Nice’s latest MS guideline does not cover DMARDs, and a lot of this is not new to us.
Take home messages
Diagnosis should be made by a neurologist, so refer if you suspect it
- Tests to do in GP before referral
- FBC, LFT, TFT, Bone profile, UE, glucose
- ESR and CRP
- B12
- HIV
- Relapses – all relapses should be discussed with a specialist before steroids are prescribed. Patients should not be given stand-by courses of steroids to hold at home.
And a little bit more detail
Symptoms to suggest MS
- Loss or reduction of vision in 1 eye with painful eye movements
- Double Vision
- Ascending sensory disturbance and / or weakness
- Problems with balance / unsteadiness / clumsiness
- Lhermitte’s symptom (when the patient leans their head forwards, they get altered sensation down their back and sometimes into their limbs)
NB – beware younger patients, where symptoms develop over 24 hrs, with a history of previous neurological symptoms and where symptoms persist for days or weeks and then resolve.
General advice to patients
- Support Groups (e.g. MS Society)
- Driving – need to inform DVLA (Advice for Medical Professionals)
- Exercise – may be beneficial
- Smoking – may increase progression to disability
- Pregnancy and pre-conception advice
- Vaccines – some live vaccines may be contraindicated. Flu vaccine may increase risk of relapse.
