Multiple Sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system, including the brain, spinal cord, and optic nerves. The body’s immune system mistakenly attacks the myelin sheath, a protective layer insulating nerve fibers, disrupting information flow within the brain and between the brain and body. Globally, MS impacts approximately 2.5 million people, leading to physical and cognitive impairments.
Multiple Sclerosis in the Chinese Population
Multiple Sclerosis is considered a rare disease in China, with prevalence rates lower than in Western populations. In 2019, an estimated 42,571 individuals were affected by MS, corresponding to an all-age prevalence of 2.99 per 100,000 people. This figure doubled from 1990, with a significant increase after 2010. However, the age-standardized prevalence rate of 2.32 per 100,000 remains lower than the global average of 21.85 per 100,000. A nationwide hospital-based study from 2016 to 2018 reported an age- and sex-adjusted incidence of 0.235 per 100,000 person-years, with higher rates in adults (0.288 per 100,000) than in children (0.055 per 100,000).
Geographical variations in MS prevalence exist across China, with a positive latitudinal gradient observed, meaning prevalence increases from south to north. Southern regions like Taiwan and Hong Kong show lower prevalence rates (0.77 cases per 100,000 population) compared to northern areas. This geographical distribution also presents a west-east altitude gradient, with residents in high-latitude and high-altitude areas being more susceptible to developing MS.
Relapsing-remitting MS (RRMS) is the most common subtype in China, accounting for approximately 85.2% of all MS patients, a proportion similar to other global regions. However, Chinese patients often present with specific clinical phenotypes that differ from typical Western MS. Opticospinal MS (OSMS), characterized by severe involvement of the optic nerves and spinal cord, accounts for a notable proportion of cases, particularly in Northern China (35.9%). This contrasts with Western Caucasian populations where primary-progressive MS (PPMS) is often more prevalent.
Neuromyelitis optica spectrum disorder (NMOSD), once considered a variant of MS, is also more common in Asian populations compared to Caucasians. NMOSD is characterized by attacks primarily affecting the optic nerves and spinal cord, often leading to more severe and recurrent episodes than MS. The presence of specific autoantibodies against aquaporin-4 (AQP4) helps distinguish NMOSD as a distinct entity from MS. Genetic and environmental factors influence MS presentation in the Chinese population, and research investigates unique genetic variants and the role of socioeconomic development in regional prevalence differences.
Diagnostic Approaches and Treatment Strategies
Diagnosing Multiple Sclerosis in China involves international diagnostic criteria, such as the McDonald criteria, which have been revised for accuracy and early detection. The 2017 McDonald criteria incorporated changes like including cortical lesions as evidence of dissemination in space and cerebrospinal fluid (CSF)-specific oligoclonal bands as evidence of dissemination in time. While broadly applied, modifications have been proposed for Asian patients to account for differing clinical presentations, such as more severe spinal cord disease and fewer brain lesions compared to Western patients.
Magnetic Resonance Imaging (MRI) plays a central role in diagnosis, detecting lesions in the brain and spinal cord that indicate dissemination in space and time. For Asian patients, MRI spinal cord lesions longer than two vertebral segments, spinal cord swelling, and complete cross-sectional involvement are considered in diagnosis. Cerebrospinal fluid analysis, particularly for oligoclonal bands, also serves as an important diagnostic tool. A proposed 2024 update to the McDonald criteria suggests using CSF kappa free light chain (kFLC) as an equivalent biomarker.
Conventional Western medicine treatments for MS in China include disease-modifying therapies (DMTs), symptomatic treatments, and rehabilitation. Before 2018, interferon beta was the only approved DMT available. Since then, the approval process for DMTs has accelerated, with seven DMTs now marketed in China as of late 2023. Despite these advancements, DMT utilization in China remains lower than in leading neurological centers globally, and accessibility and affordability continue to be challenges.
Traditional Chinese Medicine (TCM) is integrated into MS management, often complementing Western treatments. TCM practices, such as acupuncture and Chinese herbal medicine, aim to balance the body’s life force (qi) and address underlying imbalances. While research on TCM’s efficacy in MS is ongoing, it is used to manage symptoms and potentially prolong remission, especially to reduce side effects of conventional immunosuppressants. Clinical trials are ongoing in China to evaluate new therapies, including stem cell therapy and novel immunotherapies.
Life with Multiple Sclerosis in China
Living with Multiple Sclerosis in China presents various social and personal challenges. The financial burden of MS is substantial, with average total annual costs for a patient estimated at approximately 168,228 CNY (around 23,720 USD). Direct medical costs alone can reach 61,976 CNY (approximately 8,739 USD) per year, with out-of-pocket expenditures constituting a significant portion. Patients also incur substantial non-medical expenses and indirect costs, such as productivity losses due to unemployment or early retirement, contributing significantly to the overall economic burden.
Social stigma is another challenge, with patients sometimes experiencing discrimination or feeling isolated. This stigma can impact private relationships, work, and education, and has been linked to increased neuropsychiatric comorbidities like anxiety and depression. The employment rate among MS patients in China is around 50.3%, with 47.6% reporting unemployment or early retirement due to the disease, a figure higher than the global average.
Family support and community networks play an important role in the lives of MS patients in China. Informal caregivers often provide continuous care, contributing to the caregiving burden on families. Patient advocacy groups and support organizations are emerging to build sustainable support structures for the MS community. These groups aim to raise awareness, provide information, and offer culturally sensitive services.
Government initiatives and healthcare policies are increasingly focused on supporting MS patients. In 2018, MS was included in China’s First National List of Rare Diseases, leading to accelerated approval of new disease-modifying therapies and efforts to include them in national reimbursement drug lists. These measures aim to improve access to treatments and alleviate financial strain. Awareness campaigns and public understanding of MS in Chinese society are also being promoted to improve early diagnosis, patient knowledge, and overall outcomes.