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Giannopapas V, Smyrni V, Kitsos DK, Stasi S, Chasiotis AK, Moschovos C, Papagiannopoulou G, Stavrogianni K, Kosmidou M, Bakalidou D, Tzartos JS, Tsivgoulis G, Giannopoulos S. Osteoarthritis in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:5015. [PMID: 39274226 PMCID: PMC11396250 DOI: 10.3390/jcm13175015] [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: 07/31/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Arthritis, particularly osteoarthritis (OA), is a common synovial condition observed in individuals with multiple sclerosis (MS). Despite its high prevalence and significant impact on the quality of life of MS individuals, there is a gap in the current literature regarding the prevalence of OA in this population and its relation to MS pathology. This systematic review and meta-analysis aimed to estimate the prevalence of OA in the MS population and explore potential associations with demographic and MS-specific characteristics. Methods: Adhering to PRISMA guidelines, a systematic search of the MEDLINE PubMed, Scopus and Google Scholar databases was conducted. Results: Fifteen studies were included in the systematic review and meta-analysis. The aggregated prevalence of OA in the MS population was 27% (95% CI: 15-40%), with substantial heterogeneity (I2 = 99.9%). Sensitivity analysis, excluding one study, showed a prevalence of 21% (95% CI: 16-28%). The risk ratio of OA in MS versus controls was 1.07 (95% CI: 0.84-1.37), indicating no significant difference. Meta-regression revealed no associations between OA prevalence and age or disease duration in MS patients. Conclusions: This study reports a 21-27% prevalence of OA in people with MS. Understanding the implications of OA in pain and mobility domains, as well as the challenges in distinguishing OA symptoms from MS manifestations, underscores the need for further research to elucidate the pathophysiological mechanisms and interactions between these conditions. Additional studies are warranted to enhance clinical management and improve outcomes for individuals with MS and co-existing OA.
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Affiliation(s)
- Vasileios Giannopapas
- Second Department of Neurology, National and Kapodistrian University of Athens, 15772 Athens, Greece
- Department of Physical Therapy, University of West Attica, 12243 Egaleo, Greece
| | - Vassiliki Smyrni
- Second Department of Neurology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Dimitrios K Kitsos
- Second Department of Neurology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Sophia Stasi
- Department of Physical Therapy, University of Peloponnese, 23100 Sparti, Greece
| | - Athanasios K Chasiotis
- Second Department of Neurology, National and Kapodistrian University of Athens, 15772 Athens, Greece
- Department of Physical Therapy, University of West Attica, 12243 Egaleo, Greece
| | - Christos Moschovos
- Second Department of Neurology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Georgia Papagiannopoulou
- Second Department of Neurology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Konstantina Stavrogianni
- Second Department of Neurology, National and Kapodistrian University of Athens, 15772 Athens, Greece
- Department of Physiology, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Maria Kosmidou
- Department of Internal Medicine, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Daphne Bakalidou
- Second Department of Neurology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - John S Tzartos
- Second Department of Neurology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Sotirios Giannopoulos
- Second Department of Neurology, National and Kapodistrian University of Athens, 15772 Athens, Greece
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Lotfi R, Bel Amgharia H, Ennaciri S, Chikhaoui M, El kardoudi A, Chigr F. The impact of fatigue on people with multiple sclerosis in Morocco. Afr J Disabil 2024; 13:1376. [PMID: 39114452 PMCID: PMC11304114 DOI: 10.4102/ajod.v13i0.1376] [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: 11/13/2023] [Accepted: 05/22/2024] [Indexed: 08/10/2024] Open
Abstract
Background Multiple sclerosis (MS), fatigue is among the leading clinical symptoms. It is one of the most disabling symptoms for most MS people. Objectives This research measures the prevalence of fatigue and its impact on the physical, cognitive, and psychosocial abilities of individuals with MS in Morocco. Method This cross-sectional and descriptive study included 152 participants. Data were collected via an online survey using the snowball method, incorporating sociodemographic characteristics and the Arabic version of the Modified Fatigue Impact Scale. Results According to the results, 89.4% of respondents experienced pathological fatigue, with an average score of 65.52 (± 18.00). There was a significant relationship between pathological fatigue, age (p = 0.0324), and clinical phenotype (p = 0.041). Fatigue negatively impacted participants' physical, cognitive, and psychological capacities, with average scores of 70.38 (± 8.15), 62.28 (± 10.23), and 73.87 (± 1.86), respectively. Conclusion The results of our study confirmed a high prevalence of fatigue among people with MS in Morocco. Sustained research in this field remains crucial, as it enables the formulation of strategies aimed at enhancing the quality of life for those impacted by MS. Contribution This study is the first in Morocco to examine fatigue prevalence in people with MS and its impact on their physical, cognitive, and psychosocial abilities. High fatigue levels hinder the integration of people with MS into professional and student life. The findings emphasize the need for effective symptom and fatigue management.
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Affiliation(s)
- Rachid Lotfi
- Department of Biology, Faculty of Sciences and Techniques, University of Sultan Moulay Slimane, Beni Mellal, Morocco
| | - Hind Bel Amgharia
- Department of Biology, Faculty of Sciences and Techniques, University of Sultan Moulay Slimane, Beni Mellal, Morocco
| | - Sami Ennaciri
- Department of Biology, Faculty of Sciences and Techniques, University of Sultan Moulay Slimane, Beni Mellal, Morocco
| | - Mourad Chikhaoui
- Department of Biology, Faculty of Sciences Ben M’Sik, University Hassan II, Casablanca, Morocco
| | - Abdeslam El kardoudi
- Department of Biology, Faculty of Sciences and Techniques, University of Sultan Moulay Slimane, Beni Mellal, Morocco
| | - Fatiha Chigr
- Department of Biology, Faculty of Sciences and Techniques, University of Sultan Moulay Slimane, Beni Mellal, Morocco
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Spirin N, Kiselev D, Baranova N, Karpova M. Nociceptive and mixed pains in patients with multiple sclerosis. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:44-51. [DOI: 10.17116/jnevro202212207244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Plow M, Motl RW, Finlayson M, Bethoux F. Response heterogeneity in a randomized controlled trial of telerehabilitation interventions among adults with multiple sclerosis. J Telemed Telecare 2020; 28:642-652. [PMID: 33100184 DOI: 10.1177/1357633x20964693] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Telerehabilitation may be effective on average but is not equally effective among all people with multiple sclerosis (MS). Thus, the purpose of this secondary analysis of a randomized controlled trial was to explore whether baseline characteristics of participants with MS influence fatigue and physical activity outcomes of three telerehabilitation interventions. METHODS Participants were randomized to contact-control intervention (CC), physical activity-only intervention (PA-only), and physical activity plus fatigue self-management intervention (FM+). The 12-week interventions were delivered over the phone. Sociodemographic (age and income), clinical (comorbidities, mental function and physical function), psychosocial (self-efficacy, outcome expectations and goal-setting), and behavioural baseline characteristics (step count and fatigue self-management behaviors) were used in a moderated regression analysis and a responder analysis to examine their influence on the Fatigue Impact Scale (FIS) and Godin Leisure-Time Exercise Questionnaire (GLTEQ) at post-test (i.e. immediately post-interventions). RESULTS No interactions terms were statistically significant in the moderation analysis. However, the responder analysis showed that baseline psychosocial characteristics and mental function were significantly different (p < 0.05) between responders and non-responders. Specifically, non-responders on the FIS at post-test in the PA-only intervention had significantly lower baseline scores in goal setting for engaging in fatigue self-management behaviours. Also, non-responders on the GLTEQ at post-test in the FM+ intervention had significantly worse baseline scores in mental function. DISCUSSION Further research is needed to understand the complex relationship among baseline characteristics, telerehabilitation and response heterogeneity. We discuss how research on examining response heterogeneity may be advanced by conducting mega-clinical trials, secondary analyses of big data, meta-analyses and employing non-traditional research designs. TRIAL REGISTRATION Clinicaltrials.gov (NCT01572714).
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Affiliation(s)
- Matthew Plow
- Frances Payne Bolton School of Nursing, Case Western Reserve University, USA
| | - Robert W Motl
- Department of Physical Therapy, The University of Alabama at Birmingham, USA
| | | | - Francois Bethoux
- Mellen Center for Multiple Sclerosis Treatment and Research, Department of Physical Medicine & Rehabilitation, Neurological Institute, The Cleveland Clinic Foundation, USA
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Hreha K, Wong J, Molton I, Nelson IK, Lee D. The impact of stroke on psychological and physical function outcomes in people with long-term physical disability. Disabil Health J 2020; 13:100919. [DOI: 10.1016/j.dhjo.2020.100919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 11/15/2022]
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Plow M, Packer T, Mathiowetz VG, Preissner K, Ghahari S, Sattar A, Bethoux F, Finlayson M. REFRESH protocol: a non-inferiority randomised clinical trial comparing internet and teleconference to in-person 'Managing Fatigue' interventions on the impact of fatigue among persons with multiple sclerosis. BMJ Open 2020; 10:e035470. [PMID: 32801193 PMCID: PMC7430436 DOI: 10.1136/bmjopen-2019-035470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system. It is considered a major cause of non-traumatic disability in young adults. One of the most common and disabling symptoms of MS is fatigue. MS fatigue can impact all aspects of quality of life, including physical, mental and social function. Fortunately, fatigue self-management interventions, such as 'Managing Fatigue: A 6 week energy conservation course', can decrease the impact of fatigue and improve health-related quality of life. The purpose of this study is to compare three modes of delivering the Managing Fatigue intervention-two remote delivery formats (teleconference and internet) and one in-person format-on perceptions of fatigue and its impact on physical, mental and social function. METHODS AND ANALYSIS A non-inferiority randomised clinical trial is being conducted to compare the three delivery formats (1:1:1 allocation ratio) among 582 participants with MS living in the Midwestern and Northeastern United States. The hypothesis is that teleconference and internet versions of the intervention are non-inferior to the traditional mode of clinical service delivery (ie, one to one, in person) in terms of the primary outcome of self-reported fatigue impact (ie, Fatigue Impact Scale) and the secondary outcome of health-related quality of life (ie, Multiple Sclerosis Impact Scale). Outcomes are being measured at baseline, 2 months, 3 months and 6 months. The primary analysis tool will be linear mixed effects model. The prespecified inferiority margin for the primary outcome is 10 points. We will also examine whether baseline characteristics (eg, sociodemographic) moderate outcomes of the Managing Fatigue intervention and whether changes in self-efficacy and fatigue self-management behaviours mediate changes in outcomes. ETHICS AND DISSEMINATION The protocol is approved centrally by the institutional review board at Case Western Reserve University. Eligible participants give consent before being enrolled and randomised into the study. The study results will be disseminated through relevant advocacy organisations, newsletters to participants, publication in peer-reviewed journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER NCT03550170; Pre-results.
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Affiliation(s)
- Matthew Plow
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Tanya Packer
- School of Occupational Therapy and School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Virgil G Mathiowetz
- Program in Occupational Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kathy Preissner
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Abdus Sattar
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Haroon M, Szentpetery A, Ashraf M, Gallagher P, FitzGerald O. Bristol rheumatoid arthritis fatigue scale is valid in patients with psoriatic arthritis and is associated with overall severe disease and higher comorbidities. Clin Rheumatol 2020; 39:1851-1858. [PMID: 31955325 DOI: 10.1007/s10067-020-04945-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022]
Abstract
AIMS To (1) determine the reliability and validity of the Bristol Rheumatoid Arthritis Fatigue scale (BRAF-NRS) in patients with psoriatic arthritis (PsA) and (2) examine possible clinical associations of worse fatigue in PsA. METHODS Study phase 1: BRAF-NRS scale validation cohort. A consecutive cohort of 70 PsA patients was recruited to complete the 3-item BRAF-NRS and the 13-item Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaires, alongside disease activity assessment. All patients also completed the BRAF-NRS questionnaire, 1 day later. Study phase 2: Identifying the potential clinical associations of fatigue by using BRAF-NRS (n = 283). A second cohort of 283 PsA patients underwent detailed skin and rheumatologic assessments including disease activity measures. Comorbidities were measured using the Charlson comorbidity index (CCI). Factors predicting worse fatigue as measured by BRAF-NRS were determined using regression analysis. RESULTS In phase 1, 67 out of 70 patients from the first cohort had complete assessments. The internal consistency of BRAF-NRS as measured by Cronbach's alpha was 0.92. Test-retest reliability as measured by the intra-class correlation coefficient was 0.97. There was excellent correlation between the BRAF-NRS and FACIT-F score(r = - 0.83) (p = <0.001, 95% CI - 0.74 to - 0.91). In phase 2, using data from the second cohort of 283 PsA patients, possible clinical associations of worse fatigue were examined. On multiple linear regression analyses, the model predicted significant association of worse fatigue scores with low education status (p = 0.03), number of deformed joints (p = 0.01), not achieving minimal disease activity state (p < 0.001), higher CCI scores, and worse health assessment questionnaire score (p < 0.001). CONCLUSIONS BRAF-NRS is a reliable, reproducible, and valid instrument for measuring fatigue in PsA. Fatigue in PsA is associated with low education status and overall more severe disease.Key Points• Fatigue is increasingly recognized as an important measure to examine among patients with PsA, but the available valid fatigue scores in PsA are relatively long and time-consuming especially when other core domains also need to be measured• BRAF-NRS is a short, easily readable, only 3-item tool to measure fatigue, and this is the first study which has examined its performance among the patients with PsA. Our results show that it is a reliable, reproducible, and valid (construct validity) instrument for measuring fatigue in PsA• This study also clearly showed a significant positive relationship between fatigue and comorbidities, and it was also found that comorbidities play the largest role in the multivariate model.
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Affiliation(s)
- Muhammad Haroon
- Division of Rheumatology, Department of Medicine, University Hospital Kerry, Tralee, Ireland. .,Department of Rheumatology, Fatima Memorial Hospital & FMH College of Medicine and Dentistry, Lahore, Pakistan.
| | - Agnes Szentpetery
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
| | - Mohsin Ashraf
- Division of Rheumatology, Department of Medicine, University Hospital Kerry, Tralee, Ireland
| | - Phil Gallagher
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
| | - Oliver FitzGerald
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
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Farragher JF, Jassal SV, McEwen S, Polatajko HJ. Energy management education and occupation-related outcomes in adults with chronic diseases: A scoping review. Br J Occup Ther 2020. [DOI: 10.1177/0308022620904327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Fatigue is a pervasive symptom of chronic disease that often interferes with occupational performance. Our objective was to describe what is known about energy management education and occupation-related outcomes in adults with chronic diseases. Methods Seven electronic databases were searched for relevant literature published before August 2019. Eligible articles were full-text, available in English, and studied energy management education in adults with a chronic disease. The first author assessed article eligibility with validation from a second reviewer, extracted characteristics of included studies, and described them using descriptive statistics. A narrative synthesis of findings was conducted for each chronic disease population. Results Forty-four studies addressed eight different chronic disease populations. The most common program delivery format was face-to-face in a group setting (42%), 39% of programs were informed by a learning theory, and their median cumulative length was 8 hours. Positive outcomes were associated with a specific, group-based energy management program in people with multiple sclerosis. The evidence on other energy management programs and in other chronic disease populations was more limited and inconclusive. Conclusions Further research is needed to understand the impact of energy management education in chronic disease populations beyond multiple sclerosis, and its impact on occupational performance.
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Affiliation(s)
- Janine F Farragher
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | | | - Sara McEwen
- Department of Physiotherapy, University of Toronto, ON, Canada
| | - Helene J Polatajko
- Department of Occupational Science & Occupational Therapy, University of Toronto, ON, Canada
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Chen J, Taylor B, Winzenberg T, Palmer AJ, Kirk-Brown A, van Dijk P, Simpson S, Blizzard L, van der Mei I. Comorbidities are prevalent and detrimental for employment outcomes in people of working age with multiple sclerosis. Mult Scler 2019; 26:1550-1559. [DOI: 10.1177/1352458519872644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: More work is needed to understand the burden of comorbidities in people with multiple sclerosis (MS). Objective: To assess prevalence of 30 comorbidities and impacts of comorbidities on employment outcomes in a working-aged MS cohort. Methods: Participants were from the Australian MS Longitudinal Study ( n = 929). Information on specific comorbidity was obtained (whether or not each was present, doctor-diagnosed, limited their activities and being treated). Results: Comorbidities most frequently reported to limit activities were osteoarthritis (51%), migraines (40%), anxiety (33%), depression (29%) and allergies (18%). Mean MS-related work productivity loss in past 4 weeks was 1.3 days for those without comorbidities and 2.5 days for those with any comorbidity. The annual population costs of work productivity loss were highest for people with depression, allergies, anxiety, migraines and osteoarthritis. Higher number of comorbidities was associated with more work productivity loss and a higher likelihood of not working. These associations were substantially reduced after adjustment for MS symptom severity. Conclusions: Comorbidities substantially impact employment outcomes and these effects were mainly mediated through MS symptom severity. This suggests that optimal and simultaneous management of comorbidities may be a viable strategy to reduce MS symptom severity, which in turn could improve employment outcomes.
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Affiliation(s)
- Jing Chen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Kirk-Brown
- Department of Management, Monash University, Narre Warren, VIC, Australia
| | - Pieter van Dijk
- Department of Management, Monash University, Narre Warren, VIC, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Rabadi MH, Aston CE. Effect of Chronic Medical Conditions in Veterans with Multiple Sclerosis on Long-Term Disability. Med Sci Monit 2016; 22:2768-74. [PMID: 27494787 PMCID: PMC4978209 DOI: 10.12659/msm.900367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The goal of this observational study was to examine the effect of common chronic medical conditions (CMCs) on long-term disability (activity limitation) in veterans already diagnosed with multiple sclerosis (MS). Material/Methods We retrospectively reviewed the electronic charts of 124 veterans with MS who have been regularly followed in our MS clinic for 10 or more years. General linear model analysis examined whether MS-related severity as measured by the Expanded Disability Status Scale (EDSS) and the presence of CMCs affected long-term disability as measured by the total score on the Functional Independence Measure (TFIM). Results Commonly encountered CMCs were increased BMI (61%), hyperlipidemia (78%), hypertension (65%), current smokers (47%), and arthritis/arthralgia (24%). Results suggest that the number of CMCs was not predictive of final TFIM scores; of the variables examined, only initial EDSS score was predictive of final TFIM scores. Conclusions The presence of CMCs did not affect the long-term disability in veterans diagnosed with MS, this was due mainly to CMCs being closely monitored and co-treated with other medical specialties.
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Affiliation(s)
- Meheroz H Rabadi
- Department of Neurology, Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Christopher E Aston
- Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
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Fiest KM, Fisk JD, Patten SB, Tremlett H, Wolfson C, Warren S, McKay KA, Berrigan LI, Marrie RA. Fatigue and Comorbidities in Multiple Sclerosis. Int J MS Care 2016; 18:96-104. [PMID: 27134583 DOI: 10.7224/1537-2073.2015-070] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fatigue is commonly reported by people with multiple sclerosis (MS). Comorbidity is also common in MS, but its association with the presence of fatigue or fatigue changes over time is poorly understood. METHODS Nine hundred forty-nine people with definite MS were recruited from four Canadian centers. The Fatigue Impact Scale for Daily Use and a validated comorbidity questionnaire were completed at three visits over 2 years. Participants were classified into groups with no fatigue versus any fatigue. Logistic regression was used to determine the relationship between fatigue and each comorbidity at baseline, year 1, year 2, and overall. RESULTS The incidence of fatigue during the study was 38.8%. The prevalence of fatigue was greater in those who were older (P = .0004), had a longer time since symptom onset (P = .005), and had greater disability (P < .0001). After adjustment, depression (odds ratio [OR], 2.58; 95% confidence interval [CI], 2.03-3.27), irritable bowel syndrome (OR, 1.71; 95% CI, 1.18-2.48), migraine (OR, 1.69; 95% CI, 1.27-2.27), and anxiety (OR, 1.57; 95% CI, 1.15-2.16) were independently associated with fatigue that persisted during the study. There was also an individual-level effect of depression on worsening fatigue (OR, 1.49; 95% CI, 1.08-2.07). CONCLUSIONS Comorbidity is associated with fatigue in MS. Depression is associated with fatigue and with increased risk of worsening fatigue over 2 years. However, other comorbid conditions commonly associated with MS are also associated with persistent fatigue, even after accounting for depression. Further investigation is required to understand the mechanisms by which comorbidities influence fatigue.
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Affiliation(s)
- Kirsten M Fiest
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - John D Fisk
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Scott B Patten
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Helen Tremlett
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Christina Wolfson
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Sharon Warren
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Kyla A McKay
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Lindsay I Berrigan
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Ruth Ann Marrie
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
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Abstract
Multiple sclerosis (MS) is an inflammatory-demyelinating disease of the central nervous system that may entail severe levels of disability in the long term. However, independently of the level of disability, MS patients frequently experience severe fatigue that can be as disabling as objective neurological deficits. For that reason, it is mandatory to perform an early diagnosis of MS-related fatigue and start a suitable treatment as soon as possible. In clinical practice, MS-related fatigue should be assessed and managed by a multidisciplinary team involving neurologists, MS nurses, occupational therapists, and physiotherapists. When assessing a person with MS-related fatigue, the first step is to rule out potential triggers or causes of fatigue, which may be related to MS, such as urinary dysfunction, pain, or muscular spasms leading to a sleep disorder, or unrelated to it. Once these causes have been ruled out and appropriately tackled, a careful therapeutic intervention needs to be decided. Therapeutic interventions for MS-related fatigue can be pharmacological or non-pharmacological. Regarding the pharmacological treatments, although many drugs have been tested in clinical trials, only amantadine is currently recommended for this indication. Regarding the non-pharmacological approaches, they can be broadly divided into physical, psychological, and mixed physical/psychological interventions. Several studies, many of them randomised clinical trials, support the use of all these types of non-pharmacological interventions to treat MS-related fatigue. Recent publications suggest that the implementation of mixed approaches, which have a naturally comprehensive nature, may have excellent results in clinical practice, in relation not only to fatigue levels but also to more general aspects of MS.
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Affiliation(s)
- Carmen Tur
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. .,Queen Square MS Centre, UCL Institute of Neurology, University College London, London, UK.
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14
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Marrie RA, Miller A, Sormani MP, Thompson A, Waubant E, Trojano M, O'Connor P, Fiest K, Reider N, Reingold S, Cohen JA. Recommendations for observational studies of comorbidity in multiple sclerosis. Neurology 2016; 86:1446-1453. [PMID: 26865523 PMCID: PMC4831039 DOI: 10.1212/wnl.0000000000002474] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/07/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To reach consensus about the most relevant comorbidities to study in multiple sclerosis (MS) with respect to incidence, prevalence, and effect on outcomes; review datasets that may support studies of comorbidity in MS; and identify MS outcomes that should be prioritized in such studies. METHODS We held an international workshop to meet these objectives, informed by a systematic review of the incidence and prevalence of comorbidity in MS, and an international survey regarding research priorities for comorbidity. RESULTS We recommend establishing age- and sex-specific incidence and prevalence estimates for 5 comorbidities (depression, anxiety, hypertension, hyperlipidemia, and diabetes); evaluating the effect of 7 comorbidities (depression, anxiety, hypertension, diabetes, hyperlipidemia, chronic lung disease, and autoimmune diseases) on disability, quality of life, brain atrophy and other imaging parameters, health care utilization, employment, and mortality, including age, sex, race/ethnicity, socioeconomic status, and disease duration as potential confounders; harmonizing study designs across jurisdictions; and conducting such studies worldwide. Ultimately, clinical trials of treating comorbidity in MS are needed. CONCLUSION Our recommendations will help address knowledge gaps regarding the incidence, prevalence, and effect of comorbidity on outcomes in MS.
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Affiliation(s)
- Ruth Ann Marrie
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH.
| | - Aaron Miller
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Maria Pia Sormani
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Alan Thompson
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Emmanuelle Waubant
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Maria Trojano
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Paul O'Connor
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Kirsten Fiest
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Nadia Reider
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Stephen Reingold
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Jeffrey A Cohen
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
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Marrie RA, Miller A, Sormani MP, Thompson A, Waubant E, Trojano M, O'Connor P, Reingold S, Cohen JA. The challenge of comorbidity in clinical trials for multiple sclerosis. Neurology 2016; 86:1437-1445. [PMID: 26888986 PMCID: PMC4831041 DOI: 10.1212/wnl.0000000000002471] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/01/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE We aimed to provide recommendations for addressing comorbidity in clinical trial design and conduct in multiple sclerosis (MS). METHODS We held an international workshop, informed by a systematic review of the incidence and prevalence of comorbidity in MS and an international survey about research priorities for studying comorbidity including their relation to clinical trials in MS. RESULTS We recommend establishing age- and sex-specific incidence estimates for comorbidities in the MS population, including those that commonly raise concern in clinical trials of immunomodulatory agents; shifting phase III clinical trials of new therapies from explanatory to more pragmatic trials; describing comorbidity status of the enrolled population in publications reporting clinical trials; evaluating treatment response, tolerability, and safety in clinical trials according to comorbidity status; and considering comorbidity status in the design of pharmacovigilance strategies. CONCLUSION Our recommendations will help address knowledge gaps regarding comorbidity that interfere with the ability to interpret safety in monitored trials and will enhance the generalizability of findings from clinical trials to "real world" settings where the MS population commonly has comorbid conditions.
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Affiliation(s)
- Ruth Ann Marrie
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH.
| | - Aaron Miller
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Maria Pia Sormani
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Alan Thompson
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Emmanuelle Waubant
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Maria Trojano
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Paul O'Connor
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Stephen Reingold
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Jeffrey A Cohen
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit (M.P.S.), Department of Health Sciences, University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
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16
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Berrigan LI, Fisk JD, Patten SB, Tremlett H, Wolfson C, Warren S, Fiest KM, McKay KA, Marrie RA. Health-related quality of life in multiple sclerosis: Direct and indirect effects of comorbidity. Neurology 2016; 86:1417-1424. [PMID: 26962068 DOI: 10.1212/wnl.0000000000002564] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/05/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the direct and indirect influences of physical comorbidity, symptoms of depression and anxiety, fatigue, and disability on health-related quality of life (HRQoL) in persons with multiple sclerosis (MS). METHODS A large (n = 949) sample of adults with MS was recruited from 4 Canadian MS clinics. HRQoL was assessed using the patient-reported Health Utilities Index Mark 3. Expanded Disability Status Scale scores, physical comorbidity, depression, anxiety, and fatigue were evaluated as predictors of HRQoL in a cross-sectional path analysis. RESULTS All predictors were significantly associated with HRQoL and together accounted for a large proportion of variance (63%). Overall, disability status most strongly affected HRQoL (β = -0.52) but it was closely followed by depressive symptoms (β = -0.50). The direct associations of physical comorbidity and anxiety with HRQoL were small (β = -0.08 and -0.10, respectively), but these associations were stronger when indirect effects through other variables (depression, fatigue) were also considered (physical comorbidity: β = -0.20; anxiety: β = -0.34). CONCLUSIONS Increased disability, depression and anxiety symptoms, fatigue, and physical comorbidity are associated with decreased HRQoL in MS. Disability most strongly diminishes HRQoL and, thus, interventions that reduce disability are expected to yield the most substantial improvement in HRQoL. Yet, interventions targeting other factors amenable to change, particularly depression but also anxiety, fatigue, and physical comorbidities, may all result in meaningful improvements in HRQoL, as well. Our findings point to the importance of further research confirming the efficacy of such interventions.
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Affiliation(s)
- Lindsay I Berrigan
- From the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - John D Fisk
- From the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- From the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Christina Wolfson
- From the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sharon Warren
- From the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kirsten M Fiest
- From the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kyla A McKay
- From the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish; Department of Psychiatry (L.I.B., J.D.F.), Department of Medicine (J.D.F.), Dalhousie University, Halifax; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; Division of Neurology, Faculty of Medicine (H.T., K.A.M.), University of British Columbia, Vancouver; Departments of Epidemiology & Biostatistics, Occupational Health, & Medicine (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine (K.M.F., R.A.M.) and Community Health Sciences (R.A.M.), College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Fiest K, Fisk J, Patten S, Tremlett H, Wolfson C, Warren S, McKay K, Berrigan L, Marrie R. Comorbidity is associated with pain-related activity limitations in multiple sclerosis. Mult Scler Relat Disord 2015; 4:470-476. [DOI: 10.1016/j.msard.2015.07.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/25/2015] [Accepted: 07/23/2015] [Indexed: 01/10/2023]
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Marrie RA, Cohen J, Stuve O, Trojano M, Sørensen PS, Reingold S, Cutter G, Reider N. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler 2015; 21:263-81. [PMID: 25623244 PMCID: PMC4361468 DOI: 10.1177/1352458514564491] [Citation(s) in RCA: 248] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Comorbidity is an area of increasing interest in multiple sclerosis (MS). Objective: The objective of this review is to estimate the incidence and prevalence of comorbidity in people with MS and assess the quality of included studies. Methods: We searched the PubMed, SCOPUS, EMBASE and Web of Knowledge databases, conference proceedings, and reference lists of retrieved articles. Two reviewers independently screened abstracts. One reviewer abstracted data using a standardized form and the abstraction was verified by a second reviewer. We assessed study quality using a standardized approach. We quantitatively assessed population-based studies using the I2 statistic, and conducted random-effects meta-analyses. Results: We included 249 articles. Study designs were variable with respect to source populations, case definitions, methods of ascertainment and approaches to reporting findings. Prevalence was reported more frequently than incidence; estimates for prevalence and incidence varied substantially for all conditions. Heterogeneity was high. Conclusion: This review highlights substantial gaps in the epidemiological knowledge of comorbidity in MS worldwide. Little is known about comorbidity in Central or South America, Asia or Africa. Findings in North America and Europe are inconsistent. Future studies should report age-, sex- and ethnicity-specific estimates of incidence and prevalence, and standardize findings to a common population.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Health Sciences Center, Canada
| | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Nadia Reider
- Department of Internal Medicine, University of Manitoba, Canada
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Marrie RA, Reider N, Stuve O, Trojano M, Sorensen PS, Cutter GR, Reingold SC, Cohen J. The incidence and prevalence of comorbid gastrointestinal, musculoskeletal, ocular, pulmonary, and renal disorders in multiple sclerosis: A systematic review. Mult Scler 2014; 21:332-41. [PMID: 25538150 PMCID: PMC4429162 DOI: 10.1177/1352458514564488] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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 I2 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.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada/Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nadia Reider
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | | | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
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Marrie RA, Reider N, Cohen J, Stuve O, Trojano M, Cutter G, Reingold S, Sorensen PS. A systematic review of the incidence and prevalence of cardiac, cerebrovascular, and peripheral vascular disease in multiple sclerosis. Mult Scler 2014; 21:318-31. [PMID: 25533300 PMCID: PMC4404402 DOI: 10.1177/1352458514564485] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Findings regarding the prevalence of vascular comorbidities in multiple sclerosis (MS) are conflicting. OBJECTIVE The objective of this review is to estimate the incidence and prevalence of vascular comorbidities and predisposing comorbidities in persons with MS and to assess the quality of the included studies. METHODS The PubMed, EMBASE, SCOPUS and Web of Knowledge databases, conference proceedings, and reference lists of retrieved articles were searched. One reviewer abstracted data using a standardized data collection form, while the second reviewer verified the abstraction. Included studies were assessed qualitatively. Quantitatively, we assessed studies using the I² statistic, and conducted meta-analyses for population-based studies only. RESULTS The prevalence of hypertension and hyperlipidemia exceeded 10% in the MS population and increased with age. While the prevalence of ischemic heart disease, congestive heart failure, and stroke were less than 5% overall, the prevalence of these conditions exceeded expectations when compared to the general population. Cardiac valvular disease, however, affected the MS population less often than expected. Problems with study quality were common. CONCLUSION Despite the relatively high prevalence of some vascular comorbidities in the MS population, important gaps exist in our understanding of their epidemiology. Most of our knowledge is based on studies conducted in a small number of regions.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Canada
| | - Nadia Reider
- Department of Internal Medicine, University of Manitoba, Canada
| | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
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Marrie RA, Reider N, Cohen J, Trojano M, Sorensen PS, Cutter G, Reingold S, Stuve O. A systematic review of the incidence and prevalence of sleep disorders and seizure disorders in multiple sclerosis. Mult Scler 2014; 21:342-9. [PMID: 25533301 PMCID: PMC4429167 DOI: 10.1177/1352458514564486] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Several studies have suggested that comorbid neurologic disorders are more common than expected in multiple sclerosis (MS). Objective: To estimate the incidence and prevalence of comorbid seizure disorders and sleep disorders in persons with MS and to evaluate the quality of studies included. Methods: The PUBMED, EMBASE, Web of Knowledge, and SCOPUS databases, conference proceedings, and reference lists of retrieved articles were searched. Two reviewers independently screened abstracts to identify relevant articles, followed by full-text review of selected articles. We assessed included studies qualitatively and quantitatively (I2 statistic), and conducted meta-analyses among population-based studies. Results: We reviewed 32 studies regarding seizure disorders. Among population-based studies the incidence of seizure disorders was 2.28% (95% CI: 1.11–3.44%), while the prevalence was 3.09% (95% CI: 2.01–4.16%). For sleep disorders we evaluated 18 studies; none were population-based. The prevalence ranged from 0–1.6% for narcolepsy, 14.4–57.5% for restless legs syndrome, 2.22–3.2% for REM behavior disorder, and 7.14–58.1% for obstructive sleep apnea. Conclusion: This review suggests that seizure disorders and sleep disorders are common in MS, but highlights gaps in the epidemiological knowledge of these conditions in MS worldwide. Other than central-western Europe and North America, most regions are understudied.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada/Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nadia Reider
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Stephen Reingold
- Scientific and Clinical Review Associates, LLC, Salisbury, CT, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, USA
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