Self-reported physical health may predict RRMS disability worsening

People with relapsing-remitting multiple sclerosis (RRMS) who report better physical health are significantly more likely to see disability progression after three years, an observational study found.

The findings suggest this patient-reported outcome measure may help predict long-term disability worsening in people with the condition.

“Our findings support that the score in the health-related quality of life in the domain of physical activity may predict confirmed disability progression,” researchers wrote in “Health related quality of life in the domain of physical activity predicts confirmed disability progression in people with relapsing remitting multiple sclerosis,” which was published in Multiple Sclerosis and Related Disorders. 

Most patients present with an initial relapsing-remitting phase marked by relapses, where neurological symptoms appear or worsen, interspersed with remission periods, where they ease or go away entirely.

Over time, those patients will transition to progressive disease stage, called secondary progressive MS (SPMS), where their disability gradually worsens even in the absence of relapses. As new therapies emerge for this progressive form, identifying the transition as early as possible is essential to maximize the effectiveness of treatment.

There are no formal diagnostic criteria that define when RRMS transitions into SPMS. Instead, the diagnosis of secondary progressive disease is made after reviewing the progression of the disorder in the preceding months and years.

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On the hunt for an earlier SPMS transition diagnosis

To see if that diagnosis could be made sooner, researchers in Italy sought to identify early predictors of disease progression that could indicate a greater likelihood of converting to SPMS. They focused on patient-reported outcome measures (PROMs), which offer a view on a person’s perspective of their own health.

The analysis included 200 RRMS patients with stable disease — meaning no worsening disability over the past year — who attended an outpatient MS center in Italy between January and December 2018. They had a mean age of 39.7, a median EDSS of 1.5 (indicating mild disability), and all were receiving either oral or injectable disease-modifying treatments. The average disease duration was 10.8 years.

Over a three-year follow-up, 42 (21%) had a confirmed disability progression, defined as a sustained increase in Expanded Disability Status Scale (EDSS) scores. 

Upon enrollment, all were asked to fill out questionnaires, including the Short Form 36- Item (SF-36), which assesses domains such as physical health, social functioning, mental health, and vitality. How fatigue interferes with daily life was examined with the Fatigue Severity Scale (FSS).

Results showed a moderate negative association between the FSS score and all domains in the SF-36 assessment, indicating more fatigue was related to worse general health.

Fatigue, physical functioning, and bodily pain scores on the SF-36 scale were all significantly associated with confirmed disability progression over the follow-up, the researchers said.

After additional analyses accounting for confounding factors were performed, only the physical functioning component of the SF-36 scale remained as an independent predictor of disability worsening, however. Specifically, RRMS patients with better physical functioning scores (above a 77.5 cutoff value) were significantly more likely to have confirmed disability worsening over the follow-up.

The findings replicate previous results from an older study, but “on a larger sample size,” supporting the hypothesis that self-rated health status, particularly physical functioning, could predict MS progression. Still, the researchers said more research to “validate PROMS protocols” is needed “because of the lack of standardized protocols to administer PROMS.”