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Multiple sclerosis in patients with rheumatoid arthritis: a nationwide, pilot study from Poland based on health care
Kamila Żur-Wyrozumska1,2, Mateusz Szeląg3, Przemysław Borowy4
1Centre for Innovative Medical Education, Jagiellonian University Medical College, Kraków, Poland.
Introduction:
Multiple sclerosis (MS) and rheumatoid arthritis (RA) are common, chronic immune‑mediated diseases that share pathogenetic pathways, but their epidemiologic relationship is uncertain.
Objectives:
We aimed to describe the association between MS and RA in the Polish population.
Patients And Methods:
This pilot, nationwide study was based on administrative health care claims sourced from the Polish National Health Fund (NHF). Between 2009 and 2021, MS and RA cases were identified through a combination of the International Classification of Diseases, Tenth Revision claims, in conjunction with the Anatomical Therapeutic Chemical codes for medications or drug program records. Annual prevalence and incidence trends were assessed. Within the study timeframe, a retrospective cohort of RA patients and a general population-based comparator were recruited, with year‑ by year assessment of MS burden. The controls were matched 1:1 for age, sex, and calendar year of RA diagnoses, from individuals with any NHF contact in the corresponding year.
Results:
In the years 2009-2021, 464 cases of concurrent MS were identified among patients with RA, whereas 813 MS cases were found in the matched control group (n = 307 519 per group). While the overall population trends suggest increased MS prevalence, annual incidence declined (P <0.001 for both RA and control), in combination with increasing age at MS diagnosis. Age- and serotype‑ specific analyses suggested that young (16-39 y) women with RA had higher MS prevalence (37.2 vs 26.9 per 10 000 patients; prevalence ratio, 1.39; 95% CI, 1-1.92; P = 0.048) than the controls. Conversely, older women with RA showed significantly lower MS prevalence rates. Mortality was comparable in both groups.
Conclusions:
Overall, RA was not associated with an increased overall MS risk, as compared with the general population. Young women with seronegative RA may be at a greater risk of MS, which warrants clarification of age, sex, and serotype‑ specific risk disparities in future prospective longitudinal studies. However, clinical vigilance for atypical MS symptoms in young women with RA should be maintained.
Insights
Rheumatoid arthritis (RA) is not linked to a higher risk of multiple sclerosis (MS) overall. However, young women with seronegative RA may face an increased risk of MS, requiring further study.
Area of Science:
- Immunology
- Epidemiology
- Rheumatology
Background:
- Multiple sclerosis (MS) and rheumatoid arthritis (RA) are chronic immune-mediated diseases with shared pathways.
- The epidemiological link between MS and RA remains unclear.
Purpose of the Study:
- To investigate the association between MS and RA within the Polish population.
- To analyze prevalence and incidence trends of MS in RA patients.
Main Methods:
- A nationwide study utilized administrative healthcare claims from the Polish National Health Fund (2009-2021).
- MS and RA cases were identified using ICD-10 codes and medication records.
- A retrospective cohort of RA patients was compared to a matched general population control group.
Main Results:
- Overall RA was not associated with an increased risk of MS.
- Young females (16-39 years) with RA showed a higher prevalence of MS (PR 1.39, P=0.048).
- MS incidence declined, while age at diagnosis increased in both RA and control groups.
Conclusions:
- RA is not generally associated with increased MS risk.
- Young women with seronegative RA may have a higher risk of MS, necessitating further research into age, sex, and serotype-specific disparities.
- Clinical awareness for atypical MS symptoms in young women with RA is recommended.
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