Several predictors may aid in the discrimination of neuromyelitis optica spectrum disorder (NMOSD) alone from NMOSD with other autoimmune diseases (AD-NMOSD), according to an article published in the Journal of Neurological Sciences. Previous studies have shown that AD-NMOSD generally leads to worse clinical outcomes and higher healthcare costs and may affect Black patients more.

A number of factors were found to be higher in the AD-NMOSD group when compared to the NMOSD group, including a history of infections requiring hospitalization 6 months before admission, grouped comorbidities, and Expanded Disability Status Scale scores before treatment. Higher numbers of antibodies for double-stranded DNA, antinuclear, ribonucleoprotein, and anti-phospholipid were also observed in the AD-NMOSD group.

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The amount of spinal cord edema and white matter occipital lesions were also higher in patients with AD-NMOSD. Laboratory analysis also revealed higher c-reactive protein levels, a higher number of cerebrospinal fluid white blood cells, and a larger ratio of urine protein to albumin levels.

In contrast, the frequency of visual symptoms, serum albumin levels, platelet counts, and optic nerve enhancements on MRI were all lower in the AD-NMOSD group than the NMOSD-only group. Response to treatment was also worse in the AD-NMOSD group.

Multivariate analysis of the groups found that a higher frequency of grouped comorbidities and lower levels of serum albumin and platelets were independent predictors of AD-NMOSD. The authors suggested that these 3 markers may be associated with higher levels of systemic inflammation and endothelial activation.

“Given the poorer clinical outcomes and significantly higher healthcare costs for AD-NMOSD patients in comparison with NMOSD-only patients, sufferers with NMOSD will benefit from earlier identification of the possibility of developing comorbid autoimmunity. Thus, earlier, and more comprehensive treatment algorithms could be implemented in this population,” the authors suggested.

During the retrospective study, a total of 41 patients were included in the analyses, including 27 patients with NMOSD only and 14 with AD-NMOSD. The patients were predominantly Black (82.9%), female (85.4%), and positive for aquaporin-4 immunoglobulin G. The most frequently associated autoimmune diseases were systemic lupus erythema (66.7%), Sjogren’s syndrome (16.4%), and thyroid disease (16.6%).


Alvarez MR, Gurung A, Velayndhan V, et al. Predictors of overlapping autoimmune disease in Neuromyelitis Optica Spectrum disorder (NMOSD): a retrospective analysis in two inner-city hospitals. J Neurol Sci. 2022;443(120460):120460. doi:10.1016/j.jns.2022.120460