title: Coexistence of systemic lupus erythematosus and multiple sclerosis: prevalence, clinical characteristics, and natural history.
abstract: OBJECTIVE
  The coexistence of systemic lupus erythematosus (SLE) and multiple sclerosis (MS) in the same individual has rarely been described. Our objective was to report on the prevalence, clinical characteristics, and prognosis of cases fulfilling the criteria for both SLE and MS.
  
  
  METHODS
  We utilized existing patient cohorts from the Departments of Rheumatology and Neurology, University of Crete, and screened patients diagnosed with either SLE (n = 728) or MS (n = 819) for features of both diseases. The clinical, laboratory, and neuroimaging findings were assessed.
  
  
  RESULTS
  We identified nine patients who fulfilled the diagnostic criteria for both SLE and MS, corresponding to a prevalence rate of 1.0-1.2% in each cohort. All patients were women, with an average age at SLE diagnosis of 42.1 years (range: 34-56 years). The diagnosis of SLE preceded the development of MS in five patients, with a time lag ≤ 5 years in four of them. Initial presentation of MS included spinal symptoms in seven patients. All patients had features of mild SLE with predominantly cutaneous, mucosal, and musculoskeletal manifestations. Accordingly, therapeutic decisions were mainly guided by the severity of the neurological syndrome. During the median follow-up of 4 years (range: 1-10 years), three patients remained stable and the remaining experienced gradual deterioration in their neurological status. SLE remained quiescent in all patients while on standard immunomodulatory MS therapy.
  
  
  CONCLUSIONS
  Occurrence of both diseases in the same individual is rare, corroborating data that suggest distinct molecular signatures. SLE and MS coexistence was not associated with a severe phenotype for either entity.
authors: Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece.
authors: Antonis
authors: A
authors: Fanouriakis
authors: Department of Neurology, University Hospital of Heraklion, Heraklion, Greece.
authors: Vasileios
authors: V
authors: Mastorodemos
authors: "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors: Cristina
authors: C
authors: Pamfil
authors: Department of Medical Imaging-MRI Unit, University Hospital of Heraklion, Heraklion, Greece.
authors: Efrosini
authors: E
authors: Papadaki
authors: Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece.
authors: Prodromos
authors: P
authors: Sidiropoulos
authors: Department of Neurology, University Hospital of Heraklion, Heraklion, Greece.
authors: Andreas
authors: A
authors: Plaitakis
authors: Department of Neurology, University Hospital of Heraklion, Heraklion, Greece.
authors: George
authors: G
authors: Amoiridis
authors: Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece; Institute of Molecular Biology and Biotechnology, Foundation of Research and Technology-Hellas, Voutes, Heraklion, Greece.
authors: George
authors: G
authors: Bertsias
authors: Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece; Institute of Molecular Biology and Biotechnology, Foundation of Research and Technology-Hellas, Voutes, Heraklion, Greece; Biomedical Research Foundation of the Academy of Athens, Athens, Greece. Electronic address: boumpasd@med.uoc.gr.
authors: Dimitrios T
authors: DT
authors: Boumpas
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D000068717:Glatiramer Acetate; D006115:Greece / Q000453:epidemiology; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016899:Interferon-beta / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000453:epidemiology*; D000069442:Natalizumab; D010455:Peptides / Q000627:therapeutic use; D015995:Prevalence; D000069283:Rituximab
chemical_list: D000305:Adrenal Cortex Hormones; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069442:Natalizumab; D010455:Peptides; D000069283:Rituximab; D006886:Hydroxychloroquine; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D001379:Azathioprine; D008727:Methotrexate
keywords: Coexistence; Multiple sclerosis; Natural history; Systemic lupus erythematosus