Neuromyelitis optica and non organ-specific autoimmunity.
BACKGROUND
Neuromyelitis optica (NMO) is often associated with other clinical or serological markers of non-organ-specific autoimmunity.


OBJECTIVE
To evaluate the relationship between NMO spectrum disorders (NMOSDs), including NMO, longitudinally extensive transverse myelitis, and recurrent optic neuritis, and autoimmune disease. We concentrated on the association with systemic lupus erythematosus (SLE), Sjögren syndrome (SS), or serological evidence of these disorders, which commonly is a source of diagnostic confusion.


METHODS
Retrospective blinded serological survey.


METHODS
Mayo Clinic College of Medicine, Rochester, and Centre Hospitalier Régional Universitaire de Lille.


METHODS
Group 1 included 153 US patients with NMOSDs (78 with NMO and 75 with longitudinally extensive transverse myelitis) and 33 control subjects with SS/SLE. Group 2 included 30 French patients with SS/SLE, 14 with NMOSDs (6 with NMO, 6 with longitudinally extensive transverse myelitis, and 2 with recurrent optic neuritis), 16 without NMOSDs, and 4 with NMO without SS/SLE.


RESULTS
For group 1, NMO-IgG was detected in 66.7%, antinuclear antibodies in 43.8%, and Sjögren syndrome A (SSA) antibodies in 15.7% of patients with NMO and longitudinally extensive transverse myelitis. Five NMO-IgG-seropositive patients with NMOSDs had coexisting SLE, SS, or both. Antinuclear antibodies and SSA antibodies were more frequent in NMO-IgG-seropositive patients than in NMO-IgG-seronegative patients (P= .001). For group 2, NMO-IgG was detected in 5 of 14 patients (35.7%) with NMOSDs and SS/SLE and in 2 of 4 patients (50.0%) with NMO without SS/SLE (P= .59). We detected NMO-IgG only in patients with NMOSDs and not in 49 controls with SS/SLE but without optic neuritis or myelitis from the 2 cohorts (P= .01).


CONCLUSIONS
Neuromyelitis optica spectrum disorders with seropositive findings for NMO-IgG occurring with SS/SLE or non-organ-specific autoantibodies is an indication of coexisting NMO rather than a vasculopathic or other complication of SS/SLE.
Pittock
Sean J
SJ
Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Lennon
Vanda A
VA
de Seze
Jerome
J
Vermersch
Patrick
P
Homburger
Henry A
HA
Wingerchuk
Dean M
DM
Lucchinetti
Claudia F
CF
Zéphir
Hélène
H
Moder
Kevin
K
Weinshenker
Brian G
BG
D000974:Antibodies, Antinuclear / Q000032:analysis; D034961:Antigens, Nuclear / Q000276:immunology; D001323:Autoantibodies / Q000032:analysis / Q000276:immunology; D020274:Autoimmune Diseases of the Nervous System / Q000276:immunology*; D015415:Biomarkers; D015331:Cohort Studies; D019084:Fluorescent Antibody Technique, Indirect; D005602:France; D006801:Humans; D007124:Immunoenzyme Techniques; D007074:Immunoglobulin G / Q000276:immunology; D007159:Immunologic Tests; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000276:immunology; D009471:Neuromyelitis Optica / Q000276:immunology*; D012189:Retrospective Studies; D012859:Sjogren's Syndrome / Q000276:immunology; D014481:United States
D000974:Antibodies, Antinuclear; D034961:Antigens, Nuclear; D001323:Autoantibodies; D015415:Biomarkers; D007074:Immunoglobulin G