Multiple sclerosis: Depression, constipation may be early signs

• Researchers are reporting that in the years leading up to a diagnosis of multiple sclerosis, individuals were more likely to have depression, constipation, urinary tract infections, and sexual problems.
• The researchers indicated that knowing these symptoms might help doctors decide whether to screen someone who is at high risk for multiple sclerosis but doesn’t have symptoms.
• They said that recognizing the early symptoms could potentially lead to earlier treatment and better symptom management.

Depression, constipation, urinary tract infections, bladder infections, and sexual problems can all predate a diagnosis of multiple sclerosis (MS) by several years.

That’s according to a study published today in Neurology, the medical journal of the American Academy of Neurology.

In it, researchers report that people with MS are more likely to have depression, constipation, and urinary tract infections (UTIs) up to five years before their diagnosis.

Sexual problems and bladder infections (cystitis) were also more common in people with MS.

In addition, the scientists found that these conditions were also more likely to occur in other autoimmune diseases, such as lupus and Crohn’s disease.

The connection between multiple sclerosis and other diseases

In their study, the researchers looked at the medical records of 20,174 people who were newly diagnosed with MS and compared them to a control group of 54,790 people who did not have the disease, matched according to age and gender.

The researchers also compared the people with MS to 30,477 individuals with Crohn’s disease and 7,337 people with lupus.

Using the medical records database, they looked for 113 diseases and symptoms occurring five years before and after the diagnosis, or before the matching date for those not diagnosed with another autoimmune disease.

They reported that people with MS were:

• 22% more likely to have depression
• 50% more likely to have constipation
• 38% more likely to have UTIs
• 47% more likely to have sexual problems
• 21% more likely to have bladder problems (cystitis)

They also observed that these conditions were also more likely to occur in people with Crohn’s disease and lupus, two other autoimmune diseases.

In addition, the scientists reported that 14% of people with MS had antidepressant prescriptions five years before their diagnosis, compared to 10% of people who did not have MS.

By five years after the diagnosis, 37% of people with MS had antidepressant prescriptions, compared to 19% without MS.

The researchers noted that knowing these conditions could be helpful when deciding whether to screen people with a family history of the disease or those who show signs of MS on brain scans but do not have symptoms yet of the disease.

The benefits of diagnosing MS early

The prodromal stage of an illness or disease is the period between initial symptoms and the full development of the condition.

“Recognizing the prodromal phase of a disease in an individual has two potential benefits,” wrote Dr. Ruth Ann Marrie, a professor at the University of Manitoba in Canada, and Raffaele Palladino, PhD, a professor of medicine at Imperial College London, in an editorial accompanying the article in Neurology.

“First, accurate identification of etiologic factors for disease depends on ensuring that the putative exposure preceded the biologic onset of the disease and that the identified symptoms are not related to a delay in diagnosis,” said the professors, who were not involved in the study. “Therefore, recognizing a prodromal phase may enhance the ability to identify etiologic factors. Second, accurate prediction that an individual is in the prodromal phase of the disease offers the tantalizing possibility that intervention in this phase could prevent or delay the evolution of more typical clinical manifestations.”

Experts react to MS symptoms study

“This study adds to a growing body of literature suggesting that there is a prodrome or ‘pre-MS’ period marked by certain symptoms and increased utilization of healthcare resources that occur in person who will eventually develop MS before definite neurologic [symptoms] of MS appear and a diagnosis is made,” said Dr. Barbara Giesser, a neurologist and MS specialist at Pacific Neuroscience Institute at Providence Saint John’s Health Center in California who was not involved in the study.

“It is important to note that the symptoms that were investigated, i.e., depression, sexual dysfunction, constipation, and urinary tract infections were also noted in persons with other autoimmune disease such as lupus and, of course, commonly occur in the general population as well, so they were not specific to MS. Also, some other factors that might have increased risk for developing MS were not examined in this study,” Geisser told Medical News Today.

“These are intriguing findings, but I agree with the authors’ statement that this will not change practice right now, and more work needs to be done in this area,” she added.

Another expert had similar concerns.

“The identified symptoms are very common, and more often than not, the vast majority of people with depression, constipation, sexual dysfunction, and urinary tract infections will not go on to develop multiple sclerosis,” said Dr. Michael Sy, a neurologist at UCI Health and an associate professor at the University of California Irvine School of medicine who was not involved in the study.

“Of note, the authors find that when women (who comprise the majority of people with MS) have more than one of those symptoms, they are not more likely to develop MS than if they only have one symptom. Thus, there is not even a pattern of symptomology that is very helpful in diagnosing MS,” Sy told Medical News Today.

“In addition, calling these symptoms prodromal or even early-stage may not be correct,” he added. “These symptoms have not been demonstrated in this study to more likely occur before other more commonly associated MS symptoms.”

“MS patients can and very commonly do acquire these symptoms as their disease progresses,” Sy explained. “In fact, many of these symptoms are incorporated into the most common scoring system for measuring MS disease progression (EDSS). Thus, identifying these symptoms does not necessarily tell us more about disease pathogenesis other than the fact that the nervous system can play a role in all of these symptoms and that MS can impact these systems.”

Limitations of the multiple sclerosis study

The researchers noted that the main limitation in their study is that the database they used did not have other factors, such as education level, ethnicity, or socioeconomic factors, so they could not determine if these factors played a role in diagnosis.

Another limitation is that the study includes slightly fewer people under 25 years of age, which, according to the authors, could explain the higher age at diagnosis than expected.

The database also included only people diagnosed and seen by primary care physicians.

The authors note that without a casual framework, it remains unclear if the pre-clinical conditions are risk factors for MS or simply nonspecific early symptoms of MS.

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