A case-control study of health records identified 9 symptoms and conditions occurring more frequently in children and adolescents in the 5 years before their multiple sclerosis diagnosis compared to controls.
The study, published in JAMA Network Open, analyzed data from 1,091 pediatric multiple sclerosis (MS) patients, 10,910 matched controls without MS, and 1,068 controls with juvenile idiopathic arthritis (JIA).
The data showed higher rates of obesity (adjusted odds ratio [AOR], 1.70), disorders of eye refraction and accommodation (AOR, 1.26), visual disturbances (AOR, 1.31), gastritis and duodenitis (AOR, 1.35), patella disorders (AOR, 1.47), heartbeat abnormalities (AOR, 1.94), flatulence (AOR, 1.43), skin sensation disturbances (AOR, 12.93), and dizziness and giddiness (AOR, 1.52) in the MS cohort versus controls without MS. Notably, skin sensation disturbances had the strongest association, suggesting it as a potential hallmark symptom.
When compared to JIA controls, four conditions remained significantly more prevalent in MS patients: obesity (AOR, 3.19), refraction and accommodation disorders (AOR, 3.08), visual disturbances (AOR, 1.62), and skin sensation disturbances (AOR, 27.70).
Researchers examined nationwide German outpatient claims data from January 2010 to December 2020 for patients under 18 years old with statutory health insurance, which covers approximately 88% of the German population. The mean age at MS diagnosis was 15.7 years, and 72.2% of MS patients were female. Cases required at least two confirmed MS diagnoses, including one by a neurologist, between 2013 and 2020. Controls were matched 10:1 by sex, age, region, and observation period.
The complementary analysis excluded 702 children (64.3%) from the MS group and 4,131 (37.9%) from the control group due to neurological or cerebrovascular diagnoses that might indicate early MS. After exclusions, obesity and refraction/accommodation disorders remained consistently associated with MS across all comparisons.
The study highlighted detection bias as a limitation, as higher healthcare utilization among pre-MS patients may lead to earlier diagnosis of comorbidities. Additionally, inpatient and privately insured patients were not included. Despite these limitations, the findings suggested that metabolic, ocular, musculoskeletal, gastrointestinal, and cardiovascular symptoms may be early indicators of pediatric MS.
Skin sensation disturbances and obesity, in particular, were associated with the highest risks, providing potential avenues for earlier recognition and intervention in pediatric MS cases. Further studies are needed to validate these associations and explore their clinical implications.
Conflict of interest disclosures can be found in the study.