Related Experiment Video
Updated: Aug 16, 2026
Human Serum Anti-aquaporin-4 Immunoglobulin G Detection by Cell-based Assay
Published on: April 5, 2019
Anti-phospholipid antibodies in patients with multiple sclerosis and MS-like illnesses: MS or APS?
J W IJdo1, A M Conti-Kelly, P Greco
1Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Objective:
To describe the frequency, clinical, and laboratory features of patients diagnosed with multiple sclerosis (MS) or MS-like illnesses (MSL) among a large, prospectively followed cohort of anti-phospholipid antibody (aPL)-positive patients.
Methods:
Between 1990 and 1995 patients referred to a university-affiliated rheumatology clinic were prospectively evaluated for aPL based on questionnaires designed to detect aPL-related symptoms and/or a family history of aPL-related illnesses. Magnetic resonance imaging (MRI) was performed when significant neurological features were present. A subgroup of all patients diagnosed with MS or MSL was identified and their clinical, laboratory, and imaging findings were reviewed.
Results:
Of 322 patients evaluated for aPL-related symptoms or events, 189 (59%) were positive for at least one class of aPL. Twenty-six of 322 patients (8%) carried a diagnosis of MS or MSL, either at the initial evaluation or during the study period. Twenty-three of the 26 individuals (88%) tested positive for aPL, while the remaining 3 (11%) tested repeatedly negative. Eighteen of the 23 patients (78%) had either more than one class of aPL or had multiple positive titers. IgM aCL was noted in 18 of the 23 patients (78%). Oligoclonal bands were noted in five patients. Antinuclear antibodies (ANA) and low complement levels were frequently observed. Blinded MRI readings showed lesions consistent with MS in the majority of cases. Clinically, 7 patients had transverse myelitis (TM), while optic neuritis (ON) was present in 8 patients. Most patients had either occult symptoms of rheumatic disease or contributory family histories. None had a defined underlying connective-tissue disease.
Conclusion:
A substantial number of aPL-positive patients have a concurrent diagnosis of MS or MSL, frequently presenting with elevated IgM aCL, optic neuritis, and transverse myelitis. The anti-phospholipid syndrome (APS) should be strongly considered as an alternative diagnosis to MS in these patients.
Insights
A significant portion of anti-phospholipid antibody (aPL)-positive patients are diagnosed with multiple sclerosis (MS) or MS-like illnesses (MSL). These patients often present with specific clinical and laboratory features, suggesting a strong link between aPL and neurological conditions.
Area of Science:
- Rheumatology
- Neurology
- Immunology
Background:
- Anti-phospholipid antibodies (aPL) are associated with an increased risk of thrombosis and pregnancy morbidity.
- Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system.
- The overlap between aPL and MS/MS-like illnesses (MSL) requires further investigation.
Purpose of the Study:
- To determine the frequency of MS or MSL diagnoses in a prospective cohort of aPL-positive patients.
- To characterize the clinical, laboratory, and imaging features of these patients.
- To explore the potential diagnostic overlap between aPL and MS/MSL.
Main Methods:
- Prospective evaluation of patients referred to a rheumatology clinic from 1990-1995 for aPL.
- aPL testing based on questionnaires for related symptoms or family history.
- Review of clinical, laboratory, and MRI findings for patients diagnosed with MS or MSL.
Main Results:
- 8% of 322 evaluated patients were diagnosed with MS or MSL.
- 23 of 26 MS/MSL patients tested positive for aPL, often with multiple positive titers or IgM aCL.
- Common findings included optic neuritis (ON), transverse myelitis (TM), and MRI lesions consistent with MS.
Conclusions:
- A substantial number of aPL-positive patients concurrently have MS or MSL.
- Elevated IgM aCL, ON, and TM are frequent presentations.
- Anti-phospholipid syndrome (APS) should be considered as an alternative diagnosis in MS patients.
Related Concept Videos
01:20Myasthenia Gravis: Overview and Treatment
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which leads...
01:19Multiple Sclerosis l: Introduction
01:22Myasthenia Gravis ll: Pathophysiology