title: Frequency of Comorbidities and Their Association with Clinical Disability and Relapse in Multiple Sclerosis.
abstract: BACKGROUND
  Multiple sclerosis (MS) patients may be at an increased risk of comorbidities due to the debilitating and chronic nature of the disease. An increased understanding of comorbidities and disease course in MS may provide new insights and enhance MS management. We aimed at investigating the frequency of comorbidities and their associations with clinical disability and relapse in MS.
  
  
  METHODS
  A prospective cohort of 198 MS patients was followed during 2002-2005 and queried about specific doctor-diagnosed comorbidities. In Australia, the MS cohort was compared to the 2007 general population with regard to the prevalence of comorbidities. Multilevel mixed-effects linear regression was used to assess the difference in subsequent disability between those who reported comorbidities and those who did not. The association of comorbidities with the hazard of relapse was assessed using survival analysis.
  
  
  RESULTS
  The age-standardised prevalence of hypertension, dyslipidaemia, asthma, psoriasis, eczema and anaemia was significantly higher in the MS cohort compared to that in the general Australian population. The level of disability (Multiple Sclerosis Severity Score) in those who reported overweight/obesity (β: 0.76 (95% CI 0.04-1.48), p = 0.037), or dyslipidaemia (β: 1.05 (95% CI 0.07-2.02), p = 0.036) was significantly higher compared to those who did not report these comorbidities, even after adjustment for potential confounders. There were no significant associations between comorbidities and change in disability. For relapse analyses, rheumatoid arthritis and anaemia were associated with more than threefold (hazard ratio, HR 3.70 (95% CI 1.80-7.58), p < 0.001) and twofold (HR 2.04 (95% CI 1.11-3.74), p = 0.022) increased risk of subsequent relapse respectively.
  
  
  CONCLUSIONS
  The prevalence of some comorbidities was higher in MS patients and associated with greater disability and relapse risk. Treatment of these comorbidities in patients with MS has the potential to improve disease course and help in the understanding of the prognosis and outcomes of MS.
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Prudence
authors.initials: P
authors.lastname: Tettey
authors.forename: Dylan
authors.initials: D
authors.lastname: Siejka
authors.forename: Steve
authors.initials: S
authors.lastname: Simpson
authors.forename: Bruce
authors.initials: B
authors.lastname: Taylor
authors.forename: Leigh
authors.initials: L
authors.lastname: Blizzard
authors.forename: Anne-Louise
authors.initials: AL
authors.lastname: Ponsonby
authors.forename: Terence
authors.initials: T
authors.lastname: Dwyer
authors.forename: Ingrid
authors.initials: I
authors.lastname: van der Mei
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D004185:Disability Evaluation; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D055815:Young Adult