Introduction
NMOSD, or Neuromyelitis Optica Spectrum Disorder, is a debilitating brain disorder characterized by the inflamed optic nerve and spinal cord. Also known as Devic disease, the disease mimics multiple sclerosis in its early stages, making its diagnosis more challenging.
This autoimmune condition causes significant neurological damage and is frequently associated with comorbidities that further complicate its management. This article intends to explain the common comorbidities associated with NMOSD and how they affect management and quality of life. It also discusses strategies for tackling and managing it.
What Are the Common Comorbidities Associated With NMOSD?
Research indicates that more than half of patients diagnosed with NMOSD develop commodities. The most common associated ones include autoimmune disorders, cardiovascular, metabolic disorders, infections, psychiatric and musculoskeletal disorders.
Autoimmune Disorders
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Sjogren's Syndrome: This is usually characterized by dry eyes (xerophthalmia) and mouth (xerostomia) due to lymphocytic infiltration of salivary and lacrimal glands. It is also called sicca syndrome. The syndrome also manifests neurologically as peripheral neuropathy (weakness, pain, numbness in hands and feet), transverse myelitis (inflammation on both sides of the spinal cord), and, rarely, optic neuritis (characterized by inflammation of the optic nerve, seen as vision loss and eye pain). There have been associations with AQP4Ab-positive patients having more Sjogren' s-positive cases. Usually, the neurologic symptoms of NMOSD precede sicca with more brain involvement. Some rare symptoms, like aphasia, apraxia, encephalopathy, and cortical blindness, have also been reported. One of the major factors in the association between Sjogren’s and NMOSD is the epitopes between AQP4 and AQPF in the CNS and salivary glands; AQP4 antibodies target both of these.
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Systemic Lupus Erythematosus(SLE): This systemic disorder is known to affect multiple organs. Optic neuropathy and transverse myelitis may be seen as a neurological manifest, and these symptoms predict the possibility of NMOSD present. The AQP4Ab gene is seen along with the SSA (Sjogren’s syndrome-related Antigen A Antibody) antibody and ANA (Antinuclear antibody) in these patients. This is the major factor for the association between this disorder and NMOSD. In most cases, symptoms of SLE recede the neurologic presentation of NMOSD.
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Autoimmune Thyroid Diseases: Chronic thyroiditis and Graves disease (an autoimmune disease characterized by hyperthyroidism) are associated with NMOSD. The reason behind this association is AQP4 channels in thyroid follicular cells. So, an antibody against these cells in NMOSD leads to thyroid problems.
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Other Autoimmune Conditions: These usually share a genetic predisposition with NMOSD. Additionally, common factors like autoantibody production and immune dysregulation lead to disorders like rheumatoid arthritis, sarcoidosis, antiphospholipid antibody syndrome, ankylosing spondylitis, systemic sclerosis, and myasthenia gravis.
Metabolic Disorders
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Diabetes: Patients with NMOSD are at an increased risk of diabetes mellitus. Steroid treatment (taken for NMOSD) has been associated with an increased risk. Chronic inflammation seen in NMOSD interferes with glucose metabolism, thereby increasing the chances of diabetes.
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Obesity: Long-term use of corticosteroid therapy and decreased physical activity due to NMOSD leads to weight gain, which can further complicate other health problems.
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Dyslipidemia: Increases in cholesterol and triglycerides are seen in NMOSD patients.
Cardiovascular Disorders: NMOSD has inflammatory components that can make complex combinations in the cardiovascular system, too. Additionally, corticosteroid usage can lead to an increase in blood pressure and further aggravate heart complications.
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Hypertension: Steroid use is known to retain sodium and fluids, increasing blood pressure.
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Ischemic Heart Disease: Inflammatory changes in NMOSD lead to an increased risk of atherosclerosis (narrowing of arteries due to plaque buildup), which can lead to ischemic heart disease (reduced blood supply to the heart).
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Heart Failure: All the above factors lead to an increased risk for heart failure.
Infections and inflammatory Disorders: Patients with NMOSD generally undergo extensive immunosuppressive treatments, which make their bodies prone to infections.
Recurrent Infections: Immune suppression due to medications for NMOSD and antibiotic intake are the causative factors. More commonly seen are respiratory and gastrointestinal infections like pneumonia and Clostridium difficile colitis.
Urinary Tract Infections: Spinal cord involvement in NMOSD leads to bladder dysfunction and infections.
Psychiatric Disorders: NMOSD is a chronic disease that has a significant debilitating effect on the body; this leads to mental health issues and negative effects on the quality of life.
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Anxiety.
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Major depression disorder.
Musculoskeletal Disorders: Using corticosteroids and neurological impairments associated with NMOSD lead to musculoskeletal disorders.
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Osteoporosis: Reduced bone mineral density and an increased risk of fractures seen.
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Muscle Weakness: This is attributed to reduced activity and disuse atrophy.
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Joint Issues: Inflammation in joints may lead to arthritis.
How Are the Comorbidities Managed?
An individual suffering from comorbidity associated with NMOSD requires a comprehensive and multidisciplinary approach to help the patient from symptoms and improve their quality of life.
A few strategies for adequate management include:
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Adopting a Healthy Lifestyle: Patients are advised to eat healthy, balanced meals, adopt a routine of exercise and activity, and avoid deleterious habits like smoking and excess alcohol intake. They should reduce salt or carbohydrate consumption in meals based on their health condition. Also, calcium and supplements are encouraged. All this is done to maintain health and reduce comorbidities.
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Providing Counseling and Support: Patients with NMOSD are more prone to depression and anxiety owing to the nature of the disease. Therefore, counseling therapy and support groups help in significantly managing mental health issues.
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Therapy: Physical and occupational therapy are advised to ensure movement, strengthen muscles, and prevent atrophy. Based on the patient's condition, customized pans are made and implemented.
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Regular Follow-Up and Full Body Checkups: It is important to get full-body assessments and checkups regularly for hypertension, diabetes, and osteoporosis so that they can be detected early on and measures can be taken to control them.
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Preventing Infections: Because of immune suppression, NMOSD patients are more prone to infection. Therefore, it is highly encouraged to advise them to practice hand hygiene and vaccinations, and there must be no delay in treatment and consultation in case of any sign of infection.
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Pharmacological Management: Patients with NMOSD are given corticosteroids and multiple pharmacological treatments. These can also be effective against comorbidities. However, the side effects of long-term use of steroids must be considered. Dose adjustments and the use of steroid-sparing agents may be needed.
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Collaborative Care: The health care professionals must collaborate. Neurologists, endocrinologists, psychiatrists, rheumatologists, general physicians, and physical therapists must all work together to improve the patient's health and quality of life.
Conclusion
Neuromyelitis optica spectrum disorder is an autoimmune disorder that is associated with a large number of comorbidities. These comorbidities arise due to common mechanisms or as a side effect of long-term corticosteroid use. It is crucial to use a multidisciplinary approach to manage them, have proper medications, adopt a healthy lifestyle, encourage regular activities, and provide the required mental health support. By fully managing the comorbidities, doctors can greatly improve the overall health of the patient.
