ACTRIMS: Comorbidities in MS
Oh, how I wish all of you could listen in to the professional presentations given at some medical conferences, especially when they are given in plain language and easily understood. We can learn so much about this disease from expert researchers.
Such was the opening keynote lecture for ACTRIMS 2022, given by Dr. Ruth Ann Marrie, Professor of Medicine at the University of Manitoba, and the Chair of the Medical Advisory Committee for the MS Society of Canada. ACTRIMS, the Americas Committee for Treatment and Research in Multiple Sclerosis, held its annual meeting in Florida, and Dr. Marrie gave the Kenneth P Johnson Memorial Lecture on one of my favorite topics, Comorbidity in Multiple Sclerosis: What, So What, What Now.
My ACTRIMS comorbidity and MS recap
Dr. Marrie in plain language outlined for the attendees, the challenges of diagnosing and treating multiple sclerosis (MS) when there are complicating factors, aka comorbidities. The presentation included sharing results from research studies over the past decade, and longer, that looked at patterns of health, habits, disease diagnosis and progression, and more.1
The reminder from this talk was that most people with MS have more going on with their health than just the demyelinating disease part and clinicians have to treat the whole person and not just their MS. I would add to this, as a person with MS I also must be aware of these additional burdens of other conditions.
Cancer and MS
There were pieces of good news for those of us with MS so let’s get it out there first. Dr. Marrie had statistics to show that people with MS are not more affected by cancer than our healthy peers, with the exception of bladder cancer and possibly ovarian cancer. There is no increase in mortality rates for people with central nervous system cancers.
Dr. Marrie did note that people with MS are perhaps getting fewer cancer screenings such as breast mammograms and that may affect the numbers. This decrease in testing may be due to access to care, or mobility issues that inhibit people with MS from going for other medical tests. On a somewhat good note, the screening rate for colon cancer is at least equal to our peers, according to Dr. Marrie, which may be due to many of us having constipation issues which call for increased testing.1
Something different is happening with people with MS when it comes to psychiatric problems. Researchers looked at other chronic diseases such as irritable bowel disease (IBD) and rheumatoid arthritis (RA) as a comparison and rates of depression and anxiety didn’t follow the same patterns as they do for MS. This is important because disability progression, both physical functioning and cognitive, is negatively impacted by psychiatric disorders.1
Know your numbers
That is the call from the heart doctors - we should all be aware of our cholesterol and triglyceride numbers and it appears this is another significant factor in MS progression. Dr. Marrie presented information on RRMS patients having faster EDSS disability change when they have elevated cholesterol numbers. There were also startling statistics showing the treatment of myocardial infarctions (heart attack) in people with MS is different than our peers. When looking at those numbers for people with MS, it was 22% longer to treatment for an MI, the mortality rate at 30 days is 46% higher and 40% higher at one-year post-MI. High rates of triglycerides are connected with relapse rates and increased GAD enhancing lesions, and demonstrate why our total health is important, according to Dr. Marrie.1
Knowing our numbers also goes for the possibility of comorbid diabetes, another autoimmune disorder. Studies presented by Dr. Marrie show people with MS and diabetes have a slower improvement time in treating fatigue and other MS symptoms.1
Mortality and MS
Dr. Marrie shared the hard fact that the median age of survival, if you have MS, remains less than our peers and is 76 years. This is a gap of 6-7 years and has not changed significantly even with the advent of new disease-modifying treatments. Comorbidities increase the chance of earlier death, with cardiovascular disease close to the top of the list.1
There were so many comorbidities that Dr. Marrie touched on in the 45-minute lecture and I will try to expand on each of these topics in future writings. The challenge from Dr. Marrie to the audience, however, was clearly explained in the 'What Now?' question. The problem of MS and comorbidities is common, and there needs to be more research on how they can be managed to improve the outcomes of living with MS.
I know my extensive list of comorbidities includes many of the above-listed conditions and am working to address them with my doctors. I hope you will do the same while we wait for the researchers to figure out the link between comorbidities and MS.
Wishing you well,
Would it have been helpful to hear from others and their experiences when you were beginning your MS journey?
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