The natural course of disease in multiple sclerosis varies. Multiple sclerosis that is clinically apparent but causes minimal disability over time has been labeled benign multiple sclerosis. The ability to predict the subsequent clinical course of multiple sclerosis on the basis of clinical and other supportive data at presentation would be invaluable. In this article we report our findings based on a retrospective analysis of 1800 patients diagnosed as having multiple sclerosis, of which 44 patients met our inclusion criteria. There was a suggestion that a low or absent number of oligoclonal bands in the cerebrospinal fluid at the time of diagnosis predicts a better prognosis. However, quantification of oligoclonal bands in cerebrospinal fluid remains an insensitive prognostic indicator and must not be used to influence decisions regarding therapeutic options.

BACKGROUND: Previous epidemiologic studies of autoimmune diseases in the US have included a limited number of diseases or used metaanalyses that rely on different data collection methods and analyses for each disease. METHODS: To estimate the prevalence of autoimmune diseases in the US, we used electronic health record data from 6 large medical systems in the US. We developed a software program using common methodology to compute the estimated prevalence of autoimmune diseases alone and in aggregate that can be readily used by other investigators to replicate or modify the analysis over time. RESULTS: Our findings indicate that over 15 million people, or 4.6% of the US population, have been diagnosed with at least 1 autoimmune disease from January 1, 2011, to June 1, 2022, and 34% of those are diagnosed with more than 1 autoimmune disease. As expected, females (63% of those with autoimmune disease) were almost twice as likely as males to be diagnosed with an autoimmune disease. We identified the top 20 autoimmune diseases based on prevalence and according to sex and age. CONCLUSION: Here, we provide, for what we believe to be the first time, a large-scale prevalence estimate of autoimmune disease in the US by sex and age. FUNDING: Autoimmune Registry Inc., the National Heart Lung and Blood Institute, the National Center for Advancing Translational Sciences, the Intramural Research Program of the National Institute of Environmental Health Sciences.

Mitoxantrone is a recently appro ved drug for patients with secondary progressive multiple sclerosis (SPMS). However, cardiac side effects limit Mitoxantrone use in SPMS and its lifetime cumulative dose should not exceed 140 mg/m². A dditionally, Mitoxantrone is contraindicated for use in SPMS patients with a baseline left ventricular ejectio n fraction (LVEF) of-50%. The goal of this study was to monitor LVEF more frequently than ordinarily recommended since experience with Mitoxantrone use in SPMS patients is limited. A n unexpected decline in LVEF in one of the SPMS patients being treated with Mitoxantrone prompted further investigation into this finding. In our clinic, 47 patients on Mitoxantrone were followed prospectively; 28 of 47 patients had received a minimum of three doses and underwent a repeat LVEF evaluation prior to their fourth dose of Mitoxantrone. O f these 28 patients, five of 28 (17.8%) had a significant decline in LVEF from baseline. It is suggested that more stringent cardiac monitoring guidelines than current Food and Drug A dministration (FDA) recommendations be used to avert potential cardiac complications in SPMS patients on Mitoxantrone.

Objectives: To examine if depression in multiple sclerosis (MS) can be accurately recognized using the Yale Single Q uestion (YSQ) screen as compared with the Beck Depression Inventory (BDI), a 21-item self-report rating scale for depression. In addition, we sought to assess the sensitivity, specificity, the positive predictive value (PPV) and the negative predictive value (NPV) of the YSQ. Background:Depression associated with MS is a major contributo r to morbidity. Screening for depression in patients with MS currently includes the BD1, which measures characteristic attitudes and symptoms of depression. However, in a busy outpatient clinic, the BDI might not be the most appro priate instrument, particularly if depression screening can be assessed accurately using simpler techniques that are easy to administer and consume less time. We compared the accuracy of the YSQ screen response against the BDI to screen for depression in MS patients, in an outpatient setting. Methods: This is a comparative outcome study of two ‘instruments’ used for screening depression in MS patients in an academic outpatient setting. A ll patients were initially screened for depression by asking patients the YSQ - ‘Do you frequently feel sad or depressed?’, followed by BDI administration. Depression was defined as a score of]-13 on the BDI. O ne hundred and twenty successive patients who presented to the MS clinic at Washington University School of Medicine and met the criteria for diagnosis of MS were screened for depression. A ll patients diagnosed as having MS, regardless of type, were included in the study. Results: O f the 120 patients studied, a total of 49 of 120 were clinically depressed as defined by a BDI cut-o ff of]-13; 71 of 120 were not. The sensitivity of the YSQ was 32 of 49=65.3% with a 95% confidence interval (0.50, 0.78), specificity was 62 of 71=87.3% (0.77, 0.94), PPV was 32 of 41=78.0% (0.62, 0.89) and NPV was 62 of 79=78.5% (0.68, 0.87). O f the 49 patients depressed by BDI criteria, 17 responded ‘no’ to the YSQ, yielding a false-negative rate of 34.7% (0.22, 0.50). The Wilcoxon -Mann -Whitney test for difference in age among those on antidepressants compared with those who were not showed no statistical difference (P =0.35). For patients on antidepressants, the mean BDI score was 16.09-8.9 (mean9-SD) and 9.59-8.7 for those not on antidepressants. Differences in BDI scores among patients on antidepressants versus those who were not were statistically significant (P B-0.0001). Patients on antidepressants had significantly higher BDI scores. Conclusions: O ur results show that the YSQ cannot replace the BDI as a screening instrument for depression in MS. The YSQ could not identify 34.7% of patients who were depressed by BDI criteria. However, as reported in a published study, BDI missed 30% of cases with early depression in MS when a cut-o ff of]-13 was used. The YSQ appears to be specific in ruling out depression when a patient is not depressed. MS is a chronic disease and since prevalence of depression varies, it is important to screen patients repeatedly over time so as not to miss the diagnosis. That BDI scores were higher among those taking antidepressants underscores the fact that this subset of patients need to be on medicatio n, but the higher scores could also represent a sampling error since the duration of antidepressant use was not studied.

Multiple sclerosis (MS) is an autoimmune demyelinating disease characterized by a complex mix of genetics and gene-environment interactions. As compared with wh