From the Guidelines
Yes, Sjögren's syndrome can mimic symptoms of multiple sclerosis (MS) due to its potential to cause neurological symptoms similar to those experienced in MS. Patients with Sjögren's syndrome may experience a range of symptoms that overlap with MS, including fatigue, cognitive difficulties, numbness or tingling in extremities, weakness, and vision problems 1. The similarity in symptoms between the two conditions can make diagnosis challenging, as both are autoimmune disorders that can affect the central nervous system.
Key Considerations for Diagnosis
- Comprehensive testing is necessary to distinguish between Sjögren's syndrome and MS, including:
- MRI imaging to identify any lesions in the central nervous system
- Cerebrospinal fluid analysis to check for abnormalities
- Blood tests for Sjögren's-specific antibodies (anti-SSA/Ro and anti-SSB/La)
- Evaluation of dry eye and dry mouth symptoms characteristic of Sjögren's syndrome
- Collaboration between neurologists and rheumatologists is often necessary to ensure an accurate diagnosis, given the overlapping symptoms of the two conditions.
Treatment Implications
- The treatment approaches for Sjögren's syndrome and MS differ significantly, with Sjögren's typically managed with immunosuppressants like hydroxychloroquine, methotrexate, or rituximab, as discussed in the EULAR recommendations for the management of Sjögren's syndrome with topical and systemic therapies 1.
- Accurate diagnosis is crucial to initiate the appropriate treatment, as using MS disease-modifying therapies in a patient with Sjögren's syndrome could be ineffective or even harmful.
From the Research
Similarities between Sjögren's Syndrome and Multiple Sclerosis
- Both Sjögren's syndrome and multiple sclerosis (MS) can present with symptoms of lesions of the brain, spinal cord, and optic tract 2.
- Autoantibodies, such as antinuclear, anti-Ro, and anti-La, can be detected in both conditions 2.
- MRI abnormalities, including periventricular and subcortical lesions, can be found in both diseases 2.
Case Studies of Sjögren's Syndrome Mimicking MS
- A 50-year-old woman presented with transient right limb palsy and numerous episodes of unilateral/bilateral optic neuropathy, which were initially thought to be MS, but were later diagnosed as primary Sjögren's syndrome (pSS) 3.
- Two patients with MS-like symptoms were found to have xerostomia and xeropharmia, and positive Ro antibodies, fulfilling the diagnostic criteria for Sjögren's syndrome 4.
- A Chinese lady developed multiple relapsing neurological events involving the brain and spinal cord, which were initially thought to be MS, but were later diagnosed as primary Sjögren's syndrome (SS) 5.
Importance of Differential Diagnosis
- Screening for biomarkers of SLE or pSS should be systematically performed in cases of acute or chronic myelopathy 3.
- Laboratory tests, such as CSF examination, antibody typing, and cranial and spinal MRI, are useful for differential diagnosis with MS 3.
- Patients with MS-like disease and autoantibodies should be carefully evaluated for other systemic autoimmune diseases, as the treatment and prognosis differ from MS 5.