Contributions
Abstract: EP1349
Type: ePoster
Abstract Category: Clinical aspects of MS - MS Variants
Introduction: It is intriguing that certain individuals harbour multiple co-existing autoimmune diseases (AuImmDs), and the mechanisms are largely not well understood.
Objective: We studied the presence of co-existing AuImmDs in neuromyelitis optica spectrum disorder (NMOSD) patients and in multiple sclerosis (MS) patients in a tropical Asian cohort.
Methods: A hospital files review was done to chart the occurrence of co-existing AuImmDs in NMOSD and MS patients followed up at the Penang General Hospital, Penang, Malaysia.
Results: Of 24 patients with aquaporin 4 antibody-positive NMOSD (96% female), AuImmDs were present in 5 of them (20.8%) - 2 with systemic lupus erythematosus (SLE), 1 with Sjogren syndrome (SS), 1 with myasthenia gravis, and 1 with thyroiditis. Four of the 5 patients had relapsing optic neuritis and myelitis, while the remaining 1 patient had first episode of optic neuritis. Due to polyclonal B cell activation, NMOSD patients with positive anti-nuclear antibody (ANA) or SSA/SSB antibodies alone but without relevant SLE/SS clinical features were inadequate to be diagnosed as having co-existing SLE/SS. Two patients with positive ANA/SSA/SSB and myelitis initially diagnosed as undifferentiated connective tissue disease were now being re-diagnosed as having NMOSD alone. For NMOSD patients without co-existing SLE, none had positive anti-ds-DNA antibody. In contrast to NMOSD patients, of the 12 clinically definite MS patients (75% female), none had co-existing AuImmDs, and none had positive ANA/SS antibodies.
Conclusions: The frequency of co-existing AuImmDs in NMOSD in this tropical Asian cohort at 20.8% is slightly lower than 29.2% reported in a European cohort (UK and Portugal), but slightly higher than 12.8% in the French Martinique cohort of predominantly Blacks. Co-existing SLE is relatively uncommon - 8.3% (this cohort), 4.7% (European cohort), and 5.1% (Martinique cohort). It is intriguing that AuImmDs in particular SLE, is not present in our MS patients. It would be interesting to investigate further the molecular pathophysiology of NMOSD and MS especially the B cells and T cells immunopathogenesis and their relationship with other AuImmDs.
Disclosure:
J.Y. Hor: nothing to disclose.
T.T. Lim: nothing to disclose.
C.F. Cheah: nothing to disclose.
Y.K. Chia: nothing to disclose.
R. Kanesalingam: nothing to disclose.
K. Tan: nothing to disclose.
H.B. Chow: nothing to disclose.
Y.M. Ching: nothing to disclose.
M. Arip: nothing to disclose.
P.E.S. Easaw: nothing to disclose.
G.B. Eow: nothing to disclose.
Abstract: EP1349
Type: ePoster
Abstract Category: Clinical aspects of MS - MS Variants
Introduction: It is intriguing that certain individuals harbour multiple co-existing autoimmune diseases (AuImmDs), and the mechanisms are largely not well understood.
Objective: We studied the presence of co-existing AuImmDs in neuromyelitis optica spectrum disorder (NMOSD) patients and in multiple sclerosis (MS) patients in a tropical Asian cohort.
Methods: A hospital files review was done to chart the occurrence of co-existing AuImmDs in NMOSD and MS patients followed up at the Penang General Hospital, Penang, Malaysia.
Results: Of 24 patients with aquaporin 4 antibody-positive NMOSD (96% female), AuImmDs were present in 5 of them (20.8%) - 2 with systemic lupus erythematosus (SLE), 1 with Sjogren syndrome (SS), 1 with myasthenia gravis, and 1 with thyroiditis. Four of the 5 patients had relapsing optic neuritis and myelitis, while the remaining 1 patient had first episode of optic neuritis. Due to polyclonal B cell activation, NMOSD patients with positive anti-nuclear antibody (ANA) or SSA/SSB antibodies alone but without relevant SLE/SS clinical features were inadequate to be diagnosed as having co-existing SLE/SS. Two patients with positive ANA/SSA/SSB and myelitis initially diagnosed as undifferentiated connective tissue disease were now being re-diagnosed as having NMOSD alone. For NMOSD patients without co-existing SLE, none had positive anti-ds-DNA antibody. In contrast to NMOSD patients, of the 12 clinically definite MS patients (75% female), none had co-existing AuImmDs, and none had positive ANA/SS antibodies.
Conclusions: The frequency of co-existing AuImmDs in NMOSD in this tropical Asian cohort at 20.8% is slightly lower than 29.2% reported in a European cohort (UK and Portugal), but slightly higher than 12.8% in the French Martinique cohort of predominantly Blacks. Co-existing SLE is relatively uncommon - 8.3% (this cohort), 4.7% (European cohort), and 5.1% (Martinique cohort). It is intriguing that AuImmDs in particular SLE, is not present in our MS patients. It would be interesting to investigate further the molecular pathophysiology of NMOSD and MS especially the B cells and T cells immunopathogenesis and their relationship with other AuImmDs.
Disclosure:
J.Y. Hor: nothing to disclose.
T.T. Lim: nothing to disclose.
C.F. Cheah: nothing to disclose.
Y.K. Chia: nothing to disclose.
R. Kanesalingam: nothing to disclose.
K. Tan: nothing to disclose.
H.B. Chow: nothing to disclose.
Y.M. Ching: nothing to disclose.
M. Arip: nothing to disclose.
P.E.S. Easaw: nothing to disclose.
G.B. Eow: nothing to disclose.