ORIGINAL RESEARCH article
Front. Neurol.
Sec. Multiple Sclerosis and Neuroimmunology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1634127
Clinical Features and Prognosis of NMOSD Patients with Positive Autoimmune Antibodies
Provisionally accepted
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Background: This study aimed to compare clinical outcomes in NMOSD patients with non-AQP4-IgG autoantibodies, specifically anti-connective tissue disease antibodies (anti-CTD Abs) and antithyroid antibodies (ATAbs), to evaluate their impact on disease severity and prognosis. Methods: A retrospective analysis was conducted using data from NMOSD inpatients with follow-up periods ≥180 days, stratified by antibody status: anti-CTD Abs (+)/(-), ATAbs (+)/(-), or double positivity (+)/(−). The primary outcomes included relapse rates, Expanded Disability Status Scale (EDSS) scores, and survival outcomes. Results: 1) Anti-CTD Abs (+): Higher proportion of female patients, increased relapse frequency; decreased red blood cell (RBC) count and aspartate aminotransferase (AST) levels. 2) ATAbs (+): Greater incidence of acute brainstem syndrome (ABS); reduced peripheral leukocyte, neutrophil, and lymphocyte counts; elevated serum urea levels. 3) Double (+): Marked female predominance, higher incidence of ABS, decreased RBC count, hemoglobin (Hb) levels, and cerebrospinal fluid (CSF) chloride concentration; elevated serum urea. 4) AQP4-IgG association: AQP4-IgG-positive patients were more frequently female, with higher prevalence of anti-CTD Abs positivity but lower prevalence of ATAbs positivity. 5) Prognostic analysis: Both double-positive and single-antibody-positive groups showed higher disability (EDSS ≥4.0/≥6.0) compared with antibody-negative patients, although no significant differences were observed between the two single-antibody subgroups. 6) Multivariate analysis identified combined antibody positivity (OR=16.292), baseline EDSS score (OR=3.179), and age at onset (OR=1.052) as independent predictors of poor clinical outcomes. Conclusion: Routine screening for anti-CTD Abs and ATAbs in NMOSD patients may aid in assessing disease severity and prognosis. Patients with double positivity represent a high-risk subgroup requiring aggressive therapeutic strategies to prevent severe disability.
Keywords: Autoimmune antibodies, Thyroid antibodies, Connective Tissue Diseases, Coexistence of autoimmune diseases, Neuromyelitis optica spectrum disorders (NMOSD)
Received: 23 May 2025; Accepted: 14 Aug 2025.
Copyright: © 2025 Liu, Liu, Yuan and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Limei Wang, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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