People who are eventually identified as having multiple sclerosis (MS) are more likely to have conditions like depression, constipation, sexual issues, and urinary tract infections (UTIs) five years before their diagnosis compared with people who don’t get MS, according to a new study published December 5 in Neurology.
Researchers also found that the conditions were more likely to occur in people who had lupus and Crohn’s disease, which are also autoimmune conditions.
These findings suggest that the biological mechanisms of multiple sclerosis can already be triggered many years before the first neurological symptoms and subsequent diagnosis, says study coauthor Celine Louapre, MD, PhD, of Sorbonne University in Paris.
Because depression, constipation, and the other conditions identified here were also found in people with other autoimmune diseases and are very common in the general population, it’s unlikely that they can be used to diagnose multiple sclerosis earlier, says Dr. Louapre.
“The exception is perhaps for people who are particularly at risk of developing MS, because of a family risk or because patients would already be followed for incidental discovery of CNS [central nervous system] inflammatory lesions on an MRI [magnetic resonance imaging scan],” she adds.
MS Prodrome May Be Detectable Years Before Neurological Symptoms or Diagnosis
There is growing recognition that MS has a prodrome, or an early phase of different symptoms that signals a high risk for future onset and diagnosis of MS, according to a review published in January 2022 in Frontiers in Neurology. Experts believe that an MS prodromal phase is detectable at least five years before MS symptom onset or 10 years before an MS diagnosis is made.
There are many signs and symptoms that have been identified as more common during the years leading up to MS including cognitive deficits, depression, fatigue, sleep disorders, pain, fibromyalgia, bowel and bladder issues, and skin conditions.
The 5 Symptoms Significantly Associated With a Future MS Diagnosis
Investigators identified about 20,000 people newly diagnosed with MS using electronic health records from databases in France and the United Kingdom. Those individuals were then compared with about 55,000 people without MS, matched by age and sex.
The people with MS were also compared with about 30,000 people with Crohn’s disease and 7,000 people with lupus.
Researchers then searched the database to see whether the participants had one or more of 113 diseases and symptoms in the five years before and after their diagnosis, or before that matching date for the people who did not have an autoimmune disease.
They found that, compared with people without MS, in the five years before diagnosis, the people with MS were:
- 22 percent more likely to have depression
- 50 percent more likely to have constipation
- 38 percent more likely to have UTIs
- 47 percent more likely to have sexual issues
- 21 percent more likely to have cystitis (bladder infections)
Depression More Likely Before and After MS Diagnosis
In a deeper dive into depression, researchers found that 14 percent of the people with MS had prescriptions for antidepressants five years before diagnosis, compared with 10 percent of the people who did not have MS. By five years after diagnosis, more than one-third (37 percent) of people with MS had antidepressant prescriptions, compared with 19 percent of those without MS.
To be clear, everyone who has these symptoms will not go on to develop MS, says Louapre.
The authors acknowledge a limitation of the study was that data was not available for other factors that could influence people’s risk of developing MS, such as education level, income, and ethnicity.
Could UTIs, Sexual Dysfunction, and Constipation Be Caused by the Same Underlying Disease Process as MS?
Researchers hope that identifying these early signs will continue to advance the understanding of the biological mechanisms that occur in the body before the actual symptoms of the disease develop.
The symptoms and conditions identified could be caused by the same underlying disease process as MS, says Louapre. “These symptoms may reflect early damage to the central nervous system. For example, urinary disorders, constipation, and sexual disorders could be due to the presence of spinal cord lesions, which would not have resulted in classic motor or sensory neurological symptoms at the time of their appearance,” she says. Spinal cord lesions (abnormal change or damage) are common in MS.
“These lesions, even if they are initially nonsymptomatic, can disrupt certain circuits, including the neurological circuits which control sphincter functions,” says Louapre.
Sphincters are ring-like muscles that allow constriction of certain body passages, including those that control the release of urine, feces, and semen.
“Similarly, MS brain damage can disrupt certain neurological circuits involved in depression, even though classic neurological symptoms are not yet present,” she says.
