Connective tissue diseases mimicking multiple sclerosis

Background: Connective tissue diseases (CTD) can involve nervous system. Diagnosis and differentiation from multiple sclerosis (MS) can be difficult especially when the disease presented by symptoms and signs related to demyelinating process. The aim of this article is to review the variant forms of central nervous system involvement in CTD especially useful points for differentiation from demyelinating disorders.

Materials and Method: We used the relevant articles in PUBMED, Scopus and other databases especially published in recent ten years.

Results: Systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), Behcet’s disease (BD), Sjogren's syndrome (SS), and some vasculitides can involve nervous system.  Patients may be present by demyelination areas in the white matter of the brain and spinal cord, which are difficult to differentiate from MS and other demyelinating processes, such as transverse myelitis and optic neuritis. On the other hand, autoantibodies such as antinuclear antibodies (ANA) and antiphospholipid antibodies (aPL) can also occur in MS. Treatment and prognosis of these diseases are quite different. In demyelinating diseases the diagnosis is established on the basis of clinical presentation, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) examination, visual evoked potentials (VEP) and autoantibody investigation.

Conclusion: In many patients, distinction between different etiologies of demyelination can be made by considering clinical and paraclinical data, but in some cases, accurate diagnosis can only be made after long-term follow-up