Daily Ards Research Analysis
A nationwide Korean cohort study links multiple sclerosis and neuromyelitis optica spectrum disorder to markedly elevated risks of autoimmune rheumatic diseases, with distinct risk patterns by neurologic disorder. Findings support proactive, targeted screening and coordinated care in neuroimmunology clinics.
Summary
A nationwide Korean cohort study links multiple sclerosis and neuromyelitis optica spectrum disorder to markedly elevated risks of autoimmune rheumatic diseases, with distinct risk patterns by neurologic disorder. Findings support proactive, targeted screening and coordinated care in neuroimmunology clinics.
Research Themes
- Autoimmune comorbidity in neuroinflammatory diseases
- Population-based risk estimation using national claims data
- Targeted screening strategies in neuroimmunology
Selected Articles
1. Risk of Autoimmune Rheumatic Diseases in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: A Nationwide Cohort Study in South Korea.
Using nationwide claims data (2010–2017) with 1:10 matched controls and a 1-year lag, MS and NMOSD were associated with substantially higher risks of autoimmune rheumatic diseases. NMOSD showed particularly high hazards for Sjögren's syndrome and systemic lupus erythematosus, indicating distinct comorbidity profiles that warrant targeted surveillance.
Impact: This large-scale cohort quantifies disease-specific autoimmune risks in MS and NMOSD, refining understanding of shared autoimmunity and guiding screening strategies. It provides actionable hazard estimates for clinical decision-making.
Clinical Implications: Consider proactive screening for Sjögren's syndrome, SLE, Behçet disease, and seropositive RA in MS/NMOSD clinics, especially in NMOSD. Integrate rheumatology-neurology co-management and tailor immunotherapy choices with awareness of coexisting autoimmunity.
Key Findings
- Overall ARD incidence: 3.56/1000 person-years in MS and 9.13/1000 person-years in NMOSD.
- Elevated ARD risk vs controls: HR 5.35 (95% CI 3.50–8.19) in MS; HR 9.13 (95% CI 5.83–14.28) in NMOSD.
- MS-specific risks increased: Behçet disease HR 17.24, SLE HR 12.25, Sjögren's syndrome HR 6.16, seropositive RA HR 3.32.
- NMOSD-specific risks increased: Sjögren's syndrome HR 82.63, SLE HR 30.85, Behçet disease HR 15.36, seropositive RA HR 3.86.
Methodological Strengths
- Nationwide claims database with standardized ICD-10 and rare disease program identifiers.
- 1:10 matched control cohorts and a 1-year lag to mitigate reverse causation.
Limitations
- Potential misclassification from administrative coding and lack of detailed clinical/laboratory data.
- Residual confounding despite matching; wide confidence intervals for rarer ARDs may reflect small event counts.
- Generalizability beyond the Korean population may be limited.
Future Directions: Prospective multi-ethnic cohorts with validated case definitions; mechanistic studies on shared autoimmunity; evaluation of targeted screening protocols and their impact on outcomes.
OBJECTIVE: To investigate the risk of autoimmune rheumatic diseases (ARDs) in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) compared with a control population using the Korean National Health Insurance Service database. PATIENTS AND METHODS: The MS/NMOSD cohorts were collected from patients registered in the Korean National Health Insurance Service database between January 1, 2010, and December 31, 2017, using the International Classification of Diseases, Tenth Revision diagnosis codes and information in the Rare Intractable Disease management program. The incidence rate and risk of ARDs that occurred after a 1-year lag period was calculated and compared with that of control cohorts matched for age, sex, hypertension, diabetes mellitus, and dyslipidemia in a 1:10 ratio. RESULTS: The incidence rates of ARDs in MS and NMOSD were 3.56 and 9.13 per 1000 person-years, respectively. The hazard ratios (HRs) of ARDs in MS and NMOSD were 5.35 (95% CI, 3.50 to 8.19) and 9.13 (95% CI, 5.83 to 14.28), respectively. The risk of Behçet disease (HR, 17.24; 95% CI, 4.12 to 72.14), systemic lupus erythematosus (HR, 12.25; 95% CI, 4.12 to 36.44), Sjögren syndrome (HR, 6.16; 95% CI, 1.80 to 21.04), and seropositive rheumatoid arthritis (HR, 3.32; 95% CI, 1.78 to 6.19) was increased in MS. In NMOSD, the risk of Sjögren syndrome (HR, 82.63; 95% CI, 19.00 to 359.38), systemic lupus erythematosus (HR, 30.85; 95% CI, 6.23 to 152.80), Behçet disease (HR, 15.36; 95% CI, 2.57 to 91.93), and seropositive rheumatoid arthritis (HR, 3.86; 95% CI, 1.80 to 8.31) was increased. CONCLUSION: The risk of ARDs was increased in MS/NMOSD, and the risk of each ARD differed between MS and NMOSD.