MS and Comorbidities: When MS Isn't Your Only Health Condition

Dealing with MS and more

In addition to living with multiple sclerosis (MS), many people with the condition also are dealing with other serious health issues. In our 2017 MS in America survey, 88% of respondents noted other health conditions besides MS. The most common health issues among people with MS from our survey were neuropathy (48%), being overweight or having obesity (40%), mood disorders (33%), hypertension or high blood pressure (30%), and migraines (30%).

Comorbidities versus secondary conditions

Experts classify the various additional health issues that someone with MS can have as comorbidities or secondary conditions. Comorbidities are a condition that is separate from the original condition, like hypertension, mood disorders, or sleep disorders. Secondary conditions are physical or mental disorders that develop as a direct or indirect consequence of the original disease. Common secondary conditions related to MS include osteoporosis and fractures.¹
All of these additional health challenges can greatly impact an individual’s quality of life, but comorbidities can also affect a person’s MS.¹

Mental disorders are common in MS

Mood disorders like depression, anxiety, and bipolar disorder are more common in people with MS than in the general population. The lifetime prevalence of anxiety in people with MS is up to 36%, and bipolar disorder also occurs more frequently in people with MS than the general population.¹

In people with MS, the lifetime prevalence of depression is nearly 50%, which is about three times higher than in the general population. The reason why depression is so much more common in people with MS isn’t well understood, but experts believe that having MS lesions in certain areas of the brain may play a role. The emergence of depression may also be an indicator of disease activity, so it is not clear whether mental conditions like depression and anxiety are truly comorbidities or a secondary condition caused by MS.¹

Our 2017 MS in America survey also found that 42% of people with MS were initially misdiagnosed with depression, suggesting that the two conditions are more entwined than some doctors may realize.

Despite the fact that mood disorders are more common in people living with MS, these conditions frequently go undiagnosed or untreated, leading to a significant negative impact on quality of life and overall health. Treatment for mood disorders in people with MS is similar to that for the general population, including pharmaceutical drugs, psychotherapy, or both.¹

Other physical conditions add to the burden of MS

Physical comorbidities are also common among people with MS, and as a person ages, their risk of developing physical comorbidities increases. Physical comorbidities are also higher among people with lower socioeconomic status.¹

One area of research is the presence of other autoimmune diseases among people with MS. The findings from research have been inconsistent, with some finding a link and others not. However, prior to being diagnosed with MS, people with MS are more likely to have had uveitis (inflammation of the middle layer of the eye which can lead to vision loss), inflammatory bowel disease (Crohn’s disease or ulcerative colitis), and bullous pemphigoid (a rare skin disease that causes large blisters) than the general population.¹

Other physical comorbidities that have been found to occur more often in people with MS include hypertension (high blood pressure), arthritis, irritable bowel syndrome, chronic lung disease, and hyperlipidemia (high levels of fat in the blood). More than 5% of people with MS also have fibromyalgia, insomnia, irritable bowel syndrome, obstructive sleep apnea, and restless legs syndrome.¹

Sleep disorders, also more common among people with MS than the general population, are a particular concern among people with MS as they greatly impact fatigue. Fatigue was cited in the 2017 MS in America survey as the symptom that has the greatest impact on a person’s daily life. It is estimated that between 25% to 54% of people with MS experience a sleep disorder, such as insomnia, nocturnal movement disorders, respiratory disorders during sleep (like sleep apnea), narcolepsy, REM sleep behavior disorder, disturbances of circadian rhythm, and restless legs syndrome.¹

MS also increases a person’s risk of developing osteoporosis as a secondary condition. Osteoporosis is a condition in which the bones become brittle and more fragile, and it affects 1 in 3 people with MS. Several of the risk factors for MS are also risk factors for osteoporosis, including being female, having a vitamin D insufficiency, and smoking. However, additional factors of MS increase a person’s risk of developing osteoporosis including inactivity, immobility, and exposure to medications like corticosteroids, antidepressants, and anticonvulsants.¹

The risk of fractures among people with MS is also higher than the general population, particularly in the femur (thigh bone), tibia (lower leg bone), and hip. Factors that increase an individual’s risk of fracture include a history of falls, increasing age, being underweight, and the use of some medications.¹

The impact of other conditions on MS

Having additional health conditions negatively impacts a person with MS in several ways:

• They have more symptoms to deal with
• Their quality of life is reduced
• Their physical disability is greater
• They may have more difficulties sticking to treatment regimens¹

What you can do

If you are coping with MS and one or more additional health conditions, getting proper treatment and making healthy life choices is more important than ever. Healthy behaviors that can have a positive impact on MS also can improve other comorbidities common to people with MS. Some of the healthy steps you can take include:

• Staying physically active, however you can
• Stopping smoking
• Getting proper nutrition, especially vitamin D
• Limiting your intake of alcohol
• Maintaining a healthy weight¹
• Getting adequate sleep

Respondents from the 2017 MS in America survey found that rest or sleep had the greatest impact on their MS symptoms. In addition, if you suspect you may have another condition, like depression, it’s important to seek out diagnosis and treatment. While having a chronic condition like MS means a loss of control in some ways, taking steps to improve your overall health can help you take back some control over your body.