The Role of Optical Coherence Tomography in Differential Diagnosis of Multiple Sclerosis and Autoimmune Connective Tissue Diseases with CNS Involvement.

Paula Wildner,Małgorzata Siger,Michał Wilczyński,Mariola Matysiak,Magdalena Oset,Ewa Zydorczak,Mariusz Stasiołek

doi:10.3390/jcm9051565

Abstract

The purpose of this study was to examine whether application of optical coherence tomography (OCT) measurements can provide a useful biomarker for distinguishing central nervous system (CNS) involvement in autoimmune connective tissue diseases (CTD) from multiple sclerosis (MS). An observational study included non-optic neuritis eyes of 121 individuals: 59 patients with MS, 30 patients with CNS involvement in CTD, and 32 healthy controls. OCT examination was performed in all subjects to measure retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, ganglion cell layer-inner plexiform layer (GCIPL) thickness, and volume of the macula. There was a significant group effect with regard to superior optic disc RNFL, macular RNFL, GCC, and GCIPL thickness, and macular volume. Post-hoc analysis revealed that MS patients have significantly smaller macular volume and thinner superior optic disc RNFL, macular RNFL, GCC, and GCIPL compared to healthy controls. CTD patients have significantly smaller superior optic disc RNFL, GCIPL, and GCC thickness compared to healthy controls. However, no significant group differences were observed between the patient groups (MS vs. CTD) on any outcome. Although a prominent retinal thinning may be a useful biomarker in MS patients, in a general population of individuals with a confirmed CNS involvement the use of OCT is not specific enough to discriminate between MS and autoimmune CTD.

Highlights

Multiple sclerosis (MS) is presumed to be the most prevalent acquired demyelinating disorder of the central nervous system (CNS) [1]
The study included a total of 121 individuals divided into three groups: patients with MS (n = 59), patients with CNS involvement in connective tissue diseases (CTD) (n = 30), and healthy controls (n = 32)
The majority of patients with CTD were diagnosed with systemic lupus erythematosus (SLE) with or without secondary antiphospholipid syndrome (APS) (8 patients)

Summary

Introduction

Multiple sclerosis (MS) is presumed to be the most prevalent acquired demyelinating disorder of the central nervous system (CNS) [1]. No fully specific diagnostic test is accessible to distinguish between MS and other CNS inflammatory disorders. The cascade of MS pathology comprises demyelination, oligodendrocyte loss, axonal damage, neuronal loss, astrogliosis, and progressive failure of remyelination [3,4]. All these processes coexist at every stage of the disease, and the progressive phase of MS becomes clinically visible when the axonal damage threshold is surpassed [5]. RNFL thinning observed in patients with neuromyelitis optica spectrum disorders (NMOSD) was associated with spreading of inflammatory activity. Patients with neuropsychiatric SLE (NPSLE) did not differ significantly from SLE patients [13]

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