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Systemic Autoimmune Features and Multiple Sclerosis
A 5-Year Follow-up Study
Ayman Tourbah, MD, PhD;
Alexis Clapin, MD;
Olivier Gout, MD;
Bertrand Fontaine, MD, PhD;
Roland Liblau, MD, PhD;
Frederic Batteux, MD;
Jean-Louis Stiévenart, MD;
Bernard Weill, MD, PhD;
Catherine Lubetzki, MD, PhD;
Olivier Lyon-Caen, MD
Arch Neurol. 1998;55:517-521.
Objectives To evaluate in patients with multiple sclerosis (MS) the occurrence of clinical systemic signs and biological autoimmune abnormalities, including positive titers of antinuclear antibodies and antiphospholipid antibodies, suggestive of autoimmune diseases that may affect the central nervous system. Also, to compare the clinical and magnetic resonance imaging features and evolution of MS in patients with and without autoimmune abnormalities.
Design and Patients Prospective study of 161 patients fulfilling the criteria of having probable or definite MS hospitalized in our institution between November 1990 and June 1992.
Results Among the 161 patients, 84 (52.1%) had at least 1 clinical and/or biological general sign suggestive of an autoimmune disease; 64 were followed up for 4 to 5 years. The diagnosis of MS was confirmed in 50 patients and is still pending in 14 of them. No significant difference was found between patients with MS who were free of autoimmune features and those with autoimmune abnormalities (MS plus) concerning the age of disease onset, the presenting symptoms and signs, symptoms found on neurologic examination, and the course of the disease. For all patients with confirmed MS, general signs were found in 13.3%, positive titers of antinuclear antibodies in 26%, and positive titers of antiphospholipid antibodies in 6.2%.
Conclusions Patients with MS with autoimmune features, including those with titers of antinuclear antibodies of 1:100 or less and/or antiphospholipid antibodies, are not different than others with MS, and therefore should not be excluded from clinical trials.
From the Fédération de Neurologie and Université Paris VI (Drs Tourbah, Clapin, Gout, Fontaine, Liblau, Lubetzki, and Lyon-Caen), INSERM U134 et CJF Pathologie de la Myéline (Drs Tourbah, Fontaine, Liblau, and Lubetzki), and Laboratoire d'Immunologie Cellulaire (Dr Liblau), Hôpital de la Salpêtrière; Neuroradiology Department, Centre Hospitalier National d'Ophtalmologie des XV-XX (Drs Tourbah and Stiévenart); and Laboratoire d'Immunologie and Université Paris V, Hôpital Cochin (Drs Batteux and Weill), Paris, France.
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