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Try out PMC Labs and tell us what you think. Learn More. Multiple sclerosis MS is an inflammatory and neurodegenerative disease whose aetiology is not Woman get fuck Bad Windsheim understood. The female sex is clearly predominant, with a sex ratio between 2 and 3. In primary progressive MS the sex ratio almost balances out.
Since the age at onset is higher for patients with progressive onset POMS than for relapsing onset ROMSit can be hypothesized that the age at onset is a decisive factor for the sex ratio. To address this aspect, we compare clinical and demographic data between females and males for the different disease courses within the population of the German MS Register by the German MS Society. Only patients with complete details in mandatory data items and a follow-up visit since Jan were included. A total of 18, patients were included in our analyses, revealing a female-to-male ratio of 2.
The age at diagnosis is higher in patients with POMS Disease progression was similar for women and men. Our analysis shows that clinical and demographic data differ more between disease courses than between men and women. For pain, depression and cognitive impairment the female sex is the decisive factor. Whether these factors are responsible for the earlier retirement of females with ROMS is not clear.
Appropriate measures for optimization of symptomatic treatment as well as to promote employment should be taken. Multiple sclerosis MS is an inflammatory and neurodegenerative disease that occurs primarily in young adults and whose aetiology is not fully understood. In MS there is a ificant predominance of the female sex compared with males, 15 with a female-to-male ratio sex ratio between 2 and 3 that has been increasing over the last decades. Increased cigarette smoking, higher body mass index may have increased the risk of developing MS, while diet especially consumption of fish and outdoor activities may have reduced the risk.
Changes in reproductive behaviour and hormonal changes also have an impact on the risk of developing MS. The latter includes taking contraceptives and the average later birth of the first. The exact role on MS is therefore difficult to determine. The causes are not clear, but various sex-specific environmental interactions might have changed over time, such as cigarette smoking, diet especially consumption of fishurban lifestyles, outdoor activities, body mass index, hormone changes in women and reproductive behaviour, which might play a role on the risk of MS.
An interesting observation is that the sex ratio almost balances out in POMS. To answer this question, we analyse the female-to-male ratio sex ratio for clinical and demographic data and for the various disease courses. On the one hand, whether the clinical data of women and men differ within the respective disease courses comparison of women and men separately for ROMS and POMS will be analysed, and on the other hand whether the data for the respective sex differ between the different disease courses clinical data of women and men in direct comparison between ROMS and POMS.
Only patients for whom data on the basic variables sex, date of birth, date of onset of the disease, and disease course at onset and symptoms were available and who had had a recent follow-up visit after 1 January were analysed. Data from the last visit are assessed. Descriptive statistics include frequencies and percentages for categorical data, means and standard deviations for metric data, and median and quartiles for ordinal data. A two-way analysis of variance was performed to compare both sexes, demographic data, symptoms and their interaction effects.
For binary outcomes generalized linear models were used with logistic link function. To achieve robust inference additional matched analyses were carried out, in which each male with MS was matched with a female with MS by year of birth, year of onset and disease course at onset, to avoid confounding.
Data transformation and statistical analysis were performed using R 3. Vienna, Austria. Data were from 21, patients who had no open queries and sufficient follow-up visits since 1 January Patients excluded either because of missing date of onset or because the disease course at Woman get fuck Bad Windsheim was not definite totalled 2, Thus, a total of 18, patients were included in the subsequent analyses.
Table 1 presents demographic data on the patients stratified by disease course at onset and sex. Whereas the differences are rather small within the various disease courses 1. Frequency of initial symptoms in females and males, broken down by disease course [relapsing onset multiple sclerosis A and progressive onset multiple sclerosis B ]. Figure 3 gives details of the current symptoms of the analysed patients.
Frequency of current symptoms in females and males, broken down by disease course [relapsing onset multiple sclerosis A and progressive onset multiple sclerosis B ]. The development of disability in patients is largely parallel for men and women in their respective courses, while patients with POMS reach EDSS 6 on average several years earlier. This is evident in terms of age and disease duration. The temporal course of disability in women red and men blue in their respective disease courses and broken down by age and disease duration. The solid line shows the proportion of patients with the corresponding EDSS left axis.
The dotted line shows the percentage of patients who have not reached an EDSS of 6 right axis. The main findings of our study are that we observed slight differences between men and women, in terms of both initial and current symptoms.
Due to the high case s for ROMS, statistical ificance is achieved for some initial symptoms such as motor and cerebellar deficits with male dominance, but the clinical relevance remains unclear. There is a higher prevalence of depression in women when symptoms first appear; this difference increases as the disease progresses and seems to be relevant already at an early stage. Women in particular are more affected in terms of neuropsychological and emotional symptoms such as fatigue, cognition, pain and, as already mentioned, depression for both disease courses.
Pain perception was associated with depression and fatigue and it has been shown that women have a higher odds ratio than men to suffer from it. The of patients differs ificantly between men and women in our analysis. Therefore, we have carried out further analyses. This analysis confirmed the ly discussed and is in accordance with the literature, where the age at onset of disease is The differences between the sexes are less pronounced than the differences between the courses of the disease.
A new aspect of our analysis is that women with a relapsing onset leave work earlier and to a greater extent than men. This is surprising, since a more rapid disability progression and a faster progression of brain atrophy as well as a decrease in cognition has been described for male patients. This discrepancy between the sexes was not seen in a study investigating depression 20 and is not known for cognition impairment. Interestingly, whereas females were more often affected by neuropsychological symptoms, males were more frequently affected by walking impairment, spasticity and ataxia.
However, our data showed that the disability progression expressed by the EDSS was parallel for women and men. Nevertheless, we were able to confirm many of the differences described so far in our study. In accordance with the most recent reports, the sex ratio in our analysis is 2. No further interactions for demographic and clinical data between the course of the disease and the sex could be shown in the analyses.
This could indicate that, in addition to the disease course, other factors, such as genetics or hormones, 192425 could be Woman get fuck Bad Windsheim and have an influence on the development and pathophysiology of the disease e. In relapsing—remitting MS patients with ificantly increased female-to-male ratiothe inflammatory component is the driver of disease activity, while in progressive patients with an almost balanced female-to-male ratio neurodegeneration is the most important.
However, these differences are not fully understood. This is also due to the fact that there are a of hormones, such as oestrogens, progesterone, androgens, prolactin, whose effects on the immune system are poorly understood, Woman get fuck Bad Windsheim example, oestrogens on the innate and adaptive immune system, and which are not understood under the influence and interaction of environmental factors. To study hormonal changes and effects on the disease, for example, after menopause, would be of great importance to be able to determine the influence of gender more precisely, but cannot be provided by our analysis.
The limitations of a registry are that data are not collected systematically as in a clinical trial. Neuropsychological symptoms have been evaluated by neuropsychological tests, specialist assessment by psychiatrists or clinical evaluation by the treating physician and our must therefore be interpreted with knowledge of these limitations. However, these data reflect reality more than a laboratory situation. Our analysis shows that the differences in clinical presentation between men and women in MS persist across the different disease courses.
The differences over the course of the disease are greater than the differences within the course of the disease between the sexes. However, depression, cognitive impairment and pain are more frequently reported in women across all disease courses. In addition, women with a relapsing onset of the disease leave work earlier. This is of great relevance and the reasons for that are unclear. Physicians should be aware of these differences and take appropriate measures e. We would like to thank all patients that have given their informed consent to be included in the GMSR.
Furthermore, this study would not have been possible without the efforts of the centres participating in the registries. Our thanks go out to all members of staff in the centres listed below for their continued efforts. Kallmann, Bamberg. Neurozentrum Bielefeld-Brackwede, Dres. Katzmann, F. Sudfeldt, Bielefeld. Praxis rechts vom Rhein, Dr med. Praxis Dres.
Neurologie an der Hase, Holger Lorenzen, Dr med. Psychiatrie u. Appy, W. Molt, Prof. Dr med. None of them resulted in a conflict of interest regarding the submitted work. DE declares no conflict of interest. None resulted in a conflict of interest. JH declares no conflict of interest to the submitted work. None of them resulted in a conflict of interest regarding the submitted manuscript. It is operated by a not-for-profit company, the MSFP. None of the industry funding in restrictions to publish data nor Woman get fuck Bad Windsheim the supporters influence on the content this manuscript.
National Center for Biotechnology InformationU. Ther Adv Neurol Disord. Published online Sep Author information Article notes Copyright and information Disclaimer. : ed. Received Apr 11; Accepted Aug 8. This article is distributed under the terms of the Creative Commons Attribution 4. This article has been cited by other articles in PMC. Abstract Background: Multiple sclerosis MS is an inflammatory and neurodegenerative disease whose aetiology is not fully understood.
Methods: To address this aspect, we compare clinical and demographic data between females and males for the different disease courses within the population of the German MS Register by the German MS Society. : A total of 18, patients were included in our analyses, revealing a female-to-male ratio of 2. Conclusion: Our analysis shows that clinical and demographic data differ more between disease courses than between men and women. Keywords: age of onset, multiple sclerosis, progressive MS, relapsing MS, sex ratio.Woman get fuck Bad Windsheim
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Relapsing and progressive MS: the sex-specific perspective