Multiple sclerosis: analysis of primary disability in St. Petersburg in 2016–2018

Abstract

Multiple sclerosis is the most common cause of disability in young patients with neurological problems, which makes it the most important medical, social, and economic problem. Analysis of the structure and dynamics of primary disability resulted from multiple sclerosis in the city of St. Petersburg was carried out from 2016 through 2018. The proportion of patients with multiple sclerosis, who were for the first time identified as disabled, was 1 in 166 (0.6%) examinations in 2016; 1 in 142 (0.7%) in 2017; and 1 in 135 (0.74%) in 2018. In the course of three years, 74.2% of patients were assigned to the third-degree disability group; 21.2% to the second-degree disability group; 3.2% to the first-degree disability group; and 1.4% of patients were deemed a “disabled child” status. Working age people (26–45 years old) prevailed among those first recognized as disabled, which accounted for 58.6%.

Analysis of types of multiple sclerosis course carried out for the year 2017 showed the prevalence of relapsing-remitting multiple sclerosis accounting for 86% of cases. Main indicators associated with the disability were as follows: work-related limitations (98.7%), limited ability to move independently (93.4%), and limited ability to perform activities of daily living (19.9%). This study showed an increase in the number of people first recognized as disabled among patients with multiple sclerosis during this period, which probably results from multiple sclerosis incidence and prevalence growth. Patients of working age with third-degree disability, predominantly women with relapsing-remitting multiple sclerosis, prevail among patients with multiple sclerosis who were first recognized as disabled, which corresponds to the literature data. Leading indicators of disability are: work-related limitations, limited ability to move independently, and limited ability to perform activities of daily living. Data obtained indicated a high medical, social, and economical significance of multiple sclerosis, which confirm the need for earliest diagnosis and timely initiation of therapy in order to slow down the disability progression in patients of working age.

Keywords

multiple sclerosis / sociomedical examination and assessment / disability

References

[1] Thompson AJ, Uitdehaag B, Taylor B, Holloway E, Tremlett H, Pandit L, Battaglia M. Atlas of multiple sclerosis 2013. MS international federation. Available at: https://www.msif.org/about-us/who-we-are-and-what-we-do/advocacy/atlas/

[2] Thompson A.J., Uitdehaag B., Taylor B., Holloway E., Tremlett H., Pandit L., Battaglia M. Atlas of multiple sclerosis 2013. MS international federation. Available at: https://www.msif.org/about-us/who-we-are-and-what-we-do/advocacy/atlas/

[3] Shmidt TE, Yakhno NN. Multiple sclerosis: Guideline. [Rasseyannyi skleroz: Rukovodstvo dlya vrachei]. 6th ed. Moscow: MEDpress-inform; 2017. 280 p. (in Russian)

[4] Шмидт Т.Е., Яхно Н.Н. Рассеянный склероз: Руководство для врачей. 6-е изд. М.: МЕДпресс-информ; 2017. 280 с.

[5] Stolyarov ID, Boyko AN, eds. Multiple Sclerosis: specialists, diagnostics, treatment. [Rasseyannyi skleroz: spetsialisty, diagnostika, lechenie]. St. Petersburg: Elbi-SPb; 2008. 320 p. (in Russian)

[6] Столяров И.Д., Бойко А.Н., ред. Рассеянный склероз: специалисты, диагностика, лечение. СПб.: Элби–СПб; 2008. 320 с.

[7] Malik O, Donnelly A, Barnett M. Fast facts: multiple sclerosis. [Rasseyannyi skleroz: kratkii spravochnik]. Moscow: Prakticheskaya meditsina; 2015. 126 p. (in Russian)

[8] Малик О., Доннелли Э., Барнетт М. Рассеянный склероз: краткий справочник. М.: Практическая медицина; 2015. 126 с.

[9] Lucchinetti CF, Popescu BF, Bunyan RF, Moll NM, Roemer SF, Lassmann H, et al. Inflammatory cortical demyelination in early multiple sclerosis. N. Engl. J. Med. 2011;365(23):2188-97. Doi: 10.1056/NEJMoa1100648.

[10] Lucchinetti C.F., Popescu B.F., Bunyan R.F., Moll N.M., Roemer S.F., Lassmann H., et al. Inflammatory cortical demyelination in early multiple sclerosis. N. Engl. J. Med. 2011;365(23):2188-97. Doi: 10.1056/NEJMoa1100648.

[11] Liu Y, Duan Y, Huang J, Ren Z, Liu Z, Dong H, et al. Different patterns of longitudinal brain and spinal cord changes and their associations with disability progression in NMO and MS. Eur. Radiol. 2018;28(1):96-103. Doi: 10.1007/s00330-017-4921-x.

[12] Liu Y., Duan Y., Huang J., Ren Z., Liu Z., Dong H., et al. Different patterns of longitudinal brain and spinal cord changes and their associations with disability progression in NMO and MS. Eur. Radiol. 2018;28(1):96-103. Doi: 10.1007/s00330-017-4921-x.

[13] Tsagkas C, Chakravarty MM, Gaetano L, Naegelin Y, Amann M, Parmar K, et al. Cortical thinning in multiple sclerosis: a 6-year longitudinal study. ECTRIMS Online Library. 2018;228127:P1749. Available at: https://onlinelibrary.ectrims-congress.eu/ectrims/2018/ectrims-2018/228127/charidimos.tsagkas.cortical.thinning.in.multiple.sclerosis.a.6-year.html

[14] Tsagkas C., Chakravarty M.M., Gaetano L., Naegelin Y., Amann M., Parmar K., et al. Cortical thinning in multiple sclerosis: a 6-year longitudinal study. ECTRIMS Online Library. 2018; 228127: P1749. Available at: https://onlinelibrary.ectrims-congress.eu/ectrims/2018/ectrims-2018/228127/charidimos.tsagkas.cortical.thinning.in.multiple.sclerosis.a.6-year.html

[15] Boyko AN, Gusev EI. Current algorithms of diagnosis and treatment of multiple sclerosis based on the individual assessment of the patient. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2017;2(2):92-106. (in Russian)

[16] Бойко А.Н., Гусев Е.И. Современные алгоритмы диагностики и лечения РС, основанные на индивидуальной оценке состояния пациента. Журнал неврологии и психиатрии им. С.С. Корсакова. 2017;2(2):92-106.

[17] Hughes J, Jokubaitis V, Lugaresi A, Hupperts R, Izquierdo G, Prat A, et al. Association of inflammation and disability accrual in patients with progressive-onset multiple sclerosis. JAMA Neurol. 2018;75(11):1407-15. Doi: 10.1001/jamaneurol.2018.2109.

[18] Hughes J., Jokubaitis V., Lugaresi A., Hupperts R., Izquierdo G., Prat A., et al. Association of inflammation and disability accrual in patients with progressive-onset multiple sclerosis. JAMA Neurol. 2018;75(11):1407-15. Doi: 10.1001/jamaneurol.2018.2109.

[19] Grishina LP, Solov’eva NN. Comparative analysis of primary and repeated disability structure due to all classes of diseases in young people in the Russian Federation during 2007-2011. Mediko-sotsial’naya ekspertiza i reabilitatsiya. 2013;(3):29-32. (in Russian)

[20] Гришина Л.П., Соловьева Н.Н. Сравнительный анализ первичной и повторной инвалидности вследствие всех классов болезней у лиц молодого возраста в Российской Федерации в 2007-2011гг. Медико-социальная экспертиза и реабилитация. 2013;(3):29-32.

[21] Grishina LP, Chaychits YuA, Akmurzaeva MM. Structure of disablement caused by nosological diseases of nervous system. Vestnik Vserossiiskogo obshchestva spetsialistov po mediko-sotsial’noi ekspertize, reabilitatsii i reabilitatsionnoi industrii. 2009;(3):103-6. (in Russian)

[22] Гришина Л.П., Чайчиц Ю.А., Акмурзаева М.М. Структура инвалидности вследствие болезней нервной системы по нозологическим формам болезней и ее гендерные особенности. Вестник Всероссийского общества специалистов по медико-социальной экспертизе, реабилитации и реабилитационной индустрии. 2009;(3):103-6.

[23] Ivanova EV, Bakhtiyarova KZ, Safronova EV. Analysis of the structure of the primary disability due to multiple sclerosis in the city of Ufa over 2010-2016. Mediko-sotsial’naya ekspertiza i reabilitatsiya. 2017;20(3):144-7. (in Russian) Doi: 10.18821/1560-9537-2017-20-3-144-147.

[24] Иванова Е.В., Бахтиярова К.З., Сафронова Е.В. Анализ первичной инвалидности вследствие рассеянного склероза по городу Уфа за 2010–2016 гг. Медико-социальная экспертиза и реабилитация. 2017;20(3):144-7. Doi: 10.18821/1560-9537-2017-20-3-144-147.

[25] Bessmertnyi YuA, Bessmertnaya GV, Bichak AA, Vil’chinskaya SA. Indicators of disability due to multiple sclerosis in Vinnytsia region. Klinicheskaya i eksperimental’naya patologiya. 2017;16(3):7-11. (in Russian) Doi: 10.24061/1727-4338.XVI.3.61.2017.28.

[26] Бессмертный Ю.А., Бессмертная Г.В., Бичак А.А., Вильчинская С.А. Показатели инвалидности вследствие рассеянного склероза в Винницкой области. Клиническая и экспериментальная патология. 2017;16(3):7-11. Doi: 10.24061/1727-4338.XVI.3.61.2017.28.

[27] Order of the Ministry of Labor and Social Protection of the Russian Federation dated August 27, 2019 No. 585n «Classifications and criteria used in the implementation of medical and social examination of persons by Federal State Institutions of medical and social examination». [O klassifikatsiyakh i kriteriyakh, ispol’zuemykh pri osushchestvlenii mediko-sotsial’noi ekspertizy grazhdan federal’nymi gosudarstvennymi uchrezhdeniyami mediko-sotsial’noi ekspertizy]. Available at: https://rosmintrud.ru/docs/mintrud/orders/1386 (in Russian)

[28] Приказ Министерства труда и социальной защиты РФ от 27 августа 2019 г. №585н «О классификациях и критериях, используемых при осуществлении медико-социальной экспертизы граждан федеральными государственными учреждениями медико-социальной экспертизы». Available at: https://rosmintrud.ru/docs/mintrud/orders/1386

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