Is It Multiple Sclerosis or Connective Tissue Disease?

Multiple sclerosis (MS) and connective tissue diseases (CTD) are autoimmune diseases that share many of the same symptoms. MS is a tissue-specific autoimmune disease that affects the myelin sheath (the fatty tissue surrounding nerves in the brain and spinal cord).

MS has similar features to connective tissue diseases, which are disorders that cause inflammation of the connective tissues throughout the body, such as cartilage, fat, ligaments, skin, and more. The similarities between these conditions can prolong and complicate the diagnostic process.

This article explains the differences and similarities between MS and connective tissue disease and why it's essential that all MS patients be screened for CTD.

MS and Connective Tissue Disease Similarities

MS presents with "demyelination" of the myelin sheaths surrounding nerves in the central nervous system (CNS). Demyelination is less likely to be found in other autoimmune and connective tissue diseases.

However, a recent study showed how demyelination might rarely occur in connective tissue diseases such as systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).

The study concluded that if demyelinated lesions are present but they're not MS, it's essential to look at other connective diseases as possible causes. The study also reported that a small percentage of people might later develop MS, which could appear in follow-up appointments.

MS and Connective Tissue Disease Differences

There are more than 200 inflammatory connective tissue disorders, and symptoms may vary. Symptoms can also affect several different parts of the body, including:

• Cartilage
• Fat
• Heart and blood vessels
• Bones
• Tendons
• Ligaments
• Skin
• Lungs
• Other associated organs
  

Connective tissue diseases may affect a specific body system. For example, symptoms that affect the heart and blood vessels can affect the pulmonary system. However, in some cases, many body systems may become involved.

Mixed connective tissue disease (MCTD) is a rare type of autoimmune disease. This condition is characterized by symptoms found in three different connective tissue disorders:

• Polymyositis: An inflammatory muscle disease
• Systemic lupus erythematosus: An inflammatory disease that damages connective tissues, including the lining of blood vessels, and cartilage
• Scleroderma: An inflammatory disease that causes skin hardening and tightening and may also affect the lungs, heart, kidneys, and digestive tract
  

Some affected with MCTD may also have symptoms of rheumatoid arthritis or Sjogren's syndrome.

MS Diagnosis

A definitive MS diagnosis usually requires advanced imaging, such as magnetic resonance imaging (MRI), the gold standard for detecting demyelination.

Computed tomography (CT) scans may also help rule out other neurological conditions and help to diagnose MS. However, CT images provide less clarity than MRIs.

Physical and neurological assessments, collecting a past medical history, laboratory blood tests, and lumbar puncture (spinal tap) may help diagnose MS symptoms. However, they cannot alone provide a diagnosis.

Connective Tissue Disease Diagnosis

Healthcare providers may order various tests for CTD depending on what symptoms a person is experiencing. Many types of connective tissue diseases require their own diagnostic testing methods. Some types of connective tissue diseases include:

• Rheumatoid arthritis (RA)
• Scleroderma
• Lupus
• Sjogren's syndrome
• Churg-Strauss syndrome
• Granulomatosis with polyangiitis
• Dermatomyositis
• Polymyositis

Along with a physical and neurological examination, your healthcare provider will gather all past medical history information. Additional diagnostic testing may include:

• CT scan
• MRI
• Blood tests, such as C-reactive protein and erythrocyte sedimentation rate (ESR)
  
• Urine test
• Tissue biopsy
• Chest X-rays to look for inflammation in the lungs
• Lumbar puncture
• Antibody tests, such as the antinuclear antibody (ANA) test
  

When to See a Healthcare Provider

You should see your healthcare provider if you have unusual physical or neurological symptoms. Without diagnostic testing, it's difficult or impossible to determine the cause of your symptoms and receive a diagnosis.

Symptoms of MS may include:

• Balance issues
• Numbness or abnormal sensation in any area
• Problems moving arms or legs
• Difficulty walking
• Coordination issues
• Tremors
• Weakness in one or more arms or legs

There is a wide range of symptoms for connective tissue diseases. Some people with a connective tissue disease experience subtle signs of the disease many years before being diagnosed. Some early symptoms may include:

• Swollen fingers and joints
• Joint pain
• Acid reflux
• Difficulty swallowing
• Muscle weakness
• Shortness of breath
• Dry cough
• Fatigue
• Rash
• Pale and cold fingers when exposed to cold temperatures (Raynaud's syndrome)
  

Summary

Multiple sclerosis (MS) and connective tissue diseases are autoimmune diseases that can share symptoms. MS affects the body's central nervous system (CNS), caused by damage to the myelin sheath. Connective tissue diseases are caused by inflammation of the connective tissues throughout the body.

One of the main differences distinguishing MS from connective tissue diseases is that myelin sheath damage is less likely to be found in other conditions. However, it can be in some cases.

A Word From Verywell 

Receiving a diagnosis for an autoimmune disease can be frightening. Fortunately, there are specialists who treat autoimmune diseases like MS and CTD, and many resources are available for symptom management. With the help of a team of healthcare providers, many people have a high quality of life with their autoimmune disease.