“An autoimmune disease rarely comes alone” – this is a saying from medical school that certainly has its validity. Since MS is an autoimmune disease, it is not surprising that one can observe a cluster of autoimmune diseases in those affected by MS or in families of those affected by MS.The combination of multiple sclerosis and autoimmune thyroid disease, especially Hashimoto’s thyroiditis, is most common. However, unlike MS, this can be easily treated – the problem is usually solved by taking thyroid hormones. Therefore, the simultaneous occurrence of these two diseases often does not attract too much attention. But other and significantly more problematic autoimmune diseases from the rheumatic group or autoimmune chronic inflammatory bowel diseases (ulcerative colitis or Crohn’s disease) are statistically more likely to occur in people with MS.
Coordination among specialties required
In the case of a joint occurrence, the goal must be for the different involved specialties to coordinate and establish a therapy that ideally treats the different autoimmune organ involvements effectively at the same time. Explained using a specific example: If a person affected by MS also suffers from rheumatoid arthritis, a B-cell depleting therapy (e.g., Rituximab) is the drug of choice, as the effect of this group of substances on both rheumatoid arthritis and MS has been proven by studies. In contrast, choosing a TNF-alpha blocker (e.g., Infliximab) – standard substances for treating joint rheumatism – would not make sense because it is known that administering TNF-alpha blockers can potentially lead to a worsening of MS in patients. This example shows how important coordination between the specialists involved is in such a situation.
The occurrence of autoimmune eye diseases is also frequently asked about by those affected. MS is known to affect the optic nerve, particularly in the early stages – this inflammation is called retrobulbar neuritis. Another autoimmune eye disease is uveitis. This term refers to the inflammation of the uvea, the middle layer of the eye. The uvea consists of the iris, the ciliary body, and the choroid. Autoimmune uveitis is observed more frequently in people with MS than in the general population. Additionally, studies have shown that people with uveitis also have an increased risk for MS. Treatment of uveitis involves using local anti-inflammatory eye drops and systemic anti-inflammatory medications like corticosteroids or traditional immunosuppressants.
The symptoms of uveitis can vary from person to person, depending on the severity and type of inflammation. Similar to retrobulbar neuritis, blurred vision, eye pain, and increased light sensitivity may occur. However, unlike retrobulbar neuritis, changes in the eye itself can also be seen with uveitis, usually in the form of significant redness – meaning, an ophthalmologist can usually easily recognize and assign uveitis. For retrobulbar neuritis, the principle “the ophthalmologist sees nothing – and the patient sees nothing” still applies – another saying from medical school.
Thus, it can be determined that both diseases can have an autoimmune cause and show a statistically increased joint occurrence, but they are usually isolated and distinguishable diseases.
