General health issues in multiple sclerosis: Comorbidities, secondary conditions, and health behaviors

Continuum (Minneapolis, Minn.) 08/2013; 19(4 Multiple Sclerosis):1046-57. DOI: 10.1212/01.CON.0000433284.07844.6b
Source: PubMed


Comorbid conditions, secondary conditions, and health behaviors are increasingly recognized to be important factors influencing a range of outcomes in multiple sclerosis (MS). This review discusses the most common comorbidities experienced in MS, their impact on clinical outcomes, and the impact of health behaviors. Osteoporosis is a common secondary condition in MS that will be discussed along with vitamin D insufficiency.
Mental comorbidity is common in MS; depression has a lifetime prevalence of 50%, while anxiety has a lifetime prevalence of 36%. Physical comorbidity is also common, with the most frequently reported conditions including hyperlipidemia, hypertension, arthritis, irritable bowel syndrome, and chronic lung disease. Fracture risk is increased among patients with MS because of an increased risk of osteoporosis and propensity for falls. Vitamin D insufficiency is common and may contribute to increased fracture risk and increased disease activity. Comorbidities and smoking are associated with diagnostic delays, increased disability progression, lower health-related quality of life, and lower adherence to treatment.
Physical and mental comorbidity and adverse health behaviors are common in patients with MS. Comorbidities and health behaviors are associated with adverse outcomes in MS and should be considered in the assessment and management of patients with MS.

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    • "Physical and psychiatric comorbidities are highly prevalent in MS, affecting more than 50% of individuals (Goldman Consensus Group, 2005) and negatively affecting quality of life, treatment outcomes (Finlayson et al., 2013), and mortality (Krokki et al., 2014). Several comorbidities that are common among persons with MS are themselves, directly associated with pain, including arthritis, migraine , and fibromyalgia (Marrie and Hanwell, 2013). However, these and other comorbidities may affect pain in MS by leading to further damage of the central nervous system, augmenting inflammation , or dysregulating pain responses (O'Connor et al., 2008; Osterberg et al., 2005; Herman et al., 1992; Walker et al., 2014). "
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    ABSTRACT: Background: Comorbidities are common in multiple sclerosis (MS). The high prevalence of pain in MS is well-established but the influence of comorbidities on pain, specifically, pain-related interference in activity is not. Objective: To examine the relationship between comorbidity and pain in MS. Methods: We recruited 949 consecutive patients with definite MS from four Canadian centres. Participants completed the Health Utilities Index (HUI-Mark III) and a validated comorbidity questionnaire at 3 visits over 2 years. The HUI's pain scale was dichotomized into two groups: those with/without pain that disrupts normal activities. We used logistic regression to assess the association of pain with each comorbidity individually at baseline and over time. Results: The incidence of disruptive pain over two years was 31.1 per 100 persons. Fibromyalgia, rheumatoid arthritis, irritable bowel syndrome, migraine, chronic lung disease, depression, anxiety, hypertension, and hypercholesterolemia were associated with disruptive pain (p<0.006). Individual-level effects on the presence of worsening pain were seen for chronic obstructive pulmonary disease (odds ratio [OR]: 1.50 95% CI: 1.08-2.09), anxiety (OR: 1.49 95% CI: 1.07-2.08), and autoimmune thyroid disease (OR: 1.40 95% CI: 1.00-1.97). Conclusion: Comorbidity is associated with pain in persons with MS. Closer examination of these associations may provide guidance for better management of this disabling symptom in MS.
    09/2015; 4(5):470-6. DOI:10.1016/j.msard.2015.07.014
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    • "Participants reporting fewer than two cardiovascular comorbidities were 1.5 times more likely to exercise than those reporting more. As reported by Marrie and Hanwell, comorbid conditions are associated with increased MS disability progression and lower adherence to treatment which could be linked to low exercise participation (Marrie & Hanwell, 2013). Exercise participation, adherence to a healthy diet and avoidance of smoking and excessive alcohol are likely parts of an overall MS self-management program to enhance healthy aging with MS (Ploughman et al., 2012a; Ploughman et al., 2012b; Ploughman et al., 2014). "
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    ABSTRACT: Background. Exercise at moderate intensity may confer neuroprotective benefits in multiple sclerosis (MS), however it has been reported that people with MS (PwMS) exercise less than national guideline recommendations. We aimed to determine predictors of moderate to vigorous exercise among a sample of older Canadians with MS who were divided into ambulatory (less disabled) and non-ambulatory (more disabled) groups. Methods. We analysed data collected as part of a national survey of health, lifestyle and aging with MS. Participants (n = 743) were Canadians over 55 years of age with MS for 20 or more years. We identified 'a priori' variables (demographic, personal, socioeconomic, physical health, exercise history and health care support) that may predict exercise at moderate to vigorous intensity (>6.75 metabolic equivalent hours/week). Predictive variables were entered into stepwise logistic regression until best fit was achieved. Results. There was no difference in explanatory models between ambulatory and non-ambulatory groups. The model predicting exercise included the ability to walk independently (OR 1.90, 95% CI [1.24-2.91]); low disability (OR 1.50, 95% CI [1.34-1.68] for each 10 point difference in Barthel Index score), perseverance (OR 1.17, 95% CI [1.08-1.26] for each additional point on the scale of 0-14), less fatigue (OR 2.01, 95% CI [1.32-3.07] for those in the lowest quartile), fewer years since MS diagnosis (OR 1.58, 95% CI [1.11-2.23] below the median of 23 years) and fewer cardiovascular comorbidities (OR 1.55 95% CI [1.02-2.35] one or no comorbidities). It was also notable that the factors, age, gender, social support, health care support and financial status were not predictive of exercise. Conclusions. This is the first examination of exercise and exercise predictors among older, more disabled PwMS. Disability is a major predictor of exercise participation (at moderate to vigorous levels) in both ambulatory and non-ambulatory groups suggesting that more exercise options must be developed for people with greater disability. Perseverance, fatigue, and cardiovascular comorbidities are predictors that are modifiable and potential targets for exercise adherence interventions.
    PeerJ 08/2015; 3(3):e1158. DOI:10.7717/peerj.1158 · 2.11 Impact Factor
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    ABSTRACT: Persons with relapsing-remitting multiple sclerosis (RRMS) are often sedentary, despite the benefits of the regular physical activity. This has motivated the search for variables that act as determinants of physical activity. Such variables are derived from theory and presumably represent targets of behavioral interventions for increasing physical activity. This prospective, observational study examined variables from social cognitive theory as determinants of physical activity 6 weeks later in persons with RRMS. Persons (N = 68) with RRMS initially completed a questionnaire battery that included measures of self-efficacy, physical, social, and self-evaluative outcome expectations, functional limitations as an impediment, social support as a facilitator, and goal setting for physical activity. The participants wore an accelerometer and completed a self-reported physical activity measure 6 weeks later. Data were analyzed using path analysis in Mplus 3.0. Self-efficacy (path coefficient = 0.19, p < 0.05), functional limitations (path coefficient = -0.33, p < 0.0001), and goal setting (path coefficient = 0.26, p < 0.01) had statistically significant direct effects on physical activity. Self-efficacy further had a statistically significant indirect effect on physical activity by way of functional limitations (path coefficient = 0.12, p < 0.05), but not by goal setting (path coefficient = 0.02, p = 0.66). This model explained 28 % of the variance in physical activity. This prospective study suggests that self-efficacy, functional limitations, and goal setting might represent modifiable targets of behavioral interventions for increasing physical activity among persons with RRMS.
    International Journal of Behavioral Medicine 01/2014; 21(6). DOI:10.1007/s12529-013-9382-2 · 2.63 Impact Factor
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