Medical management of patients with multiple sclerosis

Abstract

The symptoms of MS overlap with those of a variety of medical conditions. Therefore, clinicians need to remain vigilant so as not to miss development of a coexisting disorder, which can cause fatigue (eg, anemia, thyroid disease, diabetes, or vitamin B₁₂ deficiency) or a myelopathy (eg, cervical spondylosis). Patients with MS are predisposed to certain conditions, particularly decreased bone mineral density and vitamin D deficiency [126,127]. Furthermore, the adverse effects of some MS therapies increase the risk of certain conditions; for example, corticosteroids used to treat relapses can precipitate or exacerbate hyperglycemia, hypertension, or mood disorders. Although occasional courses of corticosteroids probably do not have deleterious effects on bone mineral density [128], chronic steroids may worsen bone mineral density loss. Chronic immunosuppression increases the risk of infection and malignancy. Finally, many MS disease therapies and symptomatic medications can cause drug-induced hepatitis.