Abstract
Multiple sclerosis (MS) is the most common demyelinating disease caused by an autoimmune inflammatory process in the central nervous system (CNS) and is associated with aberrant immune response to myelin selfantigens. Coexistence of MS with other autoimmune disorders, including connective tissue disorders including systemic lupus erythematosus, rheumatoid arthritis, Sjögren’s syndrome and scleroderma have been reported previously. In the present article we report the coexistence of MS, familial mediterranean fever and ankylosing spondylitis in a patient and review the clinical presentation, neurologic findings, cerebrospinal fluid and radiologic characteristics and treatment options. We further discuss the immunopathogenetic mechanisms for a possible association between MS and autoimmune disorders.
Similar content being viewed by others
References
Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG (2000) Multiple sclerosis. N Engl J Med 343:938–952
Lucchinetti C, Bruck W, Parisi J et al. (2000) Heterogeneity of multiple sclerosis lesions: implications for the pathogenesis of demyelination. Ann Neurol 47:707–717
Lassmann H, Bruck W, Lucchinetti CF (2007) The immunopathology of multiple sclerosis: an overview. Brain Pathol 17:210–218
Pelidou SH, Tsifetaki N, Giannopoulos S et al. (2007) Multiple sclerosis associated with systemic sclerosis. Rheumatol Int 27:771–773
Noseworthy JH, Bass BH, Vandervoort MK et al. (1989) The prevalence of primary Sjogren’s syndrome in a multiple sclerosis population. Ann Neurol 25:95–98
Delalande S, de Seze J, Fauchais AL et al. (2004) Neurologic manifestations in primary Sjogren syndrome: a study of 82 patients. Medicine (Baltimore) 83:280–291
Soliotis FC, Mavragani CP, Moutsopoulos HM (2004) Central nervous system involvement in Sjogren’s syndrome. Ann Rheum Dis 63:616–620
Kinnunen E, Jarvinen P, Ketonen L, Sepponen R (1993) Co-twin control study on cerebral manifestations of systemic lupus erythematosus. Acta Neurol Scand 88:422–426
Pelidou SH, Giannopoulos S, Tzavidi S et al. (2007) Neurological manifestations of connective tissue diseases mimicking multiple sclerosis. Rheumatol Int 28:15–20
Mpofu S, Moots RJ (2003) A case of multiple sclerosis associated with rheumatoid arthritis and positive anticardiolipin antibodies. Ann Rheum Dis 62:376
Theodoridou A, Settas L (2006) Demyelination in rheumatic diseases. J Neurol Neurosurg Psychiatry 77:290–295
Livneh A, Langevitz P, Zemer D et al. (1997) Criteria for the diagnosis of familial Mediterranean fever. Arthritis Rheum 40:1879–1885
Noseworthy JH, Ebers GC (1989) Primary biliary cirrhosis and multiple sclerosis. Am J Gastroenterol 84:1584–1585
Gedalia A, Zamir S (1993) Neurologic manifestations in familial Mediterranean fever. Pediatr Neurol 9:301–302
Topcuoglu MA, Karabudak R (1997) Familial Mediterranean fever and multiple sclerosis. J Neurol 244:510–514
Karabudak R, Dogulu CF, Nurlu G et al. (2003) Central nervous system demyelination in familial Mediterranean fever: is it a coincidence? Eur J Neurol 10:327–328
Akman-Demir G, Gul A, Gurol E et al. (2006) Inflammatory/demyelinating central nervous system involvement in familial Mediterranean fever (FMF): coincidence or association? J Neurol 253:928–934
Yucesan C, Canyigit A, Turkcapar N (2004) The coexistence of familial Mediterranean fever with multiple sclerosis. Eur J Neurol 11:716–717
McDonald WI, Compston A, Edan G et al. (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127
Simon A, van der Meer JW (2007) Pathogenesis of familial periodic fever syndromes or hereditary autoinflammatory syndromes. Am J Physiol Regul Integr Comp Physiol 292:R86–98
Samuels J, Ozen S (2006) Familial Mediterranean fever and the other autoinflammatory syndromes: evaluation of the patient with recurrent fever. Curr Opin Rheumatol 18:108–117
Bradley JR (2008) TNF-mediated inflammatory disease. J Pathol 214:149–160
Lidar M, Livneh A (2007) Familial Mediterranean fever: clinical, molecular and management advancements. Neth J Med 65:318–324
Keegan BM, Noseworthy JH (2002) Multiple sclerosis. Annu Rev Med 53:285–302
Broadley SA, Deans J, Sawcer SJ et al. (2000) Autoimmune disease in first-degree relatives of patients with multiple sclerosis. A UK survey. Brain 123:1102–1111
Becker KG, Simon RM, Bailey-Wilson JE et al. (1998) Clustering of non-major histocompatibility complex susceptibility candidate loci in human autoimmune diseases. Proc Natl Acad Sci U S A 95:9979–9984
Maddison PJ (1991) Overlap syndromes and mixed connective tissue disease. Curr Opin Rheumatol 3:995–1000
Alarcon-Riquelme ME (2005) The genetics of shared autoimmunity. Autoimmunity 38:205–208
Gregersen PK, Behrens TW (2006) Genetics of autoimmune diseases: disorders of immune homeostasis. Nat Rev Genet 7:917–928
Theodoridou A, Settas L (2008) Demyelination in rheumatic diseases. Postgrad Med J 84:127–132
Marik C, Felts PA, Bauer J et al. (2007) Lesion genesis in a subset of patients with multiple sclerosis: a role for innate immunity? Brain 130:2800–2815
Pittock SJ, Lennon VA, de Seze J et al. (2008) Neuromyelitis optica and non organ-specific autoimmunity. Arch Neurol 65:78–83
Borhani Haghighi A, Ansari N, Mokhtari M et al. (2007) Multiple sclerosis and gluten sensitivity. Clin Neurol Neurosurg 109:651–653
Ferro MT, Franciotta D, Riccardi T et al. (2008) A case of multiple sclerosis with atypical onset associated with autoimmune hepatitis and silent coeliac disease. Neurol Sci 29:29–31
Nicoletti A, Patti F, Lo Fermo S et al. (2008) Frequency of celiac disease is not increased among multiple sclerosis patients. Mult Scler 14:698–700
Palopoli JJ, Waxman J (1987) Colchicine neuropathy or vitamin B12 deficiency neuropathy? N Engl J Med 317:1290–1
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kale, N., Icen, M., Agaoglu, J. et al. Clustering of organ-specific autoimmunity: a case presentation of multiple sclerosis and connective tissue disorders. Neurol Sci 29, 471–475 (2008). https://doi.org/10.1007/s10072-008-1015-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-008-1015-1