Multiple Sclerosis And Connective Tissue Disease

Multiple sclerosis (MS) is an autoimmune disease in which the immune system damages the central nervous system, leading to demyelination, i.e., destruction of the myelin sheaths that perform the task of isolating neurons in the brain and spinal chord. Multiple sclerosis usually targets young adults, women in particular. Autoimmune connective tissue diseases include various organ-specific and systemic conditions such as lupus and Sjogren's that affect structural tissue. There are over 200 different diseases in this family. Connective tissue diseases are mainly caused by gene mutations that hit tissue production and several types of specific and overlapping autoimmune diseases.

Nowadays, connective tissue diseases are divided into two categories: a) autoimmune connective tissue disorders such as lupus disorders, rheumatoid arthritis, and dermatomyositis, and b) heritable connective tissue disorders (HCTDs) such as Ehlers-Danlos syndrome, epidermolysis bullosa, and Marfan syndrome arising out of caused by gene mutations.

How multiple sclerosis is caused is still unknown. However, the most likely cause seems to be a combination of hereditary factors, an environmental factor such as a virus and a deficiency in the immune system. Being an autoimmune disease, multiple sclerosis is most probably caused by an attack launched by the body's own immune system.

Studies have revealed that systemic lupus erythematosus, primary Sjogren's syndrome and systemic sclerosis may be linked with acute transverse myelitis and chronic relapsing neurological syndromes. These mimic multiple sclerosis in the same people and/or their kin. Research has indicated that there are various types of connective tissue disorders which mimic multiple sclerosis and acute disseminated encephalomyelitis. From these findings this is evident that that the diagnosis of multiple sclerosis should be reviewed on a regular basis by looking for the development of connective tissue disorders in the patients or their relatives.

Another study analyzed retrospectively the clinical, laboratory and imaging findings of multiple sclerosis, such as the manifestations in a cohort of 132 patients referred to the neurology in and outpatient clinic. In 132 consecutive patients, the proposed clinical and laboratory diagnostic criteria for multiple sclerosis and connective tissue disorders were assessed systematically. Cerebrospinal fluid serology and brain or spinal cord MRI were examined in each of them. Those who were suspected to have been affected by connective tissue disorders were made to undergo Schirmer test, Rose Bengal staining and biopsy of minor salivary glands. It was observed that a total of 115, i.e., 87 per cent of patients were diagnosed to have definite multiple sclerosis, while 17, i.e., 13 per cent were diagnosed to have connective tissue disorders.

Researchers observed neurological and MRI findings in both groups. It was found that the majority of patients having connective tissue disorders demonstrated extra-neurological manifestations like Raynaud's phenomenon, arthritis, livedo reticularis, purpura and presence of multiple autoantibodies in their sera. This showed the necessity of systematically screening all patients with multiple sclerosis for connective tissue disorders. In the absence of pathognomonic clinical and laboratory findings, the diagnosis of multiple sclerosis is a diagnosis of exclusion.

It is found that an acute isolated neurological syndrome poses a big diagnostic problem, as it is common in multiple sclerosis, but can also be the only feature or first manifestation in systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), Sjoegren's syndrome (SS), and Adamantiades-Behcet disease (BD).

• Cassandra Bagley
• 15/02/2009, 12:59 AM
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