Is multiple sclerosis (Multiple Sclerosis, MS) primarily managed by rheumatology or neurology?

From the Guidelines

Multiple sclerosis (MS) should be managed by neurologists, not rheumatologists, as they specialize in disorders of the nervous system, including the brain, spinal cord, and peripheral nerves, which are the primary sites affected in MS. The disease involves demyelination and damage to nerve fibers in the central nervous system, leading to symptoms like muscle weakness, coordination problems, vision issues, and cognitive changes. While rheumatologists treat autoimmune conditions affecting joints and connective tissues, MS specifically targets the nervous system. Neurologists have specialized training in diagnosing MS through clinical evaluation, MRI imaging, spinal fluid analysis, and evoked potential tests, as recommended by the European Academy of Neurology–ECTRIMS guidelines on the treatment of MS 1. They manage MS with disease-modifying therapies such as interferon beta medications, glatiramer acetate, dimethyl fumarate, fingolimod, ocrelizumab, and natalizumab, among others. Neurologists also coordinate comprehensive care including symptom management, rehabilitation services, and monitoring for disease progression and treatment efficacy.

Some key considerations in the management of MS include:

• The use of natalizumab for highly active relapsing-remitting MS, which is influenced by the occurrence of progressive multifocal leukoencephalopathy (PML) 1
• The importance of early detection of PML, followed by rapid cessation of natalizumab therapy and plasma exchange to restore immune function, which appears to be associated with a good prognosis 1
• The role of MRI in the diagnosis and monitoring of MS, including the use of MRI criteria to support the diagnosis and rule out other disorders 1
• The potential benefits of autologous haematopoietic stem cell transplantation (AHSCT) for the treatment of relapsing–remitting MS that is refractory to conventional disease-modifying therapies (DMTs) 1

Overall, the management of MS requires a comprehensive and multidisciplinary approach, with neurologists playing a central role in the diagnosis, treatment, and coordination of care.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Multiple Sclerosis Classification

Multiple sclerosis (MS) is classified as a neurodegenerative disease, specifically affecting the central nervous system.

• It is characterized by inflammatory demyelination with axonal transection 2
• The disease is influenced by gender, genetic, and environmental factors 3

Specialization for Treatment

The treatment of MS falls under the specialty of neurology.

• Neurologists diagnose and treat MS using a combination of signs and symptoms, radiographic findings, and laboratory findings 2
• Disease-modifying therapies (DMTs) are available for relapsing-remitting MS and secondary progressive MS with activity, which are typically managed by neurologists 2, 4

Rheumatology Involvement

While MS is primarily a neurological condition, rheumatologists may be involved in the treatment of certain aspects of the disease.

• However, there is no direct evidence to suggest that rheumatology is a primary specialty for MS treatment 5, 2, 4, 6, 3
• The focus of MS treatment is on managing the neurological symptoms and slowing disease progression, which is typically the domain of neurologists 2, 4