Milder multiple sclerosis course in patients with concomitant inflammatory bowel disease

It is known that patients with inflammatory bowel disease (IBD) have an increased risk of developing MS and conversely, MS patients and first degree relatives have an increased risk of developing IBD. The clinical impact of either disease on the natural history of the other is not fully known and so this study looks at the clinical course of MS-IBD patients compared with that of patients presenting with either disease in isolation.

The study included 66 MS-IBD patients, 251 isolated MS cases and 257 isolated IBD cases. Outcomes measured included EDSS in MS and the extent of disease extension in IBD at the last clinical evaluation. In 62% of MS- Crohn’s disease (CD) cases and 66% MS-ulcerative colitis (UC) cases, MS was diagnosed prior to the IBD diagnosis, with a median interval of 6 years. While, when IBD was first diagnosed the median interval between IBD diagnosis and MS onset was 5 years.

Results from this study showed that MS-IBD patients had a milder neurological course of MS than isolated MS patients. The MS-IBD group had a lower median EDSS, a lower percentage of patients reaching EDSS 3.0 or 4.0 and this group also had a lower proportion progressing from the relapsing-remitting form of the disease to the secondary progressive form of the disease. MS had no impact on the course of IBD.

These findings raise the question of whether the gut plays a role in the immunomodulation of inflammation in the central nervous system.

Authors: Zéphir H, Gower-Rousseau C
Source: Mult Scler. 2013 Dec 10. [Epub ahead of print]
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