Patients with first-attack neuromyelitis optica spectrum disorder (NMOSD) who also have connective tissue disease have a higher recurrence rate, more recurrences, and earlier first recurrences, according to a new study.

The findings also indicated that these patients have enhanced systemic inflammatory reactions and higher serum homocysteine levels that may help identify connective tissue disease in first-attack NMOSD patients. It is common for a patient to have NMOSD and connective tissue disease at the same time. 

The results were published online in the journal Frontiers.

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In the present study, a team of researchers from China compared the characteristics of patients with first-attack NMOSD who also have connective tissue disease with those who do not have connective tissue disease.

The researchers analyzed a total of 113 patients with NMOSD, whom they divided into 2 groups based on the presence or absence of connective tissue disease. There were no major differences between the 2 groups in terms of demographics, clinical features, cerebrospinal fluid analysis, and magnetic resonance imaging findings.

However, the relapse rate, the number of recurrences, and the time of the first recurrence were different between the 2 groups of patients. More precisely, the time of the first recurrence was shorter in patients with NMOSD and connective tissue disease. 

Moreover, the serum lymphocyte-to-monocyte ratio, albumin levels, serum erythrocyte sedimentation rate, and homocysteine levels were different between the 2 groups, with lymphocyte-to-monocyte ratio and albumin levels being higher in patients with NMOSD without connective tissue disease and the sedimentation rate and serum homocysteine levels being higher in patients with both diseases.

The researchers calculated that serum homocysteine levels were independently associated with the occurrence of NMOSD with connective tissue disease. The sensitivity of predicting the coexistence of first-attack NMOSD and connective tissue disease based on the levels of homocysteine in the serum was 56% while its specificity was 89.8% suggesting that serum homocysteine levels can help screen NMOSD patients with connective tissue disease.


Yao Y, Yang X, Zhou Y, et al. Comparative analysis of clinical and imaging data of first-attack neuromyelitis optica spectrum disorders with and without connective tissue disease. Front Neurol. 2022;25;13:969762. doi:10.3389/fneur.2022.969762