engleski

Historic, epidemiologic, clinical, genetic and socio-economic aspects of multiple sclerosis in Croatia.

In 1897, F. Gutschy reported in the &laquo ; ; ; ; Liečnički Viestnik&raquo ; ; ; ; two pathologically verified cases of multiple sclerosis (MS), the first official report of MS in Croats. Until 1945, the papers on MS in Croatia elaborated only its clinical aspects, and from 1946 to 2003 the reports covered all aspects of the disease. The prevalence of MS in Croatia varies from moderate to high rates (Dubrovnik in the south‑ east: 52 per 100 000 population ; Gorski Kotar in the north-west 122.4 per 100 000 population). In the eastern Croatia, heavily involved in the war lasting from 1991 to 1995, the incidence of MS has doubled in the last ten years. On March 1, 2004, the Croatian MS register lists 1272 patients, clinically definite cases (Poser’ s criteria). The sex ratio (F/M) ranges between 1.0 and 13.0 (peninsula Istria). Fulltime employed MS patients represent 15.8% ; bed-ridden patients 13.9%, and patients with orthopedic aids 44.5%. The mean duration of life of MS patients in Croatia is 49.7 years (95%CI: 47.6-51.1) 25 years shorter than in the general population. The most common forms of MS treatment in Croatia are the use of corticosteroids in acute relapse (67.11%), and recombinant interferon (11.3%) in patients with relapsing-remitting disease. Alternative medicine is used by 20% of patients. Analytic epidemiology of MS in Croatia shows the disease to be more frequent among the third-born, those having light-color eyes, a higher economic status, a past history of trauma and/or retro bulbar optic neuritis, and in consumers of unpasteurized milk, animal fat and smoked meat. Association between MS and other diseases hasn’ t been found, except for allergic rhinitis. To date, conjugal and geminate MS has not yet been confirmed in Croatia. The values of heritability coefficients in the relatives of the first, second and third degrees do not differ greatly among themselves. Repeated surveys of MS in Croatia have consistently ranked Gorski Kotar, among the high risk areas of MS in Central Europe: 85.1 per 100 000 population (1971), 125.0 per100 000 population (1999). The annual mean incidence (1948-1991) is 3.9 per 100 000 native inhabitants/years. The age at onset of MS is earlier here than in any other part of Croatia (26.1, SD 7.9). Emigrants from this region carry risk for MS if they emigrate after adolescence. An affected family member is identified in 35.9% of the autochthonous population. The haplotype DR B1*15, DQ A1*0102, DQ B1*0602, particularly allele DR B1*15, dispose this population to MS. The major legal problem of MS patients in Croatia is how to realize the legally guaranteed rights to retirement, health insurance, and social welfare.

multiple sclerosis, epidemiology, genetics, clinical features, socio-economic aspects, Croatia

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