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Sun Exposure and MS Disease Progression
TAKE-HOME MESSAGE
- The association between latitude and MS is gaining renewed interest. A few recent studies have confirmed that a lower level of sun exposure can be associated with an increased risk of MS, especially in children. In this study, the investigators reported a novel finding that a low level of sun exposure was associated with higher scores of MS disability progression. The study was well-designed and conducted, with proper control for multiple potential confounders in the statistical model. The study included more than 3000 participants who had been followed for longer than 15 years. The investigators considered various factors, including disease-modifying therapy, disease duration, baseline disability scores, ethnic origin, physical activity, and BMI, among others. Interestingly, sunbathing or frequently visiting sunny areas was associated with better disability outcomes, including EDSS scores and patient-reported outcomes. The study also found an inverse dose-dependent association between sun exposure and disability — the higher the levels of sun exposure, the lower the MS-associated disability scores.
- This study provides clinicians and patients with evidence that appropriate sun exposure is associated with better outcomes in patients with MS, independent of other factors, including vitamin D levels. This should be a talking point in the clinic, especially because many people are avoiding sun exposure owing to skin cancer campaigns and the changing world that we are living in, with children not spending as much time outdoors as they used to.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND AND PURPOSE
Higher latitude has been associated with increased occurrence of multiple sclerosis (MS) and with more severe disease. The aim was to study the impact of sun exposure habits on MS disease progression and health-related quality of life.
METHODS
Patients from a population-based case-control study were categorized based on sun exposure habits at diagnosis and were followed up to 15 years post-diagnosis through the Swedish MS registry (n = 3314) with regard to changes in Expanded Disability Status Scale (EDSS). Linear mixed models were used to analyse long-term changes, while Cox regression models, with 95% confidence intervals, were used to investigate outcomes, including 24-week confirmed diasability worsening, EDSS3, EDSS4, and physical worsening as measured by the physical component of the Multiple Sclerosis Impact Scale 29.
RESULTS
Compared to average sun exposure (median value), low exposure to sunlight was associated with faster EDSS progression, increased risk of confirmed disability worsening (hazard ratio [HR] 1.48, 95% CI 1.21-1.81), increased risk of reaching EDSS 3 (HR 1.35, 95% CI 1.02-1.79), EDSS 4 (HR 1.47, 95% CI 1.01-2.20) and self-reported physical worsening (HR 1.27, 95% CI 1.00-1.62). Significant trends revealed a lower risk of unfavourable outcomes with increasing sun exposure.
CONCLUSIONS
Very low levels of sun exposure are associated with worse disease progression and health-related quality of life in patients with MS.
Additional Info
Disclosure statements are available on the authors' profiles:
Association between sun exposure habits and disease progression in multiple sclerosis
Eur. J. Neurol. 2024 Mar 05;[EPub Ahead of Print], J Wu, T Olsson, L Alfredsson, AK HedströmFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.