What's the Difference Between Lupus and Multiple Sclerosis?

Learn What Distinguishes Lupus From Multiple Sclerosis

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What are the differences and similarities between lupus (systemic lupus erythematosus) and MS (multiple sclerosis? This is an important question, even more of an issue as some people with lupus are misdiagnosed as having MS and vice versa. Let's take a look at how these conditions are alike, and how they can be differentiated so that you and your doctor make the right diagnosis.

Lupus and MS Basics

Lupus (systemic lupus erythematosus) and MS (multiple sclerosis) can appear similar in many ways.

In fact, people may easily be misdiagnosed as having MS, when they really have lupus.

Both lupus and MS are chronic autoimmune diseases. There are roughly 100 different autoimmune diseases, with many overlapping symptoms. In these conditions, the immune system—instead of attacking an invader such as bacteria or viruses—attacks your own body

In lupus, the immune system may attack various organs in the body, particularly the skin, joints, kidneys, heart, lungs or nervous system. (For some people, lupus only affects the skin, a condition known as discoid lupus erythematosus.)

In multiple sclerosis, the immune system specifically attacks the myelin sheath, the fatty protective layer on nerve fibers in the brain and spinal cord. The myelin sheath can be thought of as you would picture the outer cover of an electrical cord. When the myelin sheath is damaged, the transmission of impulses from the brain to the body and the body to the brain can be affected.

Similarities Between Lupus and MS

Lupus and MS are very different diseases, but they have several things in common:

  • They are both autoimmune conditions.
  • We don't know the exact causes - Just as we don't know the clear cause of lupus, we are uncertain about the causes of MS.
  • They are clinical diagnoses, meaning there isn't a lab test or imaging study which can confirm the diagnosis for certain. Rather, the diagnosis of lupus or MS relies on a set of characteristic symptoms, signs and lab tests that can't be explained by another diagnosis.
  • They affect people in the same age group. Both diseases most commonly affect the same population—younger women—although they affect other populations as well.
  • They are both relapsing/remitting conditions. Both lupus and MS can follow a pattern of remission and relapse which repeats (they are both relapsing-remitting disorders.)
  • They can both cause brain lesions on MRI which are similar.
    While the nerves are the primary target of MS, lupus sometimes affects the nerves as well.
  • Both conditions appear to have a genetic element and may occur within families.
  • Both conditions are commonly misdiagnosed at first.
  • Both conditions tend to cause problems with fatigue, headaches, muscle stiffness, and memory problems.

Differences Between Lupus and MS

In addition to the similarities, there are several differences commonly found between lupus and MS. These differences are especially important as the treatments for the two diseases are usually quite different. MS is the most common neurological disease that strikes young people. About half of lupus patients will have central nervous system (brain and spinal cord) symptoms. Yet, while both lupus and MS can affect the central nervous system, they tend to do so in different ways.

Differences in Symptoms of Lupus and MS

There are often similarities between lupus and MS with regard to symptoms; both diseases tend to cause neurological symptoms including problems with memory, muscle and joint pain, and fatigue. Yet there are differences as well. In general, the damage to the body is more generalized with lupus than with MS.

According to the National Multiple Sclerosis Society, the following common effects of lupus on the nervous system do not typically occur in people with MS:

  • Migraine headaches
  • Changes in personality
  • Changes in cognitive function
  • Epileptic seizures
  • Stroke

The most common symptoms of lupus are rashes and arthritis.

In contrast, rashes are uncommon with MS and the most common symptoms include double vision, numbness, tingling, or weakness in one of the extremities, and problems with balance and coordination.

Differences in Laboratory Tests Between Lupus and MS

Antiphospholipid antibody testing is one way that doctors can start to distinguish lupus from MS.

While antinuclear antibodies may be found in some people with MS, their presence is much less common than with lupus. With lupus, it is uncommon to not have antinuclear antibodies (ANA-negative lupus.)

Rarely, people with lupus will have transverse myelitis. This condition is marked by spinal cord inflammation and damage to the myelin sheath. It mimics MS and is sometimes the only lupus symptom. It can, therefore, confuse a diagnosis. Studies have found that testing antinuclear and anti-aquaporin-4 antibodies may be helpful in distinguishing neuromyelitis optic in lupus from multiple sclerosis.

Differences in imaging Studies with Lupus and MS

In general, a brain MRI will show more lesions with MS ("black holes and bright spots,") but sometimes the brain lesions found with lupus or MS can be indistinguishable.

Differences in the Treatments for Lupus and MS

It is important to recognize the differences between lupus and MS when making a diagnosis because the treatment for the two conditions is quite different.

The most common treatments for lupus include non-steroidal anti-inflammatory drugs, steroids (corticosteroids) and antimalaria drugs. Immunosuppressive drugs (DMARDS or disease modifying anti-arthritis drugs) may be used for severe disease, especially that which affects the kidneys.

In contrast, the most common medications used to treat MS include interferons (such as Avonex,) immunosuppressant drugs, and immunomodulators.

Differences in Prognosis Between Lupus and MS

Between 80 and 90 percent of people with lupus will live a normal lifespan. The prognosis of lupus has changed. In 1955 only half of people were expected to live five years. Now, 95 percent of people are alive after 10 years. The life expectancy with MS is on average seven years shorter than for someone without MS, but this can vary considerably between different people with the disease. Some people with the very aggressive disease may die after a relatively short time with the disease, whereas many people live a normal lifespan.

Why Misdiagnosis Sometimes Happens

In addition to transverse myelitis, in which lupus can mimic MS (but which is treated differently,) there are several other commonalities between lupus and MS that can contribute to a misdiagnosis:

  • Both diseases are immunological.
  • Both affect a similar population.
  • Both have a relapsing–remitting course
  • Both may have neurological symptoms.
  • Both may have brain lesions.

What Happens With a Misdiagnosis (When Lupus is Misdiagnosed as MS)?

Since different medications are used to treat lupus and MS, one of the problems with a misdiagnosis is that you are not getting the best treatments for your disease. Yet that's not all, as some MS medications can make lupus symptoms worse.

Bottom Line on Lupus vs MS

If you have been diagnosed with either lupus or MS, especially if your condition is considered "atypical," talk to your doctor. Ask about and learn about your diagnosis. If you don't understand something, ask again. Make sure you are seeing a specialist who is an expert at treating either lupus or MS. Learn about the doctors who care for people with lupus and the specialists who care for people with MS.

You may also want to get a second opinion. Some people are hesitant to request a second opinion, but not only does this not offend your doctor, it is expected when people are coping with a serious medical condition.

You might feel like you are very alone coping with your diagnosis. Many people with MS are hesitant to talk about their condition in public, and people with lupus often find that people say hurtful things when learning of their disease. There is less understanding about lupus or MS in the population at large relative to many other medical conditions. Many of the symptoms are not visible to others, resulting in "silent suffering."

Consider joining a support group or an online support community. This can be a good way to meet other people who are coping with some of the same challenges and is often a great way to learn more about your disease and the latest research.

Thankfully, there are now many organizations focused on providing support for people with these diseases. Check out these MS support organizations or ways to find support if you have lupus.

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