Prevalence of comorbid autoimmune diseases and antibodies in newly diagnosed multiple sclerosis patients

Konstantin Fritz Jendretzky; Lisa-Marie Lezius; Thea Thiele; Franz Felix Konen; André Huss; Lena Heitmann; Yunus Emre Güzeloglu; Philipp Schwenkenbecher; Kurt-Wolfram Sühs; Jelena Skuljec; Mike Peter Wattjes; Torsten Witte; Christoph Kleinschnitz; Refik Pul; Hayrettin Tumani; Stefan Gingele; Thomas Skripuletz

doi:10.1186/s42466-024-00351-2

Prevalence of comorbid autoimmune diseases and antibodies in newly diagnosed multiple sclerosis patients

Neurol Res Pract. 2024 Nov 12;6(1):55. doi: 10.1186/s42466-024-00351-2.

Authors

Konstantin Fritz Jendretzky^#¹, Lisa-Marie Lezius^#¹, Thea Thiele², Franz Felix Konen¹, André Huss³, Lena Heitmann¹, Yunus Emre Güzeloglu¹, Philipp Schwenkenbecher¹, Kurt-Wolfram Sühs¹, Jelena Skuljec⁴, Mike Peter Wattjes⁵, Torsten Witte², Christoph Kleinschnitz⁴, Refik Pul⁴, Hayrettin Tumani³, Stefan Gingele¹, Thomas Skripuletz⁶

Affiliations

¹ Department of Neurology, Hannover Medical School, Hannover, Germany.
² Department of Rheumatology and Clinical Immunology, Hannover Medical School, Hannover, Germany.
³ Department of Neurology, University Hospital of Ulm, Ulm, Germany.
⁴ Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, Essen, Germany.
⁵ Department of Neuroradiology, Charité Berlin, Corporate Member of Freie Universität zu Berlin, Humboldt-Universität zu Berlin, erlin, Germany.
⁶ Department of Neurology, Hannover Medical School, Hannover, Germany. Skripuletz.Thomas@mh-hannover.de.

^# Contributed equally.

Abstract

Background: Diagnosing multiple sclerosis (MS) is challenging due to diverse symptoms and the absence of specific biomarkers. Concurrent autoimmune diseases (AID) or non-specific antibodies further complicate diagnosis, progression monitoring, and management. Data on AID prevalence in MS patients are sparse. This study aims to identify concurrent AIDs alongside MS.

Methods: In this retrospective single-center study, we analyzed patient records at our university hospital from 2010 to 2017, focusing on cases suspected of inflammatory demyelinating disease. The 2017 McDonald criteria were applied. Additionally, we measured neurofilament light (NfL) levels from available CSF samples in our biobank.

Results: We identified a total of 315 patients, of whom 66% were women. In total, 13.7% of all patients had concurrent AID, while 20.3% had isolated antibody findings without AID. The most common AID was autoimmune thyroiditis (8.9%), followed by chronic inflammatory skin diseases (1.6%), arthritis (1%), type 1 diabetes (1%), Sjögren's syndrome (0.6%), and inflammatory bowel diseases (0.6%). Cardiolipin antibodies were the most frequent isolated antibody finding (8.6%). Our data showed that, from the perspective of the initial demyelinating event, neither comorbid AID nor isolated antibodies significantly influenced relapses or MS progression over a median follow-up of 9 months. Standard CSF parameters and NfL levels were similar between the groups at the time of MS diagnosis.

Conclusion: Our study shows that AIDs, particularly autoimmune thyroiditis, frequently occur at the onset of MS. The proportion of AIDs commonly treated with immunomodulatory therapy in our cohort was similar to that observed in the general population. Comorbid AID did not affect NfL levels, indicating similar disease activity. Future research should explore new AID emergence during the course of MS, especially considering the increased incidence of rheumatic diseases later in life.

Keywords: Autoimmune diseases; Comorbidity; Multiple sclerosis; Neurofilament light; Prevalence.