[shakna]

> They state very bluntly that MS is an autoimmune disease... when did this become clear to mainstream science?

A while. The primary symptom of MS, the demylination, is caused by the immune system attacking the myelin. The _why_ of the immune system's attack is still unknown at this point in time, but that it _does_ has been known since at least 1965, with Schumacher's criteria.

[doctor_eval]

I don’t think it’s that settled at all, certainly not in 1965. Prineas in 2001 showed that MS progression may occur in the absence of immune cells and inflammation, for example [0], and people have complained of progression even when taking extremely strong immunosuppressants.

While involvement of the immune system seems likely, and certainly most treatments target the immune system, I don’t think causality has been rigorously demonstrated. It has however been a few years since I looked into it.

As an aside, ISTM quite likely that there may be several causes for MS.

[0] https://pubmed.ncbi.nlm.nih.gov/11706971/

[darkerside]

I wonder how often science gets derailed simply because people are in the habit of expecting a single answer to their questions. We know that car accidents cause lacerations, although there are plenty of cases that happen in the absence of car accidents. Isn't it possible that MS is a symptom with multiple possible causes, any of which could set off a vicious cycle of nerve degeneration?

[neltnerb]

The scientists don't get derailed, but I get too many forwarded articles with silver bullets. One of my friends suggested intentionally getting stung by bees. This is magical thinking for a complex illness.

On the other hand, tecfidera had as the active ingredient a chemical I can buy from alfa aesar for $22 a liter. There's a lot of things that no one has studied yet I guess, for better and worse.

[nnmg]

> Prineas in 2001 showed that MS progression may occur in the absence of immune cells and inflammation

MS researcher here. MS as an autoimmune attack is largely settled in mainstream neuroscience. The paper you cited does not show what you said it does. From the paper: > restricted largely to short segments of disrupted myelin located within linear aggregates of microglial cells

The paper is interesting because it shows that demyelination is happening in lesions that we thought were inactive, but actually do contain microglia and macrophages (immune cells) eating myelin (i.e. an autoimmune --immune system attacking self-- attack). The paper is paywalled but I but you can read it on sci-hub (https://sci-hub.scihubtw.tw/10.1002/ana.1255) Although just reading the abstract says the opposite of what you are claiming, the entire thing is about microglia and macrophages contributing to lesions that the researchers thought were inactive.

[doctor_eval]

OK. I might be quoting the wrong paper, and I’m not a researcher, but I remember clearly that he found a case (14yo girl IIRC) who died during an attack, and there was no immune activity at the site of at least one of the lesions.

If I’m wrong about this then I will accept it, I don’t have an axe to grind.

[neltnerb]

MS is a catch all. Multiple causes can result in demyelination even if the mechanism is the immune system. You have MS if you have demyelination products detectable in your spinal fluid and have lesions on the spinal cord. Whether it's a genetic, environmental, or some other underlying condition clearly varies, for instance the version that I have is almost certainly genetic because of family history but plenty of other people get it with no family history.

But I think people are pretty sure that certain B cells are the easiest to interrupt culprit, my current medication literally just kills a specific B cell and that treatment last six months. Take from that what you will.

[shakna]

_Causality_ is unlikely to be demonstrated until a direct cause is known, and for a complicated illness like MS, it is likely to be a variety of factors, an active and changing area of research.

That in itself doesn't in any way mean that MS wouldn't be classified as autoimmune, however. If there is a high degree of immune system involvement, then it is generally classified as autoimmune, or immune-mediated. And that had been demonstrated. Such as in this [0] paper.

[0] https://doi.org/10.1016%2Fj.febslet.2014.04.007

[unionpivo]

You seem to be well informed. Do you know if there are any studies on: if one suffers from one autoimune condition is he more likely to suffer from others?

[shakna]

I am in no way an expert, which makes me very hesitant to answer these sorts of questions. I am a random person on the Internet. Take that into account when you read what I've written, and weigh it very skeptically.

My knowledge comes from my own health. I was diagnosed with fibromyalgia (which is probably not an autoimmune disease. Probably.), after a ten year long process. MS was the other diagnosis being considered at the end of that process. If I had lesions, MS, if not, FM. Because the latter leaves no physical traces that can currently be detected (there is some progress on that front, but one study does not a trend make).

Some illnesses do have a likelihood to be co-morbid with others. FM for example, has a large number of illnesses it often masks, which may mean it is more likely to have that sort of comorbidity, or it may mean that the statistical model to work out if it is more likely to occur is extremely difficult to create.

I can't speak to whether a disease being autoimmune in nature makes it more likely to trigger other autoimmune illnesses, but it wouldn't be surprising to me. A malfunctioning immune system can malfunction in unexpected ways.

[GordonS]

IME, many doctors, and even some consultants, use fibromyalgia as a catch-all where there is chronic pain and fatigue, but they can't find the underlying cause - basically a big umbrella to cover what are likely a broad spectrum of diseases and health issues.

I suffer from chronic pain and fatigue, and was previously diagnosed with fibromyalgia by both a rheumatologist and a neurologist, despite not even meeting the diagnostic criteria, and having an unrelated auto-immune health issue. Later on, via a skin biopsy I insisted on, it was discovered that I had small fibre neuropathy - damage to the small nerves responsible for pain signalling.

You didn't say anything about your specific symptoms, but if you have chronic limb pain, it might be worth looking at getting a biopsy.

[shakna]

> IME, many doctors, and even some consultants, use fibromyalgia as a catch-all where there is chronic pain and fatigue, but they can't find the underlying cause - basically a big umbrella to cover what are likely a broad spectrum of diseases and health issues.

That is very much not myself. I meet all the diagnostic criteria, and regularly experience somewhere around a hundred of the two hundred known symptoms. There is not another illness that matches my symptoms as well as fibromyalgia. I am a case study in what FM looks like at its very worst (literally, I've been featured in several journals as a case study).

I went through a variety of nerve studies before the diagnosis was made, and they're functioning perfectly. Including multiple biopsies. Getting the FM diagnosis is not easy where I live, most specialists would rather send you away with no diagnosis than that one. I met the criteria for FM on day one, and went through a decade of being tested for absolutely everything else.

The propensity for overdiagnosis, in some nations, of FM, causes me no end of pain whenever I raise the illness. There is always someone who feels the need to tell me that they believe it doesn't exist, or think that I must have something else that has gone undiagnosed, or think that they can suddenly cure it. That's exactly why I don't talk about it in detail. People think that they're helping, especially if they're empathetic. But all it does is undercut the last fifteen years. It makes the suffering more... Lonely. I can appreciate the sentiment, but I've never been able to appreciate the gesture.

I do expect that somewhere in the future FM will be split into several different types, and even illnesses. The illness is extremely "young", it got its name in 1993 (30-40 years younger than MS). Most of the illness is a total unknown at this point in time. There's no real global agreement as to what kind of illness FM is. It gets called autoimmune, neurological, rheumatoid, etc. depending on where you live. The evidence is currently leaning towards neurological, as FM has markers in the white matter of the brain that are unique to those who suffer from it. But we'll probably need another decade or two to be certain about that.

[WillPostForFood]

There is some mixed data, but the consensus is that MS is strongly correlated with other autoimmune diseases. This article has a good summary of several papers on the subject. You can scan down to the section on "Studies of Autoimmune Comorbidities in Multiple Sclerosis"

https://touchneurology.com/multiple-sclerosis/journal-articl...