Autoimmune comorbidity in demyelinating diseases of the central nervous system Samarina

Abstract

Autoimmune diseases (ADs) are a broad group of phenotypically heterogeneous conditions characterized by both unique and common clinical and immunological manifestations, with varying rates of progression and responses to pathogenetic therapy. More than 10 per cent of the global population suffers from at least one of ADs, and in recent decades there has been a worldwide trend towards an increase in the number of cooccurring autoimmune conditions, particularly in regions and countries with a high level of socio-demographic development. Given their shared risk factors and immunopathological mechanisms, demyelinating diseases of the central nervous system are associated with an increased likelihood of developing a concomitant ADs, which may unpredictably influence the course of the demyelinating process and the choice of optimal treatment. This review examines the co-occurrence of multiple sclerosis and neuromyelitis optica spectrum disorders (NMOSD) with anti-aquaporin-4 antibodies (AQP4) with the most common associated ADs, and summarises the evidence regarding the preferred therapeutic approaches in each specific case.