Patients With Multiple Sclerosis Miss More Work Even Before Diagnosis, Study Finds

Patients with multiple sclerosis (MS) begin missing significant amounts of work years before they are diagnosed with the disease, according to a new study.

The study also found that patients continue to miss more work than their peers following diagnosis, although the reasons for those missed work days are not always directly related to MS.

The data come from an 8-year longitudinal study performed in Sweden. A total of 2567 people diagnosed with MS between the years of 2009 and 2012 were compared with 10,268 references matched based on sex, age, education level, and other factors. The database was analyzed to capture the enrollees’ sick absences (SAs) as well as their use of the country’s disability pension (DP) system. The results were published in the journal Multiple Sclerosis and Related Disorders.¹

Patients who would go on to be diagnosed with MS missed an average of 10.3 more days of work due to sickness or disability in the 4 years prior to diagnosis. In the 4 years following diagnosis, the patients averaged 68.9 more missed days of work due to sickness or disability compared with the control group. Most of the patients with MS who used their DP did so due to MS, but 15% of cases were due to other health issues.

Corresponding author Chantelle Murley, MSc, of Sweden’s Karolinska Institute, wrote with colleagues that delays between the start of MS symptoms and a definitive diagnosis may be the reason many patients miss significant numbers of work days prior to MS diagnosis, although they noted that such delays are likely shorter now due to updated MS diagnostic criteria.

“The excess SA days due to other neurological diagnoses somewhat decreased after MS diagnosis and may reflect the investigation period to establish the MS diagnosis,” they wrote. “Additionally, healthcare seeking prior to MS diagnosis may lead to the identification of other diagnoses and subsequent SA/DP diagnoses.”

The number of missed work days following diagnosis are also probably decreasing due to medical advances, the authors said. In particular, disease-modifying therapies likely lessen the amount of missed work that patients experience following diagnosis, although Murley and colleagues said it is too early for long-term data to be available on the matter.

Patients with MS also likely miss work due to a range of documented comorbidities, the authors said.

“A surprising finding was the remaining increased risk of DP from non-MS causes even after MS diagnosis among the MS patients compared with references,” they noted.

One reason could be depressive or autoimmune disorders, which are known to be more common among patients with MS compared with the general population. However, the authors noted that the question gets more complicated with issues like cardiovascular and musculoskeletal disorders, which have previously been found to be better predictors of DP use among the general population compared with the MS population.

As patients with MS aged, their risk of DP use increased, likely due to the progression of the disease, the authors said.

“Importantly, we add that for MS patients, comorbidities (in themselves or in combination with MS) are also contributing to higher levels of SA and DP with diagnoses other than MS,” they concluded. “Future studies investigating comorbidities among MS patients and their SA/DP diagnoses are warranted.”

Reference

Murley C, Karampampa K, Alexanderson K, Hillert J, Friberg E. Diagnosis-specific sickness absence and disability pension before and after multiple sclerosis diagnosis: an 8-year nationwide longitudinal cohort study with matched references. Mult Scler Relat Disord. 2020;42:102077. doi:10.1016/j.msard.2020.102077