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

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

Konstantin Fritz Jendretzky #  1 , Lisa-Marie Lezius #  1 , Thea Thiele  2 , Franz Felix Konen  1 , André Huss  3 , Lena Heitmann  1 , Yunus Emre Güzeloglu  1 , Philipp Schwenkenbecher  1 , Kurt-Wolfram Sühs  1 , Jelena Skuljec  4 , Mike Peter Wattjes  5 , Torsten Witte  2 , Christoph Kleinschnitz  4 , Refik Pul  4 , Hayrettin Tumani  3 , Stefan Gingele  1 , Thomas Skripuletz  6
Affiliations

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

Konstantin Fritz Jendretzky et al. Neurol Res Pract. .

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.

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Conflict of interest statement

Declarations Ethics approval and consent to participate This study was approved by the institutional ethics committee (no. 8172-BO-K-2018). Consent for publication Not applicable. Competing interests The authors declare no conflict of interest. Outside the submitted work, the authors received honoraria for lectures, travel grants, or research grants. KFJ received research support from Else Kröner Fresenius Foundation and travel compensation and congress fee from Merck and Novartis. TT received honoraria from Boehringer Ingelheim, Janssen and Galapagos. LML reports no disclosures. FFK received travel grants from Merck and Novartis. AH reports no disclosures. LH reports no disclosures. YEG reports no disclosures. PS reports no disclosures. KWS reports honoraria for lectures or travel reimbursements for attending meetings from Biogen, Merck, Bavarian Nordic and Bristol-Myers Squibb as well as research support from Bristol-Myers Squibb. JS received lecture fees from Merck and Sanofi, and travel grant from Novartis and Sanofi. MPW received speaker or consultancy honoraria from Alexion, Bayer Healthcare, Biogen, Biologix, Bristol Myers Squibb, Celgene, Genilac, Imcyse, IXICO, Icometrix, Medison, Merck-Serono, Novartis, Roche, Sanofi-Genzyme, and publication royalties from Springer and Elsevier. TW reports honoraria for lectures and travel grants from Abbvie, Biogen, Boehringer Ingelheim, Celgene, Chugai, CSL Behring, Euroimmun, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, Siemens, Takeda, UCB. CK received lecture and consultancy fees from Biogen, Roche, and Novartis. RP received honoraria for lecturing and consulting from Alexion, Bayer Healthcare, Biogen, Bristol-Mayers Squibb, Hexal, Merck Serono, Mylan, Novartis, Roche, Sanofi Genzyme. He received research funds from Merck Serono and Novartis. HT has participated in meetings sponsored by or received honoraria for acting as an advisor/speaker for Alexion, Bayer, Biogen, Bristol-Myers Squibb, Celgene, Diamed, Fresenius, Fujirebio, GlaxoSmithKline, Horizon, Janssen-Cilag, Merck, Novartis, Roche, Sanofi-Genzyme, Siemens, and Teva. All not related to the present work. SG received consulting and/or speaker honoraria from Alexion, Alnylam Pharmaceuticals, AstraZeneca, GSK, Pfizer and Merck. His research is supported by the Deutsche Forschungsgemeinschaft (DFG), Else Kröner Fresenius Foundation, Hannover Biomedical Research School (HBRS), Alnylam Pharmaceuticals and CSL Behring. TS reports research support from Alnylam Pharmaceuticals, CSL Behring, Novartis, Siemens; honoraria for lectures and travel expenses for attending meetings from Alexion, Alnylam Pharmaceuticals, argenx, Bayer Vital, Biogen, Bristol Myers Squibb, Celgene, Centogene, CSL Behring, Euroimmun, Grifols, Hexal AG, Horizon, Janssen-Cilag, Merck Serono, Novartis, Pfizer, Roche, Sanofi, Siemens, Swedish Orphan Biovitrum, Teva, Viatris; consultant fees from Alexion, Alnylam Pharmaceuticals, Biogen, Centogene, CSL Behring, Grifols, Hexal AG, Janssen-Cilag, Merck Serono, Novartis, Roche, Sanofi, Swedish Orphan Biovitrum, Viatris.

Figures

Fig. 1
Fig. 1
Schematic flowchart of the number of multiple sclerosis (MS) patients and their further categorization into subgroups according to the presence of comorbid autoimmune diseases (AID) or isolated antibody findings (ABF)
Fig. 2
Fig. 2
Frequencies of comorbid autoimmune diseases (A). Frequencies of antibody findings in the absence of corresponding disease diagnosis. Thyroid autoantibodies were TSH receptor antibodies (TRAb) and thyreoperoxidase antibodies (TPOAb), cardiolipin and alpha fodrin antibodies consisted of immunoglobulin G (IgG) and immunoglobulin A (IgA) antibodies (B). ANA, antinuclear antibodies; anti-DNA, anti-double stranded deoxyribonucleic acid antibodies
Fig. 3
Fig. 3
Comparison of the measured CSF NFL concentration between the groups. Lines and error bars indicate median ± interquartile range. NFL, neurofilament light; CSF, cerebrospinal fluid; MS and AID, multiple sclerosis patients with comorbid autoimmune disease; MS without AID, multiple sclerosis patients without comorbid autoimmune disease
See this image and copyright information in PMC

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