Background: There is increasing evidence of prodromal multiple sclerosis (MS). Objective: The aim of this study was to determine whether fatigue, sleep disorders, anaemia or pain form part of the MS prodrome. Methods: This population-based matched cohort study used linked administrative and clinical databases in British Columbia, Canada. The odds of fatigue, sleep disorders, anaemia and pain in the 5 years preceding the MS cases’ first demyelinating claim or MS symptom onset were compared with general population controls. The frequencies of physician visits for these conditions were also compared. Modifying effects of age and sex were evaluated. Results: MS cases/controls were assessed before the first demyelinating event (6863/31,865) or MS symptom onset (966/4534). Fatigue (adj.OR: 3.37; 95% CI: 2.76–4.10), sleep disorders (adj.OR: 2.61; 95% CI: 2.34–2.91), anaemia (adj.OR: 1.53; 95% CI: 1.32–1.78) and pain (adj.OR: 2.15; 95% CI: 2.03–2.27) during the 5 years preceding the first demyelinating event were more frequent among cases, and physician visits increased for cases relative to controls. The association between MS and anaemia was greater for men; that between MS and pain increased with age. Pre-MS symptom onset, sleep disorders (adj.OR: 1.72; 95% CI: 1.12–2.56) and pain (adj.OR: 1.53; 95% CI: 1.32–1.76) were more prevalent among cases. Conclusion: Fatigue, sleep disorders, anaemia and pain were elevated before the recognition of MS. The relative anaemia burden was higher in men and pain more evident among older adults.

中文翻译：

---

多发性硬化症前驱期的疲劳、睡眠障碍、贫血和疼痛

背景：越来越多的证据表明前驱多发性硬化症 (MS)。目的：本研究的目的是确定疲劳、睡眠障碍、贫血或疼痛是否是 MS 前驱症状的一部分。方法：这项基于人群的匹配队列研究使用了加拿大不列颠哥伦比亚省的相关行政和临床数据库。将 MS 病例首次脱髓鞘或 MS 症状出现前 5 年内出现疲劳、睡眠障碍、贫血和疼痛的几率与普通人群进行比较。还比较了这些病症的医生就诊频率。评估了年龄和性别的修饰效果。结果：在首次脱髓鞘事件 (6863/31,865) 或 MS 症状发作 (966/4534) 之前评估 MS 病例/对照。疲劳（调整OR：3.37；95% CI：2.76–4.10）、睡眠障碍（调整OR：2.61；95% CI：2.34–2.91）、贫血（调整比值：1.53；95% CI：1.32–1.78）和疼痛（调整比值：2.15；95% CI：2.03–2.27）在第一次脱髓鞘事件前的 5 年内更频繁在病例中，与对照组相比，病例的就诊次数增加了。男性多发性硬化症与贫血之间的关联更大；MS 和疼痛之间的关系随着年龄的增长而增加。MS 前症状发作、睡眠障碍（调整比值：1.72；95% CI：1.12-2.56）和疼痛（调整比值：1.53；95% CI：1.32-1.76）在病例中更为普遍。结论：疲劳、睡眠障碍、贫血和疼痛在识别 MS 之前升高。男性的相对贫血负担更高，老年人的疼痛更明显。27) 在第一次脱髓鞘事件之前的 5 年内，病例中更频繁，并且与对照组相比，病例的医生就诊次数增加。男性多发性硬化症与贫血之间的关联更大；MS 和疼痛之间的关系随着年龄的增长而增加。MS 前症状发作、睡眠障碍（调整比值：1.72；95% CI：1.12-2.56）和疼痛（调整比值：1.53；95% CI：1.32-1.76）在病例中更为普遍。结论：疲劳、睡眠障碍、贫血和疼痛在识别 MS 之前升高。男性的相对贫血负担更高，老年人的疼痛更明显。27) 在第一次脱髓鞘事件之前的 5 年内，病例中更频繁，并且与对照组相比，病例的医生就诊次数增加。男性多发性硬化症与贫血之间的关联更大；MS 和疼痛之间的关系随着年龄的增长而增加。MS 前症状发作、睡眠障碍（调整 OR：1.72；95% CI：1.12-2.56）和疼痛（调整 OR：1.53；95% CI：1.32-1.76）在病例中更为普遍。结论：疲劳、睡眠障碍、贫血和疼痛在识别 MS 之前升高。男性的相对贫血负担更高，老年人的疼痛更明显。56) 和疼痛 (adj.OR: 1.53; 95% CI: 1.32–1.76) 在病例中更为普遍。结论：疲劳、睡眠障碍、贫血和疼痛在识别 MS 之前升高。男性的相对贫血负担更高，老年人的疼痛更明显。56) 和疼痛 (adj.OR: 1.53; 95% CI: 1.32–1.76) 在病例中更为普遍。结论：疲劳、睡眠障碍、贫血和疼痛在识别 MS 之前升高。男性的相对贫血负担更高，老年人的疼痛更明显。