Characterizing Patients with Multiple Sclerosis and Coexisting Scleroderma or Ankylosing Spondylitis
Lucas Garfinkel1, Katherine Stankevich1, Emily Lai1, Mary Penckofer1, Manisha Koneru2, Aswathi Sajeendran2, Alison Riggs2, Marina Santos De Sousa2, Donald Barone3, Cris Constantinescu3, Jesse Thon2, Judy Diep3, Olga Thon3
1Cooper Medical School of Rowan University, 2Cooper University Hospital, 3Cooper Neurological Institute
Objective:
In this case series, we present 11 multiple sclerosis (MS) patients with coexisting scleroderma or ankylosing spondylitis. We will characterize this population and determine differences between patients with multiple autoimmune diseases and patients with MS only.
Background:

MS is a chronic immune-mediated disease affecting more than 2 million people worldwide. Coexistence with other autoimmune disorders, such as systemic lupus erythematosus (SLE), are well described. However, there is less known regarding MS patients concurrently diagnosed with scleroderma or ankylosing spondylitis.

Design/Methods:
This is a single-center retrospective case series.
Results:

All nine patients with coexisting relapsing-remitting MS and scleroderma are female, with an average age of 45 (±14.47) at MS diagnosis. Six were previous smokers with an average 15 pack-years (±11.83). Hypertension was diagnosed in four patients, hyperlipidemia in two, and thyroid cancer in one. Autoimmune comorbidities included SLE in three, hypothyroidism in two, and rheumatoid arthritis in one. Psychological comorbidities included depression and anxiety in three patients, separately. At MS diagnosis, eight had abnormal brain MRIs while three had cervical and thoracic lesions. CSF data from four patients showed an average cell count of 22.75/μL (±5.18), glucose of 101.67 mg/dL (±15.94), protein of 36.5 mg/dL (±22.72), and IgG index of 5.12 mg/dL (±5.36). Five patients had 3 or more oligoclonal bands in CSF only. The average vitamin D level was 29 ng/mL (±18.71).

Two patients with concurrent MS and ankylosing spondylitis (one female, one male), had abnormal brain, cervical, and thoracic MRIs with lesions spanning more than three spinal segments. One has hypertension and depression while the other has schizophrenia, anxiety, and Ehlers-Danlos syndrome.
Conclusions:
Our report characterizes 11 MS patients with co-occurring scleroderma or ankylosing spondylitis. Although statistical comparisons are limited by sample size, relative to established norms for MS, these patients may have higher rates of smoking, psychiatric comorbidities, and other autoimmune diseases.
10.1212/WNL.0000000000211480
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