Camilla Bengtsson

Background: Comorbidity is of significant concern in multiple sclerosis (MS). Few population-based studies have reported conditions occurring in MS after diagnosis, especially in contemporary cohorts. Objective: To explore incident comorbidity, mortality and hospitalizations in MS, stratified by age and sex. Methods: In a Swedish population-based cohort study 6602 incident MS patients (aged ≥18 years) and 61,828 matched MS-free individuals were identified between 1 January 2008 and 31 December 2016, using national registers. Incidence rates (IRs) and incidence rate ratios (IRRs) with 95% CI were calculated for each outcome. Results: IRs of cardiovascular disease (CVD) were higher among MS patients than MS-free individuals, (major adverse CVD: IRR 1.42; 95% CI 1.12–1.82; hemorrhagic/ischemic stroke: 1.46; 1.05–2.02; transient ischemic attack: 1.65; 1.09–2.50; heart failure: 1.55; 1.15–2.10); venous thromboembolism: 1.42; 1.14–1.77). MS patients also had higher risks of several non-CVDs such as autoimmune conditions (IRR 3.83; 3.01–4.87), bowel dysfunction (2.16; 1.86–2.50), depression (2.38; 2.11–2.68), and fractures (1.32; 1.19–1.47), as well as being hospitalized and to suffer from CVD-related deaths ((1.91; 1.00–3.65), particularly in females (3.57; 1.58–8.06)). Conclusion: MS-patients experience a notable comorbidity burden which emphasizes the need for integrated disease management in order to improve patient care and long-term outcomes of MS.

Background Low socioeconomic status (SES), measured through a variety of ways (e.g. formal education, occupation, household income, ethnicity) has been associated with an increased risk of rheumatoid arthritis (RA), an elevated economic burden for patients and society, as well as a worse disease outcome. Objectives To investigate the effect of educational status (achieving a university/college degree) on the prognosis of RA overall, as well as on disease subsets based on ACPAs, in terms of DAS28, physician assessment, VAS-pain, and HAQ. Methods We used cases from the population-based EIRA study with outcomes followed-up in the Swedish Rheumatology Quality Register (N=3021). We categorized the outcomes in different ways: 1) having equal to/above vs. below median levels; 2) achieving low disease activity, good response, and remission vs. not achieving; 3) having scores decreased over the median vs. less than median. We calculated the ORs of those outcome categories as an effect of higher education, both at diagnosis and for the first three follow-up visits (3, 6, 12 months). Results We found patients of higher education initiated with less pain and less functional disability (VAS-pain: 49 (28-67) vs. 53 (33-71), pvs. 1.00 (0.63-1.50), p=0.001). The effects persisted across the follow-up period. They had greater chances to achieve pain remission (3-month-visit: 1.35 (1.08-1.69); 6-month-visit: 1.22 (0.95-1.56); 1-year-visit: 1.23 (1.00-1.52)) and improve to a larger extent (HAQ decrease over the median: 3-month-visit: 1.45 (1.13-1.86); 6-month-visit: 1.41 (1.07-1.86); 1-year-visit: 1.43 (1.12-1.82)). Conclusions Higher educated patients experienced less pain and less functional disability starting from baseline throughout the first year receiving standard care; they achieved pain remission more and attain greater improvements on physical function as compared to less educated patients. We could not identify any distinct effects of educational background on disease activity related outcomes. Disclosure of Interest None declared