Chronic Lower Limb Edema in People with Multiple Sclerosis: Prevalence, Cause and Impact

Background: Chronic lower limb edema (CLLE) is a feature of advanced multiple sclerosis (MS) but its prevalence and causative factors are not clearly established. The aims of the study were to determine the prevalence and possible causative factors of CLLE in people with MS, and to examine the impact of CLLE on participants’ quality of life. Methods and Results: The prevalence of CLLE was determined by questionnaire (i.e., self-reported) and by clinical examination. Possible causative factors were recorded including level of disability using Expanded Disability Status Scale (EDSS) and the impact on participants’ quality of life was assessed using LYMQOL. The self-reported prevalence of CLLE was 42.4% (101/238). The prevalence determined by clinical assessment was 61.9% (99/160). Possible causative factors were shown to include age, reduced mobility, and vasomotor autonomic dysfunction. In the multivariate analysis, only EDSS was statistically significant ( p = 0.002) with an incidence rate ratio (sd) of 2.1 (0.52). In those with CLLE, scores in the function, appearance, and symptom domains of LYMQOL demonstrated a poorer quality of life. There was a higher incidence of cellulitis in those with CLLE (14% compared with 2%). Conclusions: CLLE is a common problem is people with MS but may not always be recognized by patients. It can impact a person’s quality of life and poses a risk of cellulitis. Improved recognition and treatment of CLLE should improve the quality of life of people with MS.