Association between demyelinating disease and autoimmune rheumatic disease in a pediatric population

Introduction: Multiple sclerosis (MS) and neuromyelitis optica (NMO) are demyelinating diseases of the central nervous system. Autoimmunity in patients with demyelinating disease and in their families has been broadly investigated and discussed. Recent studies show a higher incidence of rheumatic autoimmune diseases among adult patients with MS or NMO and their families, but there are no studies in the pediatric population. Objective: To evaluate an association of MS and NMO with autoimmune rheumatic diseases in pediatric patients. Method: 22 patients younger than 21 years old with MS or NMO diagnosed before the age of 18 years were evaluated regarding epidemiological data, clinical presentation, association with autoimmune diseases, family history of autoimmune diseases, laboratory findings, imaging studies and presence of auto-antibodies. Results: Among the patients studied, there was a prevalence of females (68.1%). The mean age of symptoms onset was 8 years and 9 months and the mean current age was 16 years and 4 months. Two patients (9%) had a history of associated autoimmune rheumatic disease: one case of juvenile dermatomyositis in a patient with NMO and another of systemic lupus erythematosus in a patient with MS. Three patients (13%) had a family history of autoimmunity in first-degree relatives. ANA was found positive in 80% of patients with NMO and 52% of patients with MS. About 15% of ANA-positive patients were diagnosed with rheumatologic autoimmune disieses. Conclusion: Among patients with demyelinating diseases diagnosed in childhood included in this study there was a high frequency of ANA positivity but a lower association with rheumatologic autoimmune diseases than that observed in studies conducted in adults. (C) 2016 Elsevier Editora Ltda.