There’s an observable rise in healthcare use 15 years before MS symptom onset: study

People diagnosed with multiple sclerosis (MS) have a steady rise in healthcare engagement in the 15 years prior to their diagnosis—more than in the general population. These healthcare visits follow a pattern over time and could indicate a long prodromal phase a new cohort study from researchers at the University of British Columbia (UBC) suggests. The researchers examined healthcare administrative data of 2,038 British Columbians with MS and a matched cohort of 10,182 people without MS from 1991 to 2018. A neurologist determined date of MS symptom onset. The paper was published in JAMA Network Open.Visits to a physician for any reason were higher in the 14 years prior to MS symptom onset compared to the matched cohort. Compared to the matched cohort, people with MS had a higher rate ratio of visits to physicians for:Ill-defined symptoms and signs 15 years prior to MS symptom onsetMental health related issues 14 years before MS symptom onsetInjury-related issues for 14 years before MS symptom onsetSensory symptoms for eight years before MS symptom onsetMusculoskeletal system symptoms five years before MS symptom onsetNervous system four years before MS symptom onset The visits to physicians in various specialties also seemed to follow a pattern, with significantly higher rate ratio of visits among patients with MS compared to the matched cohort to:Family medicine for each year starting 15 years before MS symptom onsetPsychiatry 12 years prior to MS symptom onsetOphthalmology for nine years before MS symptom onsetNeurology for eight years before MS symptom onsetEmergency medicine five years before MS symptom onsetRadiology three years before MS symptom onset The findings hint that there is a long and complex prodromal phase of MS before clinical symptoms lead to a diagnosis, noted Dr. Marta Ruiz-Algueró, a postdoctoral fellow at UBC and the study’s first author. “We’re only now starting to understand what these early warning signs are, with mental health-related issues appearing to be among the earliest indicators.”Senior author Helen Tremlett and colleagues published a study in Neurology in 2023 suggesting people with MS have a higher psychiatric morbidity (including visits to psychiatrists and medication use) during this prodromal period than the general population. Previous studies by Tremlett and others examine data five to 10 years before MS diagnosis, but this study investigated healthcare use 25 years prior to a diagnosis. Knowing the red flags could mean earlier intervention, “whether that’s through monitoring, support or preventive strategies,” said Tremlett in a UBC press release. “It opens new avenues for research into early biomarkers, lifestyle factors and other potential triggers that may be at play during this previously overlooked phase of the disease.” Tremlett is a professor of neurology at UBC’s faculty of medicine and investigator at the Djavad Mowafaghian Centre for Brain Health.Other neurological diseases have a better understood prodromal period, such a Parkinson’s disease, where symptoms such as mood disorders and sleep disorders appear years before motor symptoms.

There’s an observable rise in healthcare use 15 years before MS symptom onset: study

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