Immune-mediated comorbidities in multiple sclerosis: a scoping review
4 affiliations
- 1Department of Medicine, Western University Schulich School of Medicine & Dentistry
- 2Department of Clinical Neurological Sciences, Western University Schulich School of Medicine & Dentistry
- 3Department of Clinical Neurological Sciences, London Health Sciences Centre
- 4Department of Clinical Neurological Sciences, London Health Sciences Centre Research Institute
Abstract
Background: Immune-mediated comorbidities are increasingly recognized in people with multiple sclerosis (PwMS), but their frequency, recorded diagnostic sequence, and clinical relevance remain incompletely characterized. We aimed to characterize their co-occurrence with MS, diagnoses following MS, associations with subsequently diagnosed MS, and relationships with MS clinical outcomes.
Methods: We conducted a scoping review guided by the PRISMA-ScR checklist. PubMed, Embase, and Scopus were searched for studies published from January 1, 2001, through February 28, 2026. Eligible studies evaluated co-occurrence; immune-mediated diseases diagnosed following MS; associations between previously diagnosed immune-mediated diseases and subsequently diagnosed MS; or associations with MS activity, disability, or progression. Additional studies were identified through backward reference screening without publication-year restrictions.
Results: Autoimmune thyroid disease, type 1 diabetes (T1D), psoriasis, inflammatory bowel disease (IBD), and bullous pemphigoid showed some of the most recurrent evidence of higher co-occurrence with MS, whereas findings for rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), vitiligo, atopic dermatitis, asthma, and less frequently studied conditions were more variable. Studies investigating immune-mediated diseases diagnosed following MS reported heterogeneous, condition-specific associations, with higher subsequent occurrence for psoriasis, IBD, and bullous pemphigoid in some populations. Studies examining previously diagnosed immune-mediated diseases and subsequently diagnosed MS reported higher estimates for selected conditions, including T1D, psoriasis, IBD, bullous pemphigoid, systemic sclerosis, and primary Sjögren’s syndrome, although their magnitude, precision, and consistency varied. Evidence regarding associations between immune-mediated comorbidities and MS activity, disability, or progression was limited and heterogeneous. A small number of studies indicated adverse disability or MRI outcomes associated with T1D, whereas findings for other conditions were mixed, outcome-specific, or inconclusive.
Conclusion: Several immune-mediated diseases demonstrated recurrent co-occurrence with MS, while separate studies reported condition-specific associations with diagnoses following MS or with subsequently diagnosed MS. Findings varied across diseases, study designs, and temporal frameworks, and may indicate shared susceptibility, surveillance bias, diagnostic delay, treatment exposure, residual confounding, or coincidental coexistence. Current evidence is insufficient to establish an MS prodrome or biologically distinct MS subgroups. Longitudinal studies using standardized disease definitions, documented diagnostic chronology, treatment data, and appropriate confounder adjustment are needed to clarify clinical and prognostic relevance.
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BibTeX
@article{solak2026immunemediated,
title = {{Immune-mediated comorbidities in multiple sclerosis: a scoping review}},
author = {Austin Daniel Solak and Patricia Mariana Riccio and Da Hee Seo and Samin Ayromlou and Azhar Mohammed Alanazi and Juan Manuel Racosta},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1911169},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1911169/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Immune-mediated comorbidities in multiple sclerosis: a scoping review
AU - Austin Daniel Solak
AU - Patricia Mariana Riccio
AU - Da Hee Seo
AU - Samin Ayromlou
AU - Azhar Mohammed Alanazi
AU - Juan Manuel Racosta
PY - 2026
DA - 2026/10/28
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1911169
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1911169/full
AB - Background: Immune-mediated comorbidities are increasingly recognized in people with multiple sclerosis (PwMS), but their frequency, recorded diagnostic sequence, and clinical relevance remain incompletely characterized. We aimed to characterize their co-occurrence with MS, diagnoses following MS, associations with subsequently diagnosed MS, and relationships with MS clinical outcomes. Methods: We conducted a scoping review guided by the PRISMA-ScR checklist. PubMed, Embase, and Scopus were searched for studies published from January 1, 2001, through February 28, 2026. Eligible studies evaluated co-occurrence; immune-mediated diseases diagnosed following MS; associations between previously diagnosed immune-mediated diseases and subsequently diagnosed MS; or associations with MS activity, disability, or progression. Additional studies were identified through backward reference screening without publication-year restrictions. Results: Autoimmune thyroid disease, type 1 diabetes (T1D), psoriasis, inflammatory bowel disease (IBD), and bullous pemphigoid showed some of the most recurrent evidence of higher co-occurrence with MS, whereas findings for rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), vitiligo, atopic dermatitis, asthma, and less frequently studied conditions were more variable. Studies investigating immune-mediated diseases diagnosed following MS reported heterogeneous, condition-specific associations, with higher subsequent occurrence for psoriasis, IBD, and bullous pemphigoid in some populations. Studies examining previously diagnosed immune-mediated diseases and subsequently diagnosed MS reported higher estimates for selected conditions, including T1D, psoriasis, IBD, bullous pemphigoid, systemic sclerosis, and primary Sjögren’s syndrome, although their magnitude, precision, and consistency varied. Evidence regarding associations between immune-mediated comorbidities and MS activity, disability, or progression was limited and heterogeneous. A small number of studies indicated adverse disability or MRI outcomes associated with T1D, whereas findings for other conditions were mixed, outcome-specific, or inconclusive. Conclusion: Several immune-mediated diseases demonstrated recurrent co-occurrence with MS, while separate studies reported condition-specific associations with diagnoses following MS or with subsequently diagnosed MS. Findings varied across diseases, study designs, and temporal frameworks, and may indicate shared susceptibility, surveillance bias, diagnostic delay, treatment exposure, residual confounding, or coincidental coexistence. Current evidence is insufficient to establish an MS prodrome or biologically distinct MS subgroups. Longitudinal studies using standardized disease definitions, documented diagnostic chronology, treatment data, and appropriate confounder adjustment are needed to clarify clinical and prognostic relevance.
SN - 1664-3224
ER -