Background Although segregation of systemic lupus erythematosus (SLE) and multiple sclerosis (MS) has been reported within families with multiple members affected with autoimmune diseases, coexistence of the two disorders in the same individual has only rarely been described.
Objectives To describe the clinical characteristics of patients fulfilling the criteria for both SLE and MS.
Methods We reviewed the medical records, laboratory and neuroimaging findings in six patients diagnosed with both SLE (ACR 1987 criteria) and MS (2010 revised McDonald criteria). Cases were identified from existing cohorts of patients with SLE (n = 728) and MS (n = 819), followed in the Departments of Rheumatology and Neurology, University of Crete.
Results All six patients were women, with an average age of SLE diagnosis at 44 years (Table), which is relatively higher from the usual age of disease onset. Antiphospholipid antibodies (aPLs) were present in two patients (33%), but none fulfilled criteria for antiphospholipid syndrome. In five patients, the diagnosis of SLE preceded the development of MS, in four of them with a time lag of ≤ 5 years (median 4 years, range from 2 to 16 years). Only one patient (case #2) had a long-standing (>20 years) history of relapsing-remitting MS (RRMS) before developing SLE. Clinical presentation of MS included spinal symptoms in five patients. All patients had mild SLE with cutaneous, mucosal and musculoskeletal manifestations, and only case #3 had history of pericarditis. Accordingly, therapeutic decisions were mainly guided by the severity of the neurological syndrome (Table). During median follow-up of 4 years (range 1-9 years), three patients remained stable and the remaining experienced gradual deterioration in their neurological status. SLE remained quiescent in all patients with standard immunomodulatory MS therapy.
Conclusions Although SLE and MS may have overlapping features, occurrence of patients fulfilling criteria for both diseases is rare, confirming microarray findings for distinct molecular signatures. In our cohort, SLE and MS co-existence was not associated with a severe phenotype for both entities. Longitudinal, larger cohorts in other ethnic groups are needed to further verify these findings.
Feng X, Reder NP, Yanamandala M, Hill A, Franek BS, Niewold TB, et al. Type I interferon signature is high in lupus and neuromyelitis optica but low in multiple sclerosis. J Neurol Sci. 2012 Feb 15; 313(1-2):48-53.
Disclosure of Interest None Declared