Photo Credit: Jacob Wackerhausen

A subset of common symptoms and diagnoses in the 5 years prior to a multiple sclerosis diagnosis in kids hints at a potential prodromal phase of the condition.

A subset of metabolic, ocular, musculoskeletal, gastrointestinal, and cardiovascular symptoms, signs, or diagnoses occurred significantly more frequently in children and adolescents in the 5 years before a multiple sclerosis (MS) diagnosis compared with controls without MS, according to a study of claims data published in JAMA Network Open.

“This is of particular importance since better characterization of early symptoms and/or risk factors, comorbid disorders, and possible prodromal features of MS may have considerable implications for early recognition of MS and subsequent progression of the disease,” Helen Tremlett, PhD, and colleagues wrote. “To our knowledge, such a systematic investigation has never been done in pediatric populations.”

The study included 1,091 children and adolescents with MS with health insurance. The researchers analyzed outpatient claims data for the patients with MS, as well as for 10,910 controls without MS and 1,068 controls with juvenile idiopathic arthritis. The use of 163 diagnostic codes was assessed among the patients for the 5 years before an initial MS diagnosis.

Among patients with MS, the mean age at MS diagnosis was 15.7 years, and 72.2% of these patients were female.

Potential Prodromal Features of Pediatric MS

Dr. Tremlett and colleagues found that nine codes showed up significantly more often in the years before an MS diagnosis compared with controls without MS, including:

• Skin sensation disturbances (adjusted odds ratio [AOR], 12.93);
  • Heartbeat abnormalities (AOR, 1.94);
  • Obesity (AOR, 1.70);
  • Dizziness and giddiness (AOR, 1.52);
  • Patella disorders (AOR, 1.47);
  • Flatulence (AOR, 1.43);
  • Gastritis and duodenitis (AOR, 1.35);
  • Visual disturbances (AOR, 1.31); and
  • Disorders of eye refraction and accommodation (AOR, 1.26).

Of the nine codes, four were significantly more common in children and adolescents with MS compared with controls with juvenile idiopathic arthritis: skin sensation disturbances (AOR, 27.70), obesity (AOR, 3.19), refraction and accommodation disorders (AOR, 3.08), and visual disturbances (AOR, 1.62).

“In this case-control study, children and adolescents with MS had diverse metabolic, ocular, musculoskeletal, gastrointestinal, and cardiovascular symptoms, signs, and diagnoses within 5 years before MS diagnosis,” researchers wrote. “These diagnoses (eg, sensory and ocular disorders) may be considered early symptoms and overlap with known risk factors (eg, obesity).”