2025-08-05 カナダ・ブリティッシュコロンビア大学(UBC)
<関連情報>
- https://news.ubc.ca/2025/08/ms-early-signs/
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2837128
- https://www.neurology.org/doi/10.1212/WNL.0000000000207843
多発性硬化症の症状発症前の医療利用 Health Care Use Before Multiple Sclerosis Symptom Onset
Marta Ruiz-Algueró, MD, PhD; Feng Zhu, MSc; Anibal Chertcoff, MD; et al
JAMA Network Open Published:August 1, 2025
DOI:10.1001/jamanetworkopen.2025.24635
Key Points
Question What are the patterns of health care use in the 25 years preceding the clinically determined onset of multiple sclerosis (MS)?
Findings In this cohort study of 2038 patients with MS and a matched cohort of 10 182 individuals without MS, all-cause physician visits were elevated 14 years before MS onset. Mental health–related visits and visits for ill-defined symptoms and signs were elevated 14 to 15 years before MS onset, followed by neurology and ophthalmology consultations (8-9 years before onset) and musculoskeletal, sensory, and nervous system visits (4-8 years before onset).
Meaning These findings suggest that MS may begin much earlier than previously recognized, with mental health–related issues as early indicators, highlighting opportunities for earlier identification and intervention.
Abstract
Importance Health care use increases before multiple sclerosis (MS) onset. However, most studies have focused on the 5 to 10 years preceding the first demyelinating disease code from administrative data. Few studies have examined patterns before clinically determined MS symptom onset from clinical records.
Objective To examine health care use 25 years before MS symptom onset in a clinical cohort from British Columbia, Canada.
Design, Setting, and Participants This matched cohort study accessed data prospectively collected from January 1991 to September 2018. All data were released mid-2024 for analysis. The study was conducted in British Columbia using publicly funded universal health insurance data. Patients with MS were identified from MS clinic records and matched with up to 5 individuals randomly selected without replacement from the general population by sex, birth year, socioeconomic status, and postal code of residency.
Main Outcomes and Measures Linked clinical and administrative data were used to compare physician visit rates 25 years before MS onset using adjusted negative binomial models and 15 years before MS onset by International Classification of Diseases, Ninth Revision (ICD-9) chapter and physician specialty.
Results A total of 2038 patients with MS (mean [SD] age at symptom onset, 37.9 [10.9] years; 1508 female [74.0%]) and 10 182 matched individuals were included. All-cause physician visit rate ratios (RRs) for patients with MS were consistently elevated from 14 years before onset (adjusted RR [ARR], 1.19; 95% CI, 1.07-1.33), peaking the year before MS onset (ARR, 1.28; 95% CI, 1.21-1.35). The RRs for ill-defined symptoms and signs were consistently elevated 15 years before onset, exceeding 1.15 and peaking at 1.37 (95% CI, 1.19-1.56) the year before MS onset. Mental health–related RRs from 14 years before onset were significant (excluding years 7, 5, and 4), with RRs in the 3 years before MS onset ranging from 1.30 (95% CI, 1.05-1.58) to 1.38 (95% CI, 1.12-1.68). Sensory, musculoskeletal, and nervous system RRs were elevated 8, 5, and 4 years before onset, respectively, with, for example, a peak of 2.42 (95% CI, 1.90-3.07) for nervous system concerns the year before MS onset. By physician specialty, general practice visit RRs were significantly elevated in each of the 15 years before MS onset, reaching 1.23 (95% CI, 1.17-1.30) in the year before onset. Psychiatry visit RRs were elevated 12 years before onset (2.59; 95% CI, 1.23-5.47). Neurology and ophthalmology RRs were significantly higher up to 8 to 9 years before onset, peaking the year before MS onset at 5.46 (95% CI, 4.30-6.93) for neurology and 1.64 (95% CI, 1.30-2.08) for ophthalmology.
Conclusions and Relevance In this matched cohort study of people with and without MS, health care use was higher among patients with MS 14 to 15 years before MS symptom onset, suggesting that MS may have started earlier than previously thought. Mental health and psychiatric issues along with ill-defined signs and symptoms might be among the earliest features of the prodromal period preceding nervous system–related and neurologic visits by 7 to 11 years.
多発性硬化症患者における前駆期における精神疾患の合併症 Psychiatric Comorbidity During the Prodromal Period in Patients With Multiple Sclerosis
Anibal S. Chertcoff, MD, Fardowsa L.A. Yusuf, MSc, Feng Zhu, MSc, Charity Evans, PhD, John D. Fisk, PhD, Yinshan Zhao, PhD, Ruth Ann Marrie, MD, PhD, and Helen Tremlett, PhD
Neurology Published:September 25, 2023
DOI:https://doi.org/10.1212/WNL.0000000000207843
Abstract
Background and Objectives
Psychiatric morbidity is common after a multiple sclerosis (MS) diagnosis. However, little is known about psychiatric comorbidity during the prodromal phase (before MS onset). To compare the prevalence and relative burden of psychiatric morbidity in individuals with MS with matched controls before MS onset.
Methods
Using linked administrative and clinical data from British Columbia, Canada, we identified cases with MS through a validated algorithm or from neurologist-diagnosed MS clinic attendees. Cases were matched by age, sex, and geographical location with up to 5 general population controls. We identified psychiatric morbidity through a validated definition and determined its prevalence in cases/controls in the 5 years before the first demyelinating claim of cases with MS (“administrative cohort”) or symptom onset (“clinical cohort”) and estimated case/control prevalence ratios with 95% CIs. We also compared the yearly number of physician visits for psychiatric morbidity, visits to psychiatrists, psychiatric-related admissions, and psychotropic dispensations pre-MS onset in cases/controls regardless of whether psychiatric morbidity algorithm was fulfilled using negative binomial regression fitted through generalized estimating equations; results were reported as adjusted rate ratios with 95% CIs. We assessed yearly trends through interaction terms between cases/controls and each year pre-MS onset.
Results
The administrative cohort comprised 6,863/31,865 cases/controls; the clinical cohort comprised 966/4,534 cases/controls. Over the entire 5-year period pre-MS onset, 28.0% (1,920/6,863) of cases and 14.9% (4,738/31,865) of controls (administrative cohort) had psychiatric morbidity, as did 22.0% (213/966) of clinical cases and 14.1% (638/4,534) controls. Psychiatric morbidity prevalence ratios ranged from 1.58; 95% CI 1.38–1.81 (clinical cohort) to 1.91; 95% CI 1.83–2.00 (administrative cohort). In the administrative cohort, health care use was higher for cases in each year pre-MS onset (all 95% CIs >1); physician visits were 78% higher in year 5 pre-MS onset and 124% 1 year before; visits to psychiatrists were 132% higher in year 5 and 146% in year 1; hospitalizations were 129% higher in year 5 and 197% in year 1; and prescription dispensations were 72% higher in year 5 and 100% in year 1. Results were not significant in the clinical cohort.
Discussion
Psychiatric morbidity represents a significant burden before MS onset and may be a feature of the MS prodrome.
