Öz
Objective: Multiple sclerosis (MS) is the most
common autoimmune disease of the central nervous system in which impaired
immune activation is involved. It is known that other autoimmune diseases are
seen more frequently in MS patients. Many
rheumatologic diseases could cause neurologic disorders that mimic MS. Our aim in this
study is to determine the rates of autoantibody positivity and the clinical significance of these positivity rates in patients with MS.
Method: 110 patients who were followed up with MS diagnosis in our clinic between
2008 and 2018 were retrospectively
evaluated for autoimmune disease biomarkers. The
diagnosis of MS was confirmed using both 2005 and 2010 Revised Mc Donald
Criteria.
Results: The ANA (antinuclear antibody)
positivity rate in our patients was 10.9%,
the ANA profile positivity was 9.1%. Anti-ds DNA (double stranded
deoxyribonucleic acid) positivity rate was 1.8%, anti-cardiolipin Ig
(immunglobulin) G and Ig M were 0.9% positive. Anti-microsomal antibody
positivity was 11.8% while anti-thyroglobulin antibody was positively 13.6%.
The value of complement 3 (C3) was found to be 92.7% normal and 4.5% higher and
2.7% lower, respectively. The C4 values were 98.2% normal, while they were
11.8% higher than normal .
Six patients had six different
diseases in which ethiopathogenesis the role of autoimmunity was also revealed ( ankylosing spondylitis, psoriasis,
systemic lupus erythematosus, morfea, ptriyazis, Sjögren's syndrome).
Conclusions: Although some autoantibody positivities
in MS patients are more frequent than healthy controls, these positivities are
not usually associated with systemic rheumatologic disease and haven’t clinical
significance. Therefore, the evaluation of autoantibodies in each MS patient
does not seem cost effective. So, the MS patients whose autoantibody levels are
to be measured should be well selected before the evaluation the patients'
medical history and complaints should be taken into consideration.
Anahtar Kelimeler
Multiple sclerosis autoimmune disease rheumatologic disease autoantibody
Kaynakça
- 1. Barcellos LF, Kamdar BB, Ramsay PP et al. Clustering of autoimmune diseases in families with a high-risk for multiple sclerosis: a descriptive study. Lancet Neurol 2006; 5: 924–31. 2. Marrie RA, Reider N, Cohen J et al. A systematic review of the incidence and prevalence of autoimmune disease in multiple sclerosis. Mult Scler 2015; 21: 282–93. 3. Kamm CP, Uitdehaag BM, Polman CH. Multiple sclerosis: current knowledge and future outlook. Eur Neurol 2014; 72: 132–41. 4. Miller DH, Weinshenker BG, Filippi M et al. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler 2008; 14: 1157–74.5. de Andre´s C, Guillem A, Rodrı ´guez-Mahou M, Lo´pez Longo FJ. Frequency and significance of anti-Ro (SS-A) antibodies in multiple sclerosis patients. Acta Neurol Scand 2001; 104: 83–7. 6. Collard RC, Koehler RP, Mattson DH. Frequency and significance of anti nuclear antibodies in multiple sclerosis. Neurology 1997; 49: 857–61.7. Garg N, Zivadinov R, Ramanathan M et al. Clinical and MRI correlates of autoreactive antibodies in multiple sclerosis patients. J Neuroimmunol 2007; 187: 159–65. 8. Heinzlef O, Weill B, Johanet C et al. Anti cardiolipin antibodies in patients with multiple sclerosis do not represent a subgroup of patients according to clinical, familial, and biological characteristics. J Neurol Neurosurg Psychiatry 2002; 72: 647–9.9. Richard-Miceli C, Criswell LA. Emerging patterns of genetic overlap across autoimmune disorders. GenomeMed 2012; 4: 6.10. Tan EM, Feltkamp TE, Smolen JS et al. Range of antinuclear antibodies in "healthy" individuals. Arthritis Rheum 1997; 40: 1601–11.11. Tourbah A, Clapin A, Gout O et al. Systemic autoimmune features and multiple sclerosis: a 5-year follow-up study. Arch Neurol 1998; 55: 517–21.12. Spadaro M, Amendolea MA, Mazzuconi MG et al. Autoimmunity in multiple sclerosis: study of a wide spectrum of autoantibodies. Mult Scler 1999; 5: 121–5.13. Barned S, Goodman AD, Mattson DH. Frequency of anti-nuclear antibodies in multiple sclerosis. Neurology 1995; 45: 384–5.14. Solomon AJ, Hills W, Chen Z et al. Autoantibodies and Sjogren’s Syndrome in multiple sclerosis, a reappraisal. PLoS One, 2013; 8: e65385.15. de Seze J, Devos D, Castelnovo G et al. The prevalence of Sjogren syndrome in patients with primary progressive multiple sclerosis. Neurology 2001; 57: 1359–63.16. Posselt RT, Coelho VN, Pigozzo DC et al. Prevalence of thyroid autoantibodies in patients with systematic autoimmune rheumatic diseases. Cross-sectional study. Sao Paulo Medical Journal 2017; 135: 535-540.
Öz
Amaç: Multipl
sklerozis (MS) bozulmuş immun aktivasyonun rol aldığı santral sinir sisteminin
en sık görülen otoimmun hastalığıdır. MS hastalarında diğer
otoimmun hastalıkların daha sık görüldüğü bilinmektedir. Ayrıca birçok
romatolojik hastalığın da santral sinir sisteminde MS’i taklit edecek nörolojik
bulgulara neden olabildiği saptanmıştır. Bizim bu çalışmadaki amacımız ise hastanemizde MS tanısı ile takipli hastalardaki
otoantikor pozitiflik oranlarını ve bu pozitiflik oranlarının klinik önemini
ortaya koymaktır.
Yöntem: 2008- 2018 yılları
arasında kliniğimizde MS tanısı ile takip edilen 110 hasta, otoimmun hastalık
biyomarkıları yönünden retrospektif olarak değerlendirildi. Hastaların
tanısının konulmasında hem 2005 hem de 2010 revize edilmiş Mc Donald Kriterleri
kullanıldı.
Bulgular:
Hastalarımızdaki ANA (antinükleer antikor) pozitifliği
oranı %10.9 iken, ANA profili pozitifliği %9.1’di. Anti-ds DNA (double stranded deoksiribonükleik asit)
pozitiflik oranı %1.8 iken, anti-kardiyolipin Ig (immunglobulin) G ve Ig M %0.9
oranında pozitifti. Anti mikrozomal antikor pozitifliği %11.8 iken,
anti-tiroglobulin antikor %13.6 oranında pozitifti. Kompleman3 (C3) değeri
%92.7 oranında normal sınırlarda iken %4.5 oranında yüksek, %2.7 oranında düşük
saptandı. C4 değerleri ise %98.2 oranında normal sınırlarda iken %11.8 oranında
yüksek olarak tespit edildi.
Altı hastamız etyopatogenezinde
otoimmunitenin rolünün saptandığı altı farklı hastalığa sahipti ( ankilozan
spondilit, psöriyazis, sistemik lupus eritematozus,
morfea, pitriyazis, Sjögren sendromu).
Sonuç: MS hastalarında
otoantikor pozitifliklerinin bazıları topluma göre daha sık olsa da çoğunlukla
bu otoantikor pozitiflikleri sistemik romatolojik hastalık varlığı ile ilişkili
değildir ve klinik açıdan anlam içermemektedir. Bu nedenle her MS hastasında
otoantikorların araştırılması maliyet açısından etkin görünmemektedir. Bu
yüzden otoantikor düzeyi ölçülecek MS hastaları iyi seçilmeli ve ölçüm öncesinde
hastaların öykü ve yakınmaları dikkate alınmalıdır.
Anahtar Kelimeler
Multiple sclerosis autoimmune disease rheumatologic disease autoantibody
Kaynakça
- 1. Barcellos LF, Kamdar BB, Ramsay PP et al. Clustering of autoimmune diseases in families with a high-risk for multiple sclerosis: a descriptive study. Lancet Neurol 2006; 5: 924–31. 2. Marrie RA, Reider N, Cohen J et al. A systematic review of the incidence and prevalence of autoimmune disease in multiple sclerosis. Mult Scler 2015; 21: 282–93. 3. Kamm CP, Uitdehaag BM, Polman CH. Multiple sclerosis: current knowledge and future outlook. Eur Neurol 2014; 72: 132–41. 4. Miller DH, Weinshenker BG, Filippi M et al. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler 2008; 14: 1157–74.5. de Andre´s C, Guillem A, Rodrı ´guez-Mahou M, Lo´pez Longo FJ. Frequency and significance of anti-Ro (SS-A) antibodies in multiple sclerosis patients. Acta Neurol Scand 2001; 104: 83–7. 6. Collard RC, Koehler RP, Mattson DH. Frequency and significance of anti nuclear antibodies in multiple sclerosis. Neurology 1997; 49: 857–61.7. Garg N, Zivadinov R, Ramanathan M et al. Clinical and MRI correlates of autoreactive antibodies in multiple sclerosis patients. J Neuroimmunol 2007; 187: 159–65. 8. Heinzlef O, Weill B, Johanet C et al. Anti cardiolipin antibodies in patients with multiple sclerosis do not represent a subgroup of patients according to clinical, familial, and biological characteristics. J Neurol Neurosurg Psychiatry 2002; 72: 647–9.9. Richard-Miceli C, Criswell LA. Emerging patterns of genetic overlap across autoimmune disorders. GenomeMed 2012; 4: 6.10. Tan EM, Feltkamp TE, Smolen JS et al. Range of antinuclear antibodies in "healthy" individuals. Arthritis Rheum 1997; 40: 1601–11.11. Tourbah A, Clapin A, Gout O et al. Systemic autoimmune features and multiple sclerosis: a 5-year follow-up study. Arch Neurol 1998; 55: 517–21.12. Spadaro M, Amendolea MA, Mazzuconi MG et al. Autoimmunity in multiple sclerosis: study of a wide spectrum of autoantibodies. Mult Scler 1999; 5: 121–5.13. Barned S, Goodman AD, Mattson DH. Frequency of anti-nuclear antibodies in multiple sclerosis. Neurology 1995; 45: 384–5.14. Solomon AJ, Hills W, Chen Z et al. Autoantibodies and Sjogren’s Syndrome in multiple sclerosis, a reappraisal. PLoS One, 2013; 8: e65385.15. de Seze J, Devos D, Castelnovo G et al. The prevalence of Sjogren syndrome in patients with primary progressive multiple sclerosis. Neurology 2001; 57: 1359–63.16. Posselt RT, Coelho VN, Pigozzo DC et al. Prevalence of thyroid autoantibodies in patients with systematic autoimmune rheumatic diseases. Cross-sectional study. Sao Paulo Medical Journal 2017; 135: 535-540.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Dahili Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Mart 2019 |
| Kabul Tarihi | 18 Mart 2019 |
| Yayımlandığı Sayı | Yıl 2019Cilt: 41 Sayı: 1 |