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We investigated whether familial MS, including degree of relatedness, is associated with baseline characteristics and disease outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included individuals with incident MS from the Swedish population-based epidemiologic investigation of multiple sclerosis study with longitudinal follow-up through the Swedish MS registry. Participants were categorized as having no family history of MS, first-degree familial MS, or second-\/third-degree familial MS. Outcomes included confirmed disability worsening (CDW), progression to Expanded Disability Status Scale milestones 3 and 4, cognitive worsening measured by the symbol digit modalities test, MRI disease activity, and worsening on the Multiple Sclerosis Impact Scale-29. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3,094 participants, 239 (7.7%) reported a first-degree relative with MS and 468 (15.1%) reported a second-\/third-degree relative with MS. Baseline characteristics were similar across groups, although HLA\u2013DRB1*15:01 positivity was more common among individuals with first-degree familial MS. No significant associations were observed between familial MS status and disability progression, cognitive decline, MRI disease activity, or patient-reported worsening. Compared with individuals without a known family history of MS, the HR for CDW was 1.06 (95% CI 0.89\u20131.30) among individuals with first-degree familial MS and 1.04 (95% CI 0.90\u20131.20) among those with second-\/third-degree familial MS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Family history of MS did not appear to have a substantial prognostic impact on long-term disease outcomes after MS onset.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14162-9","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T06:32:19Z","timestamp":1790404339000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Family history of multiple sclerosis and long-term outcomes"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6612-4749","authenticated-orcid":false,"given":"Anna Karin","family":"Hedstr\u00f6m","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Olsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Alfredsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,26]]},"reference":[{"key":"14162_CR1","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.1016\/S0140-6736(08)61620-7","volume":"372","author":"A Compston","year":"2008","unstructured":"Compston A, Coles A (2008) Multiple sclerosis. 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