Objective:

The aim of this study is to determine biomarkers and MRI findings that differentiate multiple sclerosis (MS) from mimics and other autoimmune disorders. 

Background:

Misdiagnosis of MS has been reported 5-18% in many cohort studies (Rjeily, 2024). This is speculated to be due to overlap between clinical presentation and MRI findings of MS and other disorders. 

Design/Methods:

An IRB approved prospective chart review design was utilized at a single county hospital. From May 2022 - August 2024, patients with MS suspicion underwent a serum immunoglobulin panel, flow cytometry of leukocyte lymphocyte receptors. Patients who had any immunosuppressive treatment prior to lab draw were excluded. After a diagnosis was established, patients were divided into the following categories: MS, MS mimics without an inflammatory or autoimmune origin such as cervical stenosis, and autoimmune disease group such as patients with neuromyelitisoptica. Data was analyzed using ANOVA, significance was set with a p-value ≤ 0.05.

Results:

63 patients were included in the study. The MS, MS mimics, and autoimmune groups had 30, 21, and 12 patients, respectively. IgG was less in the MS group (1049.85) compared to mimics (1142) and autoimmune disorders (1468.56) (p = 0.017). IgG3 was also found to be lower in MS (47.4) compared to control (57) and autoimmune (141.3) (p= 0.02). MRI abnormalities in the supratentorial region were more severe in MS compared to autoimmune and control (p<0.01). Rheumatoid factor was higher in the autoimmune group (64.50) compared to MS (8.33) and MS mimics (8) (p< 0.01). CD4 was 44.17, 50.18, and 52.45 in MS, mimics, and autoimmune respectively ( p= 0.07). 

Conclusions:

The immunoglobulin subclass showed decreased IgG and IgG3 at baseline in MS patients compared to autoimmune neurologic diseases and non-autoimmune MS mimics such as spinal stenosis.