What’s the Difference Between MS and Lupus?

If you’ve been dealing with frequent “invisible” symptoms like headaches, fatigue, confusion, and more, it can be scary to think about what could be wrong. It’s normal to fear that symptoms around your memory and cognition are linked to a neurological issue. But that might not be the case.

Instead, your symptoms might be cause by an autoimmune disease. Multiple sclerosis (MS) and systemic lupus erythematosus (SLE, or lupus) are both autoimmune conditions with overlapping symptoms including fatigue, depression, difficulty concentrating, and memory issues.

Of course, these conditions cause more than cognitive issues, and there are also many differences in physical symptoms between MS and lupus. Recognizing what these are and getting the right diagnosis from your doctor will help you get the treatment you need to manage your symptoms and start to feel better.

“MS is an autoimmune disease that affects the central nervous system (CNS)—the brain, the spinal cord, and the optic nerves,” says Tirisham Gyang, M.D., a neurologist at The Ohio State University Wexner Medical Center in Columbus, OH.

With MS, which affects approximately one million Americans, the immune system attacks part of the central nervous system, creating abnormal inflammation. “The target of that inflammatory response is myelin,” says Dr. Gyang. “Myelin is the fatty coating or insulation that surrounds the nerves and the axons of the nerves. With MS, there’s inflammatory activity that keeps attacking or destroying that myelin, so we call MS a demyelinating disease. Normal myelin is stripped out due to that abnormal inflammation.”

Sclerosis is the medical term for the distinctive scar-like tissue (also called plaques or lesions) that are the result of the immune system’s attack on myelin, per the National Library of Medicine.

Lupus, which affects approximately 1.5 million Americans, is also an autoimmune disease, but unlike MS—which only targets the CNS—it can affect nearly every organ in the body.

“The body is made up of different types of immune cells that do all sorts of different things,” says Nikil Revuri, M.D., a rheumatologist at Summit Health in Clifton, NJ. “When a person has lupus, the immune system mistakenly attacks the body’s healthy tissues and organs. With lupus, B cells and T cells become overactive. This creates autoantibodies that cause inflammation and attack the skin, muscles, joints, kidney, brain, and more.”

Left unchecked, this inflammation can lead to serious complications, including kidney damage, seizure and memory problems, heart damage, blood clots, inflammation of blood vessels, low blood cell counts, and inflammation of the tissue surrounding the lungs, per the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Both MS and lupus are classified as autoimmune diseases, which means the body’s own immune cells have gone rogue and are attacking different tissues. “MS primarily affects the nervous system, the brain, and spinal cord,” says Dr. Revuri. “Lupus can also affect the brain and spinal cord, in addition to other organs in the body.”

Overlapping symptoms of MS and lupus can include:

• Brain fog

• Confusion

• Difficulty concentrating

• Fatigue

• Memory problems

• Mood changes, such as depression

In addition, both autoimmune diseases are more prevalent in women. About nine out of 10 people with lupus are women, according to the Centers for Disease Control and Prevention (CDC), with those in childbearing years (ages 15 to 44) having the highest risk. MS is three times more common among women than men and is also prevalent during childbearing years, according to the National Multiple Sclerosis Society.

Despite both being autoimmune conditions, there are several key differences between multiple sclerosis and lupus. For instance, MS symptoms are driven by the CNS. “MS is purely a neurologic disease, while someone with lupus is more likely to have non-neurologic symptoms because it’s a systemic autoimmune condition,” explains Dr. Revuri. “It’s possible for someone to have lupus and only have neurologic symptoms, but it is quite rare.”

Other symptoms of MS can include:

• Bladder or bowel dysfunction

• Blurred, double vision, or loss in vision

• Hearing loss

• Muscle weakness, especially in the arms and/or legs

• Numbness and tingling, most commonly in the hands or feet

• Spasticity (twitches and spams in the muscles)

• Speech problems

• Trouble balancing or feeling dizzy when walking

On the other hand, the most common symptom of lupus is joint pain, says Dr. Revuri. “Joint swelling, pain, and stiffness (especially in the morning) are some red flags,” he says. This is one of the reasons that lupus can be confused with rheumatoid arthritis (RA).

Other symptoms of lupus can include:

• Anemia

• Eye inflammation

• Fever

• Fingers and/or toes feeling numb and/or turning blue

• Hair loss

• Heart, kidney, or lung problems

• Pain and swelling in the joints

• Sensitivity to the sun

• Skin rashes (particularly a malar, or butterfly rash)

While some symptoms of MS and lupus might feel similar, there are distinct differences a doctor will look at in order to get a diagnosis.

Diagnosing Lupus

“A person who has lupus will have a host of other problems aside from neurologic ones,” says Dr. Revuri. “We’ll start by looking at the whole picture, which may include joint swelling, rashes, muscle inflammation, weakness or muscle pain, and kidney issues such as protein in the urine.”

Specific tests can also pinpoint which autoimmune disease is causing symptoms. “Patients with lupus tend to have abnormal antibodies, and we test for this in the blood,” says Dr. Gyang. “A common one we see is antinuclear antibodies (ANA).” Dr. Revuri adds that 97% of lupus patients will have ANA in their blood work. “There will be other specific antibodies—like anti-double-stranded DNA (anti-dsDNA)—in addition to protein in the urine and elevated inflammation markers called erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).” All of these can be used to help diagnose lupus, he says.

Diagnosing MS

With MS, imaging tests can help your doctor make a diagnosis in addition to bloodwork.

Additional tests for MS include:

• An MRI scan, which can show lesions or damage in the brain or spinal cord caused by inflammation.

• A spinal tap or lumbar puncture, which takes a small sample of spinal fluid to test for changes in antibodies.

• Optical coherence tomography (OCT), to examine retinal nerve fiber and thickness of the retina.

• Evoked potential tests, which uses electrodes placed on the scalp to measure the speed of messages along the sensory nerves to the brain.

• Neuropsychological testing to help measure cognitive function including memory, concentration, and motor skills.

There is no cure for MS or lupus, but disease-modifying therapies (DMTs) have made it possible to slow, delay, or reverse the progression of these autoimmune conditions, says Dr. Gyang.

Most medications for MS and lupus are immunosuppressive, meaning they help target the immune responses that attack the brain, spinal cord, and other organs of the body affected by inflammation.

Drugs to treat MS include:

• Aubagio (teriflunomide)

• Avonex, Rebif (interferon beta 1a)

• Bafiertam (monomethyl fumarate)

• Briumvi (ublituximab)

• Campath, Lemtrada (alemtuzumab)

• Copaxone, Glatopa (glatiramer acetate)

• Gilenya (fingolimod)

• Kesimpta, Arzerra (ofatumumab)

• Mavenclad (cladribine)

• Mayzent (siponimod)

• Ocrevus (ocrelizumab)

• Ponvory (ponesimod)

• Tecfidera (dimethyl fumarate)

• Tysabri (natalizumab)

• Vumerity (diroximel fumarate)

• Zeposia (ozanimod)

Drugs to treat lupus include:

• Arava (leflunomide)

• Azasan, Imuran (azathioprine)

• Benlysta (belimumab)

• Cellcept (mycophenolate)

• Medrol (methylprednisolone)

• Otrexup, Rasuvo, Rheumatrex, and Trexall (methotrexate)

• Plaquenil (hydroxychloroquine)

• Rituxan, Truxima (rituximab)

• Sandimmune, Neoral, Gengraf (cyclosporine)

• Saphnelo (anifrolumab-fnia)

“The cornerstone of lupus treatment in most cases is hydroxychloroquine,” adds Dr. Revuri. “It’s an antimalarial drug that has been around for a long time, and it modulates the immune system in lupus patients without suppressing it.”

It’s possible to have MS and lupus together, but it’s not common. A report published in Advances in Psychiatry & Neurology found there have only been 18 cases of MS and lupus coexisting in one patient recorded worldwide.

Where there may be a higher risk of comorbidity is with family history. “Autoimmune diseases tend to run in clusters, especially in families,” says Dr. Gyang. “If you have genetic susceptibility, you may be prone to having not just one but multiple autoimmune diseases. For example, you could have MS and type 1 diabetes, lupus, Sjogren’s syndrome, or another autoimmune disease.”

Still, Dr. Revuri says the underlying problems between MS and lupus are very different, stemming from different abnormalities. As such, a rheumatologist and neurologist would work very closely together when treating someone with both of these diseases to make sure they are treating the active symptoms.

“Even though MS and lupus both use immunosuppressive medications, the way these drugs work are very different, so it’s important to understand which disease is causing which symptoms if MS and lupus exist together,” says Dr. Revuri.

Multiple sclerosis and lupus are both autoimmune conditions that can include symptoms like difficulty concentrating, brain fog, and fatigue. But while multiple sclerosis only affects the central nervous system, lupus can damage many other parts of the body, including the joints, skin, kidneys, heart, and lungs. It’s important to talk to your doctor if you notice any of these symptoms or if something seems off, so you can get the right diagnosis and start with the treatments you need to help manage your condition.