Healthcare Visits Increase Up to 15 Years Before MS Onset

Medscape

5 days ago

TOPLINE:
Healthcare use was elevated much earlier than previously recognized among patients with multiple sclerosis (MS) in new research. Physician visits for 'ill-defined symptoms and signs' increased from 15 years before MS symptom onset and mental health-related and psychiatry visits increased 14 years and 12 years before, respectively. However, nervous system-related and neurology visits increased significantly only 4 years and 8 years before the onset of MS symptoms.
METHODOLOGY:
The cohort study included more than 2000 patients with MS (mean age at symptom onset, 38 years; 74% women) with a known date of MS symptom onset. Data were obtained from the British Columbia MS clinical database (1991-2018).
Each patient with MS was matched by sex, birth year, socioeconomic status, and postal code at the year of MS onset with up to five individuals without MS randomly selected from the general population in British Columbia.
Researchers compared annual rates of physician visits during the 25 years before MS onset between the cohorts.
They also compared the difference in annual physician visit rates during the 15 years before MS onset on the basis of the International Classification of Diseases, Ninth Revision chapter and physician specialty.
TAKEAWAY:
All-cause physician visit rate ratios (RRs) for patients with MS were consistently elevated from 14 years before MS onset (adjusted RR, 1.2; 95% CI, 1.1-1.3), peaking in the year before MS onset (adjusted RR, 1.3; 95% CI, 1.2-1.4).
Mental health-related and psychiatry visits increased significantly from 14 years and 12 years before MS onset (RRs; 1.8 and 2.6, respectively), with both remaining elevated in most subsequent years.
In contrast, neurology visits were significantly elevated for up to 8 years before MS onset (RR, 1.6) and nervous system conditions were elevated from only 4 years before (RR, 1.4), both peaking in the year before onset.
Healthcare visits for ill-defined symptoms and signs consistently exceeded 1.15 from 15 years before MS onset, peaking in the year before (RR, 1.4).
IN PRACTICE:
'MS can be difficult to recognize as many of the earliest signs — like fatigue, headache, pain, and mental health concerns — can be quite general and easily mistaken for other conditions,' study investigator Helen Tremlett, The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada, said in a press release.
'Our findings dramatically shift the timeline for when these early warning signs are thought to begin. By identifying these earlier red flags, we may eventually be able to intervene sooner — whether that's through monitoring, support, or preventive strategies,' Tremlett added.
SOURCE:
This study was led by Marta Ruiz-Algueró, MD, PhD, The University of British Columbia and Djavad Mowafaghian Centre for Brain Health. It was published online on August 1 in JAMA Network Open.
LIMITATIONS:
This study lacked detailed clinical information and only considered issues that prompted individuals to seek medical care. Potential miscoding or misclassification may have occurred. Additionally, a potential recall bias and challenges with medical history taking may have influenced the findings.
DISCLOSURES:
This study was funded in part by the National Multiple Sclerosis Society and MS Canada. Several investigators reported having financial ties with various sources either during the conduct of the study or outside the submitted work. Full details are provided in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.