It’s hard enough having a diagnosis of multiple scerlosis, the autoimmune condition that damages nerves and leads to physical and emotional challenges. But it’s even harder to cope with MS when you have additional chronic health conditions or “comorbidities,” such as high blood pressure or heart disease.
“It can be overwhelming, just from the sheer logistics. You’re trying to manage doctor appointments, prescriptions and refills for MS, and then we add other things, like getting blood pressure under control or quitting smoking,” says Dr. Robert Bermel, director of the Mellen Center for Multiple Sclerosis at Cleveland Clinic and assistant professor of neurology at Cleveland Clinic Lerner College of Medicine.
MS and Comorbidities
Comorbidities are common in people with MS. That became especially clear in 2015, when a team of international researchers (known as the MS Comorbidities Project) combed through hundreds of studies to uncover the conditions more likely to occur in people with MS.
Scientists found five common comorbidities in people with MS: depression, anxiety, high blood pressure, high cholesterol and chronic lung disease (such as asthma).
They found that some conditions occurred more frequently in people with MS than previously believed, such as stroke, heart disease, congestive heart failure, arthritis, inflammatory bowel disease or irritable bowel syndrome, seizure disorders, sleep disorders, bipolar disorder and alcohol abuse.
Researchers observed that certain cancers were common in people with MS, including cervical, breast and digestive system cancers. The risk for developing meningiomas (benign tumors on the spinal cord or brain) and urinary system cancers appeared higher in people with MS compared to people without MS. And the risk for developing other cancers — pancreatic, ovarian, prostate and testicular cancers — was lower than expected in people with MS, compared to people who don’t have MS.
Scientists also noted that the most common autoimmune diseases that coincide with MS are thyroid disease and psoriasis.
What’s the Connection?
Comorbidities can occur either before or after an MS diagnosis. Exactly why a secondary condition develops isn’t always clear. In some cases, it may be related to MS. Anxiety and depression, for instance, are often tied to the damage MS causes in brain areas that regulate mood.
[See: Am I Just Sad — or Actually Depressed?]
Another example: “Some people with MS have trouble with mobility. This may lead to being less physically active and overweight, which in turn may increase the risk of high blood pressure, high cholesterol and diabetes,” says Dr. Ruth Ann Marrie, who leads the MS Comorbidity Project and is a professor of medicine and community health sciences at the University of Manitoba in Canada.
In other cases, comorbidities and MS may share common risk factors. “For example, smoking increases the risk of MS and increases the risk of chronic lung disease,” Marrie explains.
“What we know for sure,” Bermel says, “is that we should work hard to control these conditions.”
Diagnosis Delays and Risks
Unfortunately, comorbidities in MS are often missed. Bermel says it may be because patients often attribute all symptoms they experience to MS and not to other undiagnosed conditions. For example, fatigue is a common side effect of MS, but it can also be caused by an underactive thyroid.
Catching comorbidities is crucial, however, and the sooner the better. “Certain comorbidities like smoking, high blood pressure and diabetes can drive MS to progress faster,” Bermel says.
And MS patients who have one or more comorbidities appear to have a two-fold higher rate of hospitalization than MS patients who don’t have comorbidities, according to the MS Comorbidities Project.
Treatment
For the most part, doctors treat MS comorbidities the same way they treat comorbidities in people without MS. For example, the approach to reducing high cholesterol in MS is exercise, a healthy diet and perhaps a cholesterol-lowering medication; the treatment for high blood pressure in MS is a low-salt diet, exercise, stress reduction and antihypertensive medication.
What about treating anxiety or depression? “A review of multiple studies suggests that similar approaches can be used to manage depression and anxiety in people with MS as people without MS. That is, medications, talk therapies of various types or a combination of these,” Marrie says.
What’s different about treating comorbidities alongside MS is that doctors take a more proactive approach to keep the MS from progressing faster. “In someone young, you might write off a comorbidity if it’s borderline. In someone young with MS, we’ll be more aggressive,” Bermel explains.
That might make the threshhold for treatment lower for certain conditions. For example, if your blood pressure is 140/90 mmHg without MS, which is just over the borderline for stage 1 hypertension (high blood pressure), a doctor might suggest exercise and a healthy diet. But for that blood pressure measurement in a person with MS, a doctor might add antihypertensives.
[See: U.S. News’ 38 Best Diets Overall.]
Teamwork
While you may rely on your neurologist for MS treatment, Bermel urges that you assemble an entire health care team to manage your MS and comorbidities. “Patients with MS tend to want to come to the neurologist for all their care, and you need a neurologist who is open-minded to conditions as they pop up. But the reality is that people still need a primary care physician and need to take care of routine health issues,” Bermel says. “It takes teamwork to keep a patient out of the hospital.”
[See: Who’s Who at Your Doctor’s Office.]
Having team members who communicate with each other will ultimately make it easier on you. It can help you prioritize which comorbidities you need to address first and how to go about it. And many times, the treatments overlap.
“Patients with MS ask me what they should do to help their MS — diet or exercise,” Bermel says. “The answer is that disease-modifying medications, smoking cessation and controlling high blood pressure, cholesterol, weight and diabetes are all important modifiable risk factors.” In other words, you have some control over reducing the chances that MS will progress, by reducing the risk for common comorbidities.
That makes you an important member of the health care team, responsible for carrying out a doctor’s orders and communicating with the team as well. “Tell a health care provider about your concerns and that you want to address them,” Marrie says. “That’s the first step.”
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Managing Multiple Sclerosis When You Have Other Health Conditions originally appeared on usnews.com
