TOPLINE:

Pain, psychiatric, and neurologic symptoms of multiple sclerosis (MS) appear years before diagnosis, with similar patterns across diverse ethnic and socioeconomic groups, a new study showed. Additionally, those who were eventually diagnosed with MS were eight times more likely to have reported early neurologic symptoms and more than twice as likely to have had early cognitive symptoms.

METHODOLOGY:

• Researchers conducted a retrospective, longitudinal, population-based nested case-control study using data from the Clinical Practice Research Datalink, comprising more than 41 million participants with at least two diagnoses of MS in England (1990-2022).
• The study included more than 15,000 adults with MS (median age, 45 years; 70% female; 93% White) and more than 81,000 age-matched control individuals with at least 5 years of retrospective data (median age, 45 years; 50% female; 88% White).
• Prediagnostic or prodromal symptoms were classified under the headings of neurologic, autonomic, cognitive, psychiatric, or pain.
• Data on sex, ethnicity, the index of multiple deprivation, and urban or rural location were analyzed across intervals of 0-2 years, 2-5 years, and 5-10 years before the date of referral to a neurology specialist.

TAKEAWAY:

• Prodromal symptoms were strongly associated with the risk for subsequent MS, with neurologic symptoms showing the highest odds (odds ratio [OR], 7.9), followed by cognitive (OR, 2.6), pain (OR, 2.2), autonomic (OR, 1.9), and psychiatric (OR, 1.75) symptoms (P < .0001 for all). Effects of all symptoms were consistent across sexes, ethnicities, deprivation levels, and urban or rural location.
• The magnitude of the association between neurologic symptoms and the risk for subsequent MS was more pronounced in men than in women at any time (ORs, 12.0 vs 8.5), which persisted across all time intervals (P < .0005). Similar patterns were observed for autonomic symptoms in both sexes at any time (ORs, 2.5 vs 2.2; P = .002) and at intervals of 0-2 years (P = .0004) but not 2-5 or 5-10 years.
• Psychiatric symptoms showed stronger associations with MS in Black, South Asian, and mixed or other individuals than in White individuals (ORs, 2.5, 2.6, and 2.5 vs 1.7, respectively; P < .0001 across all time windows). Similar patterns were observed among Black and mixed or other individuals compared with White individuals for pain (ORs, 3.0 and 3.4 vs 2.1, respectively) and neurologic (ORs, 10.5 and 13.8 vs 7.6, respectively) symptoms.
• No interaction between deprivation or urban or rural location and any of the prodromal symptoms was observed at any time before diagnosis.

IN PRACTICE:

“This is the strongest evidence yet that MS gives us clues years before diagnosis. If doctors know what to look for, they can potentially spot the disease earlier and act to start treatment before significant damage is done,” study investigator Ruth Dobson, Wolfson Institute of Population Health, Queen Mary University of London, London, England, said in a press release.

“Our study shows that the very earliest features of MS are similar regardless of someone’s ethnic or socioeconomic background. Efforts to detect MS earlier or identify people at high risk should therefore be inclusive and representative of the whole population,” Co-investigator Benjamin M. Jacobs, also of the Wolfson Institute of Population Health, added.

SOURCE:

The study was led by Pooja Tank, Wolfson Institute of Population Health, Queen Mary University of London. It was published online on September 24 in Annals of Clinical and Translational Neurology.

LIMITATIONS:

The study was limited by missing demographic data, particularly on ethnicity. The broad ethnicity categories used in the study did not represent biological constructs or homogeneous groups. Symptom reporting in primary care may have been subject to inaccuracies and underreporting, with potential bias in recording across different ethnicities and sexes due to varying sociolinguistic contexts. Additionally, the study did not account for potential confounding variables such as physical activity or education.

DISCLOSURES:

This study was funded by the National Multiple Sclerosis Society. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.