidence of both IBD among MS patients and MS among IBD patients. We estimated the risk of concurrent IBD and MS comorbidity, using data from all available case-control studies. We calculated the corresponding Risk ratios (RRs) in each included case-control study to express the risk of IBD and MS concurrence at a given population. We performed additional subgroup analyses according to the type of registry from which the data of the cases were exported (IBD or MS registry) and the IBD type (Crohn's disease, CD or Ulcerative colitis, UC). We included 10 studies, comprising a total of 1,086,430 patients (0.08% of them with concurrent IBD and MS). Pooled RR for IBD/MS comorbitity was 1.54 (95% CI 1.40-1.67; p < 0.0001) with no differences (p = 0.91) among IBD and MS registries (RR 1.53, 95% CI 1.36-1.72, p < 0.001 for MS comorbidity in IBD patients vs. RR 1.55, 95% CI 1.32-1.81, p < 0.001 for IBD comorbidity in MS patients). No difference was also found on the risk of MS comorbidity among patients with CD or UC (RR 1.52, 95% CI 1.34-1.72, p < 0.001 vs. RR 1.55, 95% CI 1.38-1.74, p < 0.001; p for subgroup differences: 0.84). In all analyses no evidence of heterogeneity or publication bias was detected. Both IBD and MS patients seem to have a fifty-percent increased risk of MS or IBD comorbidity, respectively, with no apparent differences between patients with CD or UC.
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21
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Malyavantham K, Weinstock-Guttman B, Suresh L, Zivadinov R, Shanahan T, Badgett D, Ramanathan M. Humoral Responses to Diverse Autoimmune Disease-Associated Antigens in Multiple Sclerosis. PLoS One 2015; 10:e0129503. [PMID: 26065913 PMCID: PMC4466031 DOI: 10.1371/journal.pone.0129503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/09/2015] [Indexed: 01/18/2023] Open
Abstract
To compare frequencies of autoreactive antibody responses to endogenous disease-associated antigens in healthy controls (HC), relapsing and progressive MS and to assess their associations with clinical and MRI measures of MS disease progression.
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Affiliation(s)
| | | | | | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York, Buffalo, NY, United States of America
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY, United States of America
| | | | - Darlene Badgett
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY, United States of America
| | - Murali Ramanathan
- Department of Neurology, State University of New York, Buffalo, NY, United States of America
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY, United States of America
- * E-mail:
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22
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Manouchehrinia A, Edwards LJ, Roshanisefat H, Tench CR, Constantinescu CS. Multiple sclerosis course and clinical outcomes in patients with comorbid asthma: a survey study. BMJ Open 2015; 5:e007806. [PMID: 25995241 PMCID: PMC4442191 DOI: 10.1136/bmjopen-2015-007806] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine if comorbid asthma is associated with accumulation of multiple sclerosis (MS)-related impairment and disability. METHOD We sent a comprehensive questionnaire to a cohort of patients with MS and examined the association between comorbid asthma and reaching Expanded Disability Status Scale (EDSS) scores 4.0 and 6.0. Multiple Sclerosis Impact Scale (MSIS-29) scores were compared between patients with MS with and without comorbid asthma. RESULTS 680 patients participated in our study of whom 88 (12.9%) had comorbid asthma. There was no difference in the prevalence of asthma between our MS cohort and the England general population (OR: 0.89, 95% CI 0.68 to 1.17). We did not observe a significant association between having asthma and the risk of reaching EDSS scores 4.0 and 6.0 (HR: 1.29, 95% CI 0.93 to 1.77, and HR: 1.33, 95% CI 0.93 to 1.89, respectively) after controlling for confounders. Patients with MS with asthma reported higher level of psychological impairments (coefficient: 2.29, 95% CI 0.1 to 4.49). CONCLUSIONS Asthma is a prevalent condition among patients with MS and it may contribute to the psychological impairment in MS. Although we did not observe significant association between comorbid asthma and physical disability in MS, it seems that the two conditions influence one another.
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Affiliation(s)
- Ali Manouchehrinia
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Laura J Edwards
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Homayoun Roshanisefat
- Department of Clinical Neuroscience, CMM; Karolinska Institute, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Christopher R Tench
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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23
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Autoimmune disease prevalence in a multiple sclerosis cohort in Argentina. Mult Scler Int 2014; 2014:828162. [PMID: 25170425 PMCID: PMC4142150 DOI: 10.1155/2014/828162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/16/2014] [Indexed: 12/18/2022] Open
Abstract
Background. Comorbid autoimmune diseases in MS patients have been studied extensively with controversial results. Moreover, no such data exists for Latin-American MS patients. Methods. We conducted a case-control study aimed to establish the prevalence of autoimmune disorders in a cohort of Argentinean MS patients. Results. There were no significant differences in autoimmune disease prevalence in MS patients with respect to controls. The presence of one or more autoimmune disorders did not increase risk of MS (OR 0.85, 95% CI 0.6-1.3). Discussion. Our results indicate absence of increased comorbid autoimmune disease prevalence in MS patients, as well as of increased risk of MS in patients suffering from other autoimmune disorders.
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Wang J, Ding Y, Fan X, Zuo X, Wang W, Cheng H, Li P, Sun L, Yang S, Zhang X. Gene-Gene Interaction between LCE and CLEC16A Increases the Risk of Psoriasis in a Chinese Population. Ann Dermatol 2014; 26:421-3. [PMID: 24966655 PMCID: PMC4069666 DOI: 10.5021/ad.2014.26.3.421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 06/11/2013] [Accepted: 06/28/2013] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jianbo Wang
- Institute of Dermatology, Department of Dermatology, No.1 Hospital, Anhui Medical University, Anhui, China
| | - Yantao Ding
- Institute of Dermatology, Department of Dermatology, No.1 Hospital, Anhui Medical University, Anhui, China
| | - Xing Fan
- Institute of Dermatology, Department of Dermatology, No.1 Hospital, Anhui Medical University, Anhui, China
| | - Xianbo Zuo
- Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui, China
| | - Wen Wang
- Institute of Dermatology, Department of Dermatology, No.1 Hospital, Anhui Medical University, Anhui, China
| | - Hui Cheng
- Institute of Dermatology, Department of Dermatology, No.1 Hospital, Anhui Medical University, Anhui, China
| | - Ping Li
- Institute of Dermatology, Department of Dermatology, No.1 Hospital, Anhui Medical University, Anhui, China
| | - Liangdan Sun
- Institute of Dermatology, Department of Dermatology, No.1 Hospital, Anhui Medical University, Anhui, China. ; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui, China
| | - Sen Yang
- Institute of Dermatology, Department of Dermatology, No.1 Hospital, Anhui Medical University, Anhui, China. ; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui, China
| | - Xuejun Zhang
- Institute of Dermatology, Department of Dermatology, No.1 Hospital, Anhui Medical University, Anhui, China. ; Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, Anhui, China
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Fellner A, Dano M, Regev K, Mosek A, Karni A. Multiple sclerosis is associated with psoriasis. A case–control study. J Neurol Sci 2014; 338:226-8. [DOI: 10.1016/j.jns.2014.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 11/25/2013] [Accepted: 01/02/2014] [Indexed: 12/27/2022]
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Khalili M, Azimi A, Izadi V, Eghtesadi S, Mirshafiey A, Sahraian MA, Motevalian A, Norouzi A, Sanoobar M, Eskandari G, Farhoudi M, Amani F. Does lipoic acid consumption affect the cytokine profile in multiple sclerosis patients: a double-blind, placebo-controlled, randomized clinical trial. Neuroimmunomodulation 2014; 21:291-6. [PMID: 24821457 DOI: 10.1159/000356145] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 09/23/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A limited amount of data exists regarding the effect of lipoic acid (LA), an oral antioxidant supplement, on cytokine profiles among multiple sclerosis (MS) patients. OBJECTIVE We aimed to assess the effect of daily consumption of LA on the cytokine profiles in MS patients. METHODS In this double-blind, placebo-controlled, randomized clinical trial, 52 relapsing-remitting MS patients with an age range of 18-50 years were recruited into 2 groups: LA consumption (1,200 mg/day) or placebo. Patients followed their prescribed supplements for 12 weeks. Fasting blood samples for cytokine profile measurement were collected at baseline and after the intervention. Anthropometric parameters were measured based on the standard guidelines. RESULTS INF-γ, ICAM-1, TGF-β and IL-4 were significantly reduced in the LA group compared to the placebo group [(INF-γ: 0.82 ± 0.2 vs. 0.2 ± 0.2 pg/ml, p < 0.0001), (ICAM-1: 20.2 ± 9.4 vs. 8 ± 10 ng/ml, p = 0.0001), (TGF-β: 103.1 ± 20.2 vs. 54.9 ± 26 ng/ml, p < 0.0001) and (IL-4: 0.1 ± 0.1 vs. 1.02 ± 1.7 ng/ml, p = 0.0112)]. No significant changes in TNF-α, IL-6, EDSS and MMP-9 were found between the LA and placebo groups (p = 0.6, p = 0.8, p = 0.09 and p = 0.8, respectively). CONCLUSION The results suggested that consumption of 1,200 mg LA per day beneficially affects several inflammatory cytokines including INF-γ, ICAM-1 TGF-β and IL-4. Further investigations are needed to verify the beneficial role of LA on other cytokine profiles among MS patients.
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Affiliation(s)
- Mohammad Khalili
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Comorbidities at multiple sclerosis diagnosis. J Neurol 2013; 260:2629-37. [DOI: 10.1007/s00415-013-7041-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 07/08/2013] [Accepted: 07/10/2013] [Indexed: 01/31/2023]
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Autoimmune disease in people with multiple sclerosis and their relatives: a systematic review and meta-analysis. J Neurol 2013; 260:1272-85. [PMID: 23315260 DOI: 10.1007/s00415-012-6790-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 01/24/2023]
Abstract
Additional autoimmune diseases in people with multiple sclerosis (MS) and their relatives have been studied many times. Studies have employed different designs, and yielded conflicting results. We performed a systematic review, and calculated overall risk of additional autoimmune diseases in people with MS and their first-degree relatives. PubMed and Web of Science were searched. Thyroid disease, diabetes, inflammatory bowel disease, psoriasis, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) were studied. A generic inverse variance model was used, and subgroup analysis was used to explore heterogeneity. The OR of thyroid disease was increased in both people with MS (OR 1.66; p < 0.00001) and their relatives (OR 2.38; p < 0.00001). A similar association was seen between MS and inflammatory bowel disease (OR 1.56; p < 0.0001) and psoriasis (OR 1.31; p < 0.0001), although not in relatives. There was no increase in the rate of either SLE or RA. Studies examining diabetes showed significant heterogeneity and evidence of publication bias. There is an increase in the rate of certain autoimmune diseases in people with MS and their first-degree relatives. However, this does not extend to all conditions studied. Given the nonspecific clinical presentation of thyroid disease, it should be considered in all people with MS presenting with nonspecific symptoms.
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Risk of comorbid inflammatory diseases in MS might not be genetically determined. Nat Rev Neurol 2012. [DOI: 10.1038/nrneurol.2012.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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