The Relationship Between NMO and Lupus

NMO is sometimes seen alongside other autoimmune conditions, especially those involving abnormal antibodies. Antibodies are proteins our immune system makes to fight germs.^1-3

In some cases, antibodies can mistakenly attack normal parts of the body. This is what happens in neuromyelitis optica spectrum disorder (NMO). Other autoimmune conditions that involve abnormal antibodies include thyroid issues, myasthenia gravis, and lupus.^1-3

What is lupus?

Lupus is a common autoimmune condition. Like in NMO, the body mistakenly attacks itself. Lupus can affect the nervous system and cause similar symptoms to NMO. For example, both lupus and NMO can have symptoms of transverse myelitis. This is inflammation of the spinal cord that can cause severe neurological issues.⁴

Along with the nervous system, lupus attacks many other organs throughout the body. These include the joints, skin, kidneys, and more. The damage can be so severe that the kidneys or other organs may have issues working properly.⁴

How often do lupus and NMO occur together?

Lupus can coexist alongside NMO. However, the exact rate these occur together is unknown. This is due to challenges in separating the 2 from each other and newer methods of diagnosing NMO. Hopefully, with advances in our understanding of NMO, experts will soon have an estimate of how often these occur together.^2,5

There is no exact answer as to why lupus and NMO might be linked. However, there are several theories. One theory is that both conditions share similar genetic risk factors. This means a person who has genes that put them at risk for developing NMO may also have genes that increase the risk for lupus.^3,4

Doctors do not know which specific genes these are right now, but there may be some overlap. The same might be true for any environmental causes that both lupus and NMO share.^3,4

Doctors also think some features of 1 disease might help lead to the development of the other. For example, the abnormal antibodies in NMO need to cross the blood-brain barrier to cause damage. It could be possible that some aspect of lupus allows for this barrier to become weaker. If the barrier is weaker, the abnormal NMO antibodies can cross and cause issues.³

Shared symptoms of NMO and lupus

Some features of lupus, such as transverse myelitis, also occur in NMO. This can lead to both being diagnosed together. It could be possible that some cases of both conditions may be an underlying issue instead. The opposite might also be true.^3,4

With advances in diagnostic tests for NMO, the true number of people with both conditions could be underestimated. Brain and nerve symptoms can occur in both NMO and lupus. Newer blood tests that detect NMO are helpful for a correct diagnosis.^3,4

People with confirmed NMO are usually on drugs that work on the immune system (immunotherapy). These drugs help to prevent the harmful effects of attacks in NMO. This makes an accurate diagnosis important.^1,3

How is lupus treated?

Lupus is treated in a similar way to NMO. The main drugs suppress the immune system. Several of these are shared by both NMO and lupus. However, there are now specific NMO drugs available. This is why a swift and correct diagnosis helps determine the best treatment plan. People with lupus may also undergo plasma exchange like in NMO. Other lupus treatment options include: ^3,4

• Kidney transplant
• Joint replacements
• Blood transfusions
• Lifestyle changes