Coexistence of Multiple Sclerosis and Ankylosing Spondylitis: Report of Two Cases

Abstract

Background: Multiple sclerosis (MS) only rarely coexists with ankylosing spondylitis (AS). The optimal management of these patients represents a major challenge. Methods: In the present study, we report 2 cases of AS with definite MS comorbidity. One of the AS-MS cases had received anti-TNFα treatment, which was discontinued due to exacerbation of the MS. In addition, we discuss 3 more AS cases with neurological symptoms and atypical white matter demyelinating MRI lesions after anti-TNFα treatment. Discussion: Given the fact that anti-TNFα drugs can potentially exacerbate a latent MS or induce atypical demyelination in the central nervous system, they should be discouraged or discontinued in relevant cases. The remaining effective therapeutic options for MS are either contradictory for AS (interferon-β), have no definite data regarding their safety/efficacy in AS (glatiramer acetate, azathioprine, natalizumab, fingolimod), or their efficacy in MS-AS is associated with increased treatment risks (rituximab). Any of these proposed treatments may require active patient's informed consent.

Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study

“…Precisely because the primal mechanism in autoimmune disorders is the loss of tolerance to self-proteins by environment-gene interactions, the coexistence of different rheumatic diseases is common. For example, AS grouped under the term AxSpA occurs in patients with rheumatoid arthritis (RA) [7, 8], gouty arthritis [9], multiple sclerosis [10, 11], and systemic lupus erythematosus [12]. …”

Co-Existence of Relapsing Remitting Multiple Sclerosis and HLA B27 Positive Ankylosing Spondylitis in a Malay Male: A Rare Occurrence

“…The inflammatory phase in MS is followed by predominantly axonal degeneration and myelin sheath damage, while in AS by degenerative phenomena and new bone formation. A number of AS patients with possible or definite MS have been reported in the literature but the association of both diseases is still considered to be rare [2][3][4][5].…”

What is the Effect of Accompanying Ankylosing Spondylitis in Treatment of Multiple Sclerosis? Is there a Resistance

“…Twenty-one cases were reported in this series and it was reported that one disease had no effect on the treatment of the other over a 5.2-year follow-up period. Lourbopoulos et al (4) suggested in a case series that if a patient did not meet the diagnostic criteria of MS, the treatment of MS should be ceased and that performing MRI once every 6-12 months and clinical follow-up would be sufficient. In the case of definitive MS, the authors recommended the use of interferon-beta or glatiramer acetate in the first step.…”