Which came first, a diagnosis of rheumatoid arthritis (RA) or multiple sclerosis (MS)?
Recently at MultipleSclerosisCentral.com, I mentioned that I would begin writing here at MyRACentral.com. Several of the commenters on that post shared that they too have both MS and RA. I also received several emails asking questions about my experience living with both multiple sclerosis and rheumatoid arthritis, including an e-mail from a reader asking me which disease was diagnosed first. She also wanted to know if symptoms from the primary disease delayed the diagnosis of the second disease.
I'm amazed by the number of people who step forward to tell me about their own combination of these two disabling diseases. Many of us have experienced difficulty in receiving an accurate diagnosis of one autoimmune disease. Imagine if you had two.
Research shows that having one autoiummune disease can delay the diagnosis of a second autoimmune disease, potentially leading to increased disability (See "Comorbidities Delay MS Diagnoses and Increase Disability" in Neurology, Multiple Sclerosis from MedPage Today).
It is hard to know if symptoms of multiple sclerosis or symptoms of rheumatoid arthritis delayed the diagnosis of either disease in my case. My journey reached a diagnosis of multiple sclerosis in October 2005 with the diagnosis of rheumatoid arthritis in April 2007, only 18 months later. But it was in 1993 that I first experienced symptoms now believed to be related to multiple sclerosis. These symptoms included impaired vision, headaches, and depression in the months following a minor whiplash event. The doctors at the student clinic in the School of Optometry at Indiana University suggested that I have an MRI. Basically, they wanted to make sure I didn't have a brain tumor.
I did not have a brain tumor and any inflammation of the optic nerve that might have been present had resolved by the time I had the MRI. Eventually my vision problems and headache went back to normal, leaving the previous symptoms still unexplained.
In 1995, I tripped on the way to a concert performance with the Evansville Philharmonic. I don't know what I tripped on, but I trashed my French horn, sprained my wrists, and broke my left arm just above the elbow (hairline fracture). After this event, I developed an ache in my left arm and wrist that I simply became accustomed to over the years.
In 2000, optic neuritis returned and stole vision from my right eye for two months. After another trip through the MRI machine and a round of high-dose corticosteroids, I still had no diagnosis (For the complete story, read "Hey!! Turn up the lights and pass me some color!")
For the next five years, I had several random and vague complaints which centered on my hands, which I wrote about in "Carpal Tunnel Syndrome or Not?" Being seronegative (for RA factor) certainly delayed my RA diagnosis, but likely reminding the doctor that "I had optic neuritis in 2000 and my mother has lupus" probably didn't help either. During these years, I also experienced fatigue, weakness, and walking problems. In the end, however, I still didn't have a diagnosis of either RA or MS.
In 2005, I finally got an MS diagnosis. It began in my left hand with tingling, numbness and weakness that traveled up my left arm, the same arm I broke when I fell in 1995. I underwent a series of tests for multiple sclerosis over the next four months. (For more information on criteria and testing, read "Beginner's Guide to MS: Do I have MS? What does it take to get diagnosed with MS?")
The MS diagnosis was not a surprise to me since it had been a possibility after having optic neuritis in 2000. However, the RA diagnosis was a surprise at the time and friends asked, "Does this mean that you do not have MS?" My quick response was, "No, it just means that I double-dipped in the autoimmune disease bucket."
Day to day, overlapping symptoms (such as fatigue, weakness, numbness, and brainfog) can create a challenge in guessing which disease is the culprit. Some days it doesn't matter the cause of the symptom, the treatment is the same. Rest.
With more than 80 types of autoimmune diseases, no wonder it is difficult to diagnose one, much less two or more in one person. (See MedLinePlus article)
If you are someone living with rheumatoid arthritis and worried that you are developing multiple sclerosis, or if you have developed multiple sclerosis, please know that it is not the end of the world. Your choices for RA treatments are limited, but RA doesn't affect how MS is treated. If you have more questions about MS and RA, I'm glad to try to answer them.