5 conditions MS patients may have years before diagnosis ID’d: Study

Prodromal symptoms also present before diagnosis of Crohn’s disease, lupus

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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People with multiple sclerosis (MS) are more likely to experience depression, sexual dysfunction, constipation, inflammation of the bladder, and urinary tract infection in the five years leading up to their diagnosis than those without the disease, a study found.

These findings parallel growing evidence that there’s a prodromal phase, in which certain unspecific symptoms become evident, sometimes years before the classic symptoms of MS emerge.

While recognizing such symptoms could allow doctors to make an early MS diagnosis and start treatment before the disease progresses, the team found the identified prodromal symptoms were not exclusive to MS. They also were present in the years before a diagnosis of Crohn’s disease and lupus, two other autoimmune diseases, underscoring the challenge of finding specific markers for an early diagnosis.

“The disease begins well before the onset of classic neurological symptoms,” Céline Louapre, MD, PhD, head of the Paris Brain Institute at Sorbonne University and a neurologist at Pitié-Salpêtrière Hospital in Paris, said in a institute press release. “These signs alone will not be enough to make an early diagnosis, but they will certainly help us better understand the mechanisms of multiple sclerosis—which has many causes—and reconstruct its natural history.”

The study, “Association Between Diseases and Symptoms Diagnosed in Primary Care and the Subsequent Specific Risk of Multiple Sclerosis,” was published in the journal Neurology.

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Diagnosis can be challenging because of overlapping symptoms

In MS, the immune system mistakenly attacks the protective covering of nerve cells in the brain and spinal cord, causing inflammation. Each attack brings about new damage, which can often be seen in MRI scans in the form of lesions, and the build up of damage over time leads to progressive disability worsening.

Not everyone experiences MS in the same way, and symptoms can range from problems with balance and vision to slurred speech and trouble swallowing. These symptoms often overlap with other diseases, making a diagnosis challenging.

“The challenge today is to detect the disease as early as possible, well before the lesions are visible on MRI, in the hope of delaying the onset of disability,” Louapre said.

Identifying a prodrome could help better understand the symptoms that lead up to an MS diagnosis and also pinpoint the exact moment when changes in the immune system begin.

Earlier work has shown that pain and trouble sleeping, as well as anxiety, depression, and other mental health issues can appear years before the known symptoms of MS manifest. Some of these symptoms may offer clues to diagnose the disease and also help to predict its course.

Now, Louapre and other researchers at the Paris Brain Institute drew on the U.K.’s Health Improvement Network database to study the frequency of 113 diseases and symptoms in the five years leading up to a diagnosis of MS.

The study included data from 20,174 people with MS; 54,790 people without MS, who served as controls; 30,477 people with Crohn’s disease; and 7,337 people with lupus.

Initially, the team found 12 conditions or symptoms that were significantly associated with MS. But after considering issues suggestive of neurological symptoms, only five remained. In particular, the odds of experiencing depression, sexual dysfunction, constipation, cystitis (inflammation of the bladder), and urinary tract infection were about 21% to 50% higher in people who went on to develop MS than in controls.

The increased frequency of these symptoms continued to hold true in the years following the diagnosis of MS.

“The overrepresentation of these symptoms persisted and even increased over the five years after diagnosis,” Louapre said.

However, these five symptoms also appeared during the prodromal phase of Crohn’s disease and lupus, which means “they lack specificity to MS,” the researchers wrote. In high-risk populations, they may serve as early warning signs of MS and potentially lead to earlier treatment interventions.