Differences Between Lupus and MS

What are the differences and similarities between lupus (systemic lupus erythematosus) and multiple sclerosis (MS)? This is an important question, especially since some people with lupus are misdiagnosed as having MS and vice versa. Knowing the differences can help you and your healthcare provider make the right diagnosis and treatment decisions.

Lupus and MS Basics

Lupus (systemic lupus erythematosus) and multiple sclerosis can appear similar in many ways. Both lupus and MS are chronic autoimmune diseases.

More than 100 different autoimmune diseases exist, with many overlapping symptoms. In these conditions, the immune system—instead of attacking an invader such as bacteria or viruses—attacks your own body.

In lupus, the immune system may attack various organs in the body, particularly the skin, joints, kidneys, heart, lungs, or nervous system. (Some forms of lupus only affect the skin, such as a condition known as discoid lupus erythematosus.)

In multiple sclerosis, the immune system specifically attacks the myelin sheath, the fatty protective layer on nerve fibers in the brain and spinal cord. The myelin sheath can be thought of as the outer cover of an electrical cord.

When the cover is damaged or missing, touching the wires could give you a shock. When the myelin sheath is damaged, impulses between the brain to the body may not be transmitted properly.​

Similarities

Lupus and MS are very different diseases, but they have several things in common:

• They are both autoimmune conditions.
• We don't know the exact causes.
• They are clinical diagnoses, meaning there isn't a lab test or imaging study which can confirm the diagnosis for certain. Rather, the diagnosis of lupus or MS relies on a set of characteristic symptoms, signs, and lab tests that can't be explained by another diagnosis.
• They affect people in the same age group. Both diseases most commonly affect the same population—younger women—although they affect other populations as well.
• They are both relapsing-remitting disorders. Both lupus and MS can follow a pattern of remission and relapse which repeats.
• They can both cause brain lesions that look similar on magnetic resonance imaging (MRI).
• While the nerves are the primary target of MS, lupus sometimes affects the nerves as well.
• Both conditions appear to have a genetic element and may occur within families.
• Both conditions are commonly misdiagnosed at first.
• Both conditions tend to cause problems with fatigue, headaches, muscle stiffness, and memory problems.

Differences

In addition to the similarities, there are several differences commonly found between lupus and MS. These differences are especially important as the treatments for the two diseases are usually quite different.

MS is the most common neurological disease that strikes young people. About half of lupus patients will have central nervous system (brain and spinal cord) symptoms. Yet, while both lupus and MS can affect the central nervous system, they tend to do so in different ways.

Differences in Symptoms

Lupus and MS have similar symptoms. Both diseases tend to cause:

• Neurological symptoms, including problems with memory
• Muscle and joint pain
• Fatigue

Yet there are differences as well. In general, lupus does more generalized damage to your body than MS, which primarily damages the nervous system.

Lupus Symptoms

Two of the most common symptoms of lupus are rashes and joint pain. The following common effects of lupus on the nervous system do not typically occur in people with MS:

• Migraine headaches
• Changes in personality
• Changes in cognitive function
• Epileptic seizures
• Stroke (less common)

MS Symptoms

In contrast, rashes are uncommon with MS. The most common MS symptoms include:

• Double vision
• Numbness
• Tingling or weakness in one of the extremities
• Problems with balance and coordination
  

Differences in Laboratory Tests

Antiphospholipid antibody testing is one way that healthcare providers can start to distinguish lupus from MS. This antibody, also called lupus anticoagulant, increases the ability of the blood to clot. It's found in 50% of cases of lupus.

While antinuclear antibodies may be found in some people with MS, their presence is much less common than with lupus. With lupus, it is rare not to have antinuclear antibodies (ANA-negative lupus.)

Rarely, people with lupus will have transverse myelitis. This condition is marked by spinal cord inflammation and damage to the myelin sheath. It mimics MS and is sometimes the only lupus symptom. It can, therefore, confuse a diagnosis.

Studies have found that testing for antinuclear and anti-aquaporin-4 antibodies may be helpful in distinguishing lupus and neuromyelitis optica from multiple sclerosis.

Differences in Treatments

It is important to recognize the differences between lupus and MS when making a diagnosis because the treatment for the two conditions is quite different.

The most common treatments for lupus include:

• Non-steroidal anti-inflammatory drugs
• Steroids (corticosteroids)
• Antimalaria drugs
• Immunosuppressive drugs (DMARDS or disease-modifying anti-arthritis drugs) for severe disease, especially cases involving major organs

The most common medications used to treat MS include:

• Interferons (such as Avonex)
• Immunosuppressant drugs
• Immunomodulators

Differences in Prognosis

With proper diagnosis and treatment, between 80% and 90% of people with lupus will live a normal lifespan. That prognosis has improved significantly. In 1955, only half of people with lupus were expected to live beyond five years. Now, 95% are alive after 10 years.

The life expectancy with MS is on average seven years shorter than for someone without MS, but this can vary considerably between different people with the disease. Some people with a very aggressive disease may die after a relatively short time with the disease, whereas many others live a normal lifespan.

The Impact of Misdiagnosis

As mentioned above, several commonalities between lupus and MS that can contribute to a misdiagnosis:

• Both diseases are immunological.
• Both affect a similar population.
• Both have a relapsing-remitting course
• Both may cause neurological symptoms.
• Both may involve brain lesions.

Since different medications are used to treat lupus and MS, one of the problems with misdiagnosis is that you won't get the best treatments for your disease. That's not all, though: Some MS medications can make lupus symptoms worse.​

If you have been diagnosed with either lupus or MS, especially if your condition is considered "atypical," talk to your healthcare provider. Ask about and learn about your diagnosis. If you don't understand something, ask again. If the diagnosis doesn't seem to fit, be sure to mention that at your next appointment.

Make sure you are seeing a specialist who is an expert at treating either lupus or an MS specialist. You may also want to get a second opinion. Some people are hesitant to request a second opinion, but not only does this not offend your healthcare provider, but it's also expected when people are coping with a serious medical condition.

You might feel like you are alone in coping with your diagnosis. Many people with MS are hesitant to talk about their condition in public, and people with lupus often find that people say hurtful things when learning of their disease.

There is less understanding about lupus or MS in the population at large relative to many other medical conditions. Many of the symptoms are not visible to others, resulting in "silent suffering."​

Consider joining a support group or an online support community. This can be a good way to meet other people who are coping with some of the same challenges and is often a great way to learn more about your disease and the latest research.

Correction - September 12, 2022: The article was updated to clarify the differences between MS and lupus symptoms.