MS treatment a step closer after drug shown to repair nerve coating
theguardian.com
theguardian.com
Just 20 years ago the first disease modification treatments were introduced. These were recurring injections of interferon-beta (1b/1a) for a 18-38% reduction in relapses and annual relapse rate (ARR) of 0.256[1]. Today there are about 20 different options, with Rituximab and humanized variants indicating an annual relapse rate of 0.044 for RRMS patients with a well understood safety profile[2]. On such medications an MS patient can expect a relapse every 22 years vs every 2.5 years unmedicated.
My pet theory is that MS research will ultimately lead to significant breakthroughs in longevity research. This is based on the morbid view that the disease is serious enough for risks to be taken in understanding auto-immune responses, crossing the blood brain barrier and remyelination.
Personally, when people think we are making good progress on something, I’m reminded of these words:
“Before this decade is out...”
Sure, great and rapid progress might require a couple percent of US GDP, and a million people working on a problem, but advancing medical research a few decades in the next 10 years, would benefit everyone.
To make great progress over a decade, we’d need to do something else to advance medical science.
The possibilities boggle my mind
My mind is blown, to say the least. Thanks for sharing!
Just a decade ago, Hepatitis C wasn't curable in nearly 100% of patients (in 12 weeks with limited side effects!). It isn't great news cycle content to focus on rehashing the great achievements we have recently made.
It's heartbreaking to have such a methodical approach for sufferers now of course.
https://www.theguardian.com/lifeandstyle/2017/jul/11/from-vi...
For some reason, every time this discussion happens, people think we spend a lot of research money on hair loss and impotence drugs.
Next, move onto how much care for people with Alzheimer’s is costing:
https://www.cbsnews.com/news/alzheimers-costs-americans-277-...
It would be cheaper to invest into medical research...
Did follow-up studies for that ever happen? Was it affirmed/refuted?
Your HCV example is a great one. Before the anti-virals, it was interferon. You had to take it for months and from talking to people, it makes you feel like you have the flu...for months. The label actually describes a risk of suicide. It’s a very rough drug to be on and the cure rate is <50%. And that’s if you stick with it, which many people don’t.
Today, we have regimens that are weeks in length, minimal side effects and 99% cure rates across all genotypes.
You’re talking about going from a very difficult to cure, chronic condition that can lead to liver failure or liver cancer to just being cured after 12 weeks.
It’s absolutely remarkable.
This news item gives me even more hope.
Out of nowhere, body and brain half-quit working. Needs wheelchair, constantly confused. And then suddenly one day it stops.
I like to hope we'll figure this out during our lifetime.
I’ve read tons of scientific papers and there are too many contradictions.
For example these diets tend to forbid gluten intake, but some research imply better outcomes for patients with high whole grain intake.
I’ve also read that inflamation is useful for preventing cancer, so what good is not having relapses when you get cancer from all the anti imflammatory stuff..
One thing is for sure, there is no one-size-fits-all and there is no magic bullet. If there's something helpful for one condition, it's probably harmful for another. The body is a complex holistic system after all.
What part of the Wahls protocol diet is suboptimal?
Aside from the extra effort and expense. I mean health wise.
Dietary science is full of contradictions, and sometimes contra-indications.
There seems to be a lot of focus on some sort of mythical one size fits all diet for everyone. As if everyone's body systems would react in the same way to any given diet and with an assumption that you can rigidly control the ingredients in your food while still getting food from the grocery store and possibly restaurants.
When evaluating diets for conditions, I would suggest trying to figure out:
a) is it grossly unhealthy / what signs could I use to see if it is affecting my health negatively? b) does it seem to work for some people? c) is it something I could feel satisfied with for a long time? d) how will I know if it's working or not? / how will I be able to confirm?
This is generally a smaller burden of proof than is there scientific consensus that it's a good idea. For many things that might have a connection to food, there isn't consensus on the mechanisms involved, and there may be multiple. It's plausible thst some mechanisms would be affected by diet, and others wouldn't, so some people would see good results by eliminating things, others would see no change, and others may have bad results.
Chronic inflammation is a cause of cancer, not a preventative.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412750/
Personally I’ll stick with treatments that have have had their efficacy well proven through rigorous medical studies rather than ones designed to sell hope on amazon.
https://twitter.com/nachristakis/status/1291414168713797638?...
Experimental drug, through the efforts of terminally ill, are able to discover/show/validate quite powerful benefits, but the drug is too dangerous to use itself. So we stop it.
It is progress and many times, progress is not easy nor cost free. Thank you to all those who, even in their terminally ill state, helped progress treatments for others.
I.e., that there’s some inherent difference between the people the drug harms, and the people it doesn’t; and if you can identify that difference, and test for it, then you can safely give the drug to only the people it doesn’t harm.
The way we currently investigate drug safety in clinical trials doesn’t really allow for this approach. We only seem to do it when a drug is initially declared as safe; introduced into the market; and then we find that it has side-effects that clearly correspond to some subpopulation.
This exact thing happened with another MS drug: natalizumab[0].
It was originally approved in 2004, but later withdrawn in 2005 due to some cases of Progressive multifocal leukoencephalopathy (PML), an opportunistic brain infection that is often fatal. The manufacturer later identified a specific antibody for a virus (JC Virus[1]) present in ~50% of the population which correlated highly with incidence of PML after 1-2 years on natalizumab (~1% chance of PML vs ~0.01% of the normal population). tl;dr the blood-brain barrier maintained by natalizumab also prevents the body from killing the JC Virus in your brain, causing inflammation and eventually death or serious permanent disability.
It was then reintroduced but now patients must undertake regular blood screening (every 6 months) for JCV antibodies, and regular (~12 months) MRI scans to monitor for inflammation (though this is pretty standard with MS these days to look for changes in lesions).
My wife has a rare type of MS (tumefactive MS, ~3000 people in the US have it) and has been on natalizumab since diagnosis about 3.5 years ago with no evidence of disease progression. The story would've been wildly different if we were born 20 years earlier before these treatments came about, it's honestly amazing. Without modern treatments it's very possible she would've been confined to a wheelchair within 10 years of diagnosis, but instead her symptoms are only really noticeable upon examination by a neurologist.
She moved to Gylenia and so far so good (or at least as good as someone can be with MS).
When she was diagnosed 12 years ago it was the beginning of "modern" MS treatments. 10 years back and it would have been disastrous. In 10 years there may be wonderful advancements.
I feel that 100-12 years ago was a true milestone.
Bexarotene also significantly elevates cholesterol markers and blood lipids, which would accelerate heart disease and shorten lifespan.
The researchers aren’t simply dismissing drugs at the first sign of side effects. We have many drugs on the market with significant contraindications due to adverse side effects in specific populations, and doctors are generally well-informed about testing for these conditions and selecting only suitable drug candidates.
> Materials to support the Pregnancy Prevention Programme in women and girls of childbearing potential taking oral acitretin, alitretinoin, or isotretinoin have been updated. Oral tretinoin and bexarotene do not have a Pregnancy Prevention Programme in light of their oncology indication and specialist care setting. However, healthcare professionals are advised that these medicines are extremely teratogenic and product information should be consulted for contraceptive and pregnancy testing requirements when used in females of childbearing potential.
When used for cancer these side effects are very common (greater than 1 in 10) or common (between 1 in 10 and 1 in 100). Some of these are going to be mild and temporary. But some of them are serious.
> Alopecia; anaemia; appetite decreased; arthralgia; asthenia; chills; constipation; deafness; diarrhoea; dizziness; dry eye; dry mouth; dyslipidaemia; eye disorders; gastrointestinal discomfort; gastrointestinal disorders; headaches; hyperhidrosis; hypersensitivity; hypoproteinaemia; hypothyroidism; increased risk of infection; insomnia; leucopenia; lymphadenopathy; muscle complaints; nausea; oedema; oral disorders; pain; pseudolymphoma; sensation abnormal; skin nodule; skin reactions; skin ulcer; thyroid disorder; vomiting; weight changes
Using Bexarotene in cancer patients makes sense because the side effects are more tolerable than dying from cancer.
Using Bexarotene in Multiple Sclerosis patients doesn’t make sense if the net effect is a worsened quality of life (significant thyroid disease) and a shortened lifespan due to accelerated heart disease (hyperlipidaemia and hypercholesterolaemia).
I have small fibre neuropathy, which has left me with constant pain. There are basically no treatments available beyond pain control, except for maybe IVIG treatments (there have been some papers showing promising results, but it's a very expensive treatment, and the NHS will not pay for it).
This is the first I've heard about metformin rejuvenating stem cells - if anyone knows more, especially in relation to nerve damage, or has some starting points for further research, I've be grateful.
This result is particularly exciting since it sounds like it's a drug and not a bio-product like IV IG or stem cell therapy.
Also, sorry to hear about your SFSN. Hope you're doing ok.
I know this may sound hard to believe, but in some cases it's possible to get insurance to cover IVIG for aaSFPN in the United States, even though it's not yet FDA approved for that condition: https://www.karger.com/Article/Fulltext/498858#scrollNav-3-6
Otherwise, IVIG for SFPN is quite expensive just about anywhere.
The ReBUILD doses were rather high though (10 tabs a day!). 1 tab would probably do it over a few months.
https://www.health.harvard.edu/blog/common-anticholinergic-d...
The data suggest correlation, not necessarily causation, but at the least I'd carefully investigate the risks before taking any anticholergic in such high doses. I do understand (with my own chronic health issues) that even with the risk of dementia later on, it may still be a possibility, depending on the severity of current symptoms.
Thanks, I've never even heard of clemastine, and it's rare to find anything notable that doesn't require a prescription in the UK! I already take another gen 1 antihistamine at night (they are very sedating for me), so I guess could swap it for clemastine.
Now all I need to do is convince someone to give me a prescription for metformin...
I've been told that IvIG isn't even a good option for me, and in any case, I'm concerned about the at times severe side effects.
There are so many people around the world suffering from various forms of neuropathy, yet it seems to get relatively little attention. Some people are in wheelchairs, some in constant and severe pain, others lose control of their bladder or bowels, and some experience all of the above. Many millions of people worldwide. It seems like there would be a greater effort to come up with new therapeutics. At the very least, it's a huge market.
Translation: come back in 2040.
Edit: I realize this might not be clear, but drug discovery is a separate paradigm from drug development. So, together they take around 10-13 years.
That was David Nichols' lab at Purdue IIRC. I also believe that they had found other, even more potent derivatives, but refused to publish them for fear they would be used as chemical weapons.
The report had claimed activity at something like 1-10mcg range, which is real spooky when you consider the impact aerosolizing that could have on a room.
It's history of discovery (as well as the 2C variants) was extremely interesting though.
I know this is a tech/curiosity forum, and that it might be confusing for a second, but I feel a bit "Black Mirrorred" if the acronym MS fully belongs to Microsoft on Hacker News. I'm against giving them that power when it's in conflict with a scientific concept such as Multiple Sclerosis as scientific thinking is part of Hacker News.
With that said, I'm fine with whatever the mods decide, I simply want the mods to have considered my argument.
Later edit: and I've never seen the name of the disease acronymed, it's always been in full.
Good nitpick :)
[1] https://www.hersenstichting.nl/hersenaandoeningen/multiple-s... <-- I know that sourcing this is a bit much, but I figured that some of you non-Dutch speakers might feel whimsical enough to look at some Dutch text for funzies. Or maybe it's just me who looks at random texts of other languages O:)
Please update your training set by reading more generally.
That would be an amazing find if it works in humans. My wife was on metformin for many years (not for diabetes) before being recently diagnosed with MS. Coincidentally she experienced her first MS symptoms shortly after stopping metformin. We suspect that use of prescription steroids along with metformin might have been masking the onset of her MS for years and in an indirect way even delayed it slightly.
She just got her first half-dose infusion of Ocrevus, other half scheduled for next week. Ocrevus is such an amazing disease-modifying drug. It's very expensive but our insurance covers it and after the initial dose, she only needs one 3-4 hour infusion every 6 months. No other medication needed on a daily basis! Ocrevus helps ensure no new flare-ups happen anytime soon but it leaves her immunocompromised and there is no remyelination. If metformin + antihistamine end up producing even a little bit of remyelination that would be a game changer because she's young and has enough time to regain everything if it just involves taking a couple of pills daily.
Unrelated but just putting this out there since it's fresh on my mind - if you or loved one ever gets diagnosed with MS or equivalent, you absolutely have to be your own advocate. Best thing you can do in the US is to get an online fax# (I use redfax) and the Dropbox app. Scan every single medical document you get with the Dropbox app, convert it to PDF, and then fax it over to 100 places as needed. Also sign up for every single patient portal including Quest/Labcorp. Be sure to get a DVD of every imaging test (CT/MRI) and upload them for free to postdicom.com to share with anyone or to just see it yourself if curious.
It is a LOT of work and very stressful. But if you're technically savvy, you can avoid a lot of driving back and forth between testing, doctor, hospital, medical centers. And above all reach out to anyone you trust for assistance, even if it's just to pick up groceries. People can surprise you with their generosity.
CRSPR is the true dream. No more MS.
MS seems to be caused by some unknown combination of environmental factors, and genetics.
You fix the bad genes, and you may become immune.
I fully believe that for chronic life threatening diseases people should be allowed to try all sorts of treatments that would be deemed unsafe.
I am sure they’ll come up with an alternative that may have similar or better safety profile and could pay for clinical trials.
No company is going to finance Phase 3 trial on patent free drug.
https://www.drugpatentwatch.com/p/generic-api/BEXAROTENE
On a side note, is anyone aware of better info source that "drugpatentwatch.com"? That site seems to lock useful info behind a paywall.
Must have been a pretty bad side effect though, my first treatment literally resulted in me needing surgery. If that was better than nothing... I'm just going to guess the side effects are very serious. Most other approved MS drugs have some nasty side effects or another already, the bar must be somewhat high given what it's treating.
OF course, there are some folks that do better or worse. I have very few day-to-day symptoms and those are mild: I'm 42. Some folks get in pretty bad shape in their 20s.
As far as side effects: Some have a much higher chance of death. When that gets to high, they deem it unsatisfactory. I wouldn't be surprised if this was instead of or including a chance of being even more disabled or damaging heart/lungs or something else that shortens life.
Anecdotes. I know. Although my progression so far has been fairly in line with my first doctor's statistics.
Did you find any (even anecdotal) correlation between some cause and the result of your disease transforming into progressive?
As far as progression, that is something that happens to some people. Some folks never have the relaspses and time in between and others, the disease turns into progressive form. If scientists haven't figured out why some are more progressive or why some folks' MS turns progressive, I highly doubt looking at one's own life is going to find a key to progression. I'm not the parent here, but I can't see the point in such a thing.
Like, yes, my life has been very stressful for years at a time. Those times weren't when it became progressive though, and good luck finding a control that has never had periods of stress and then doing statistics on them somehow...
I was more pointing out that males, when they get it, are more likely to have a hard time and more likely to get primary forms and the relapsing forms are more likely to turn progressive early on (women wind up catching up after menopause sometimes).
And yeah, everyone has stress. They thought that stress caused relapses at one time, though, but further research has ruled it out. They can look at folks that have had undue stress and look at timing of relapses vs times of major stress to see if the link is correct. The 'stress-free life' advice still gets passed around though.
Stress seems to trigger attacks and symptoms though, I don't think that part is controversial.
I am lucky, mostly: I'm 42 and have a bit of fingertip numbness and get some electric shocks sometimes. I wasn't diagnosed until around 2 years ago, though I had ON in my 20's.
It is somewhat odd, though: My neuro first tried to put my fears to rest, assuring me that it wasn't the same disease as it was even 5 years ago due to the drugs available. I wish more of them worked on progressive forms as well, and I'm still hoping for some miracle - it doesn't have to be a cure, per se, but something that at least heals more often.
Source: friends with very normal lives
That's not true at all (edit: oh I see what you meant--see other comments). My mother was diagnosed before I was 5 and survived until my 30s. I volunteered some with the MS society and there were many man and women who had lived with for several years.
For most of her life, there weren't drugs like betaseron or avonex. Those drugs also had terrible side-effects. I remember listening to a much older woman with MS talking to my mom and how when she was younger she got onto some clinical trial, but got terribly terribly ill. She decided then she wasn't going to be a guinea pig.
The woman said her life slowed down, and she couldn't keep up with a lot of her old friends, but formed new ones. She kept on living.
My mother kept hoping she'd be cured and took treatments as they were approved. They had pretty bad side-effects, and they didn't reverse the existing degeneration, just attempted to prevent further damage.
If you're diagnose with something like this, your health decisions are your own and you should make them carefully. But no matter what you decide, keep living. Adjust your life, deal with your "number of spoons," and keep going as best you can, even as you watch your mobility be taken from you by your own immune system.
There's a slowly progressing form of MS, and a quickly progressing form of MS. I'm not sure of the medical names in English.
You can definitely become old with MS.
My father got the diagnose in begin 70s (1972?) and I was born in 1983. He passed away in 2015 due to complications of MS. The disease affected him everywhere. I mean, I never seen him properly walk, but he only ended in a wheelchair end of '00s. It affected his short-term memory. It affected his kidneys, he was on dialysis for about 6 years. Eventually due to other complications he got infections, ended up with an amputation. He never fully recovered from that. He got infections elsewhere, and half a year later passed away.
[1] My father always kept hope for getting a treatment. He tried a lot of (insane) diets back in the 70s and 80s. None worked. Treatment-wise, they can stop the disease from progressing, but the people who get that treatment who are first in line are youth and people with the quickly progressing version. My father lacked both these variables, so he down below on the list.
Now, from what I understand in this century there's been various medication which can severely slow MS progression down, or even (more recently) completely halt the progression. The challenge with MS nowadays is reversing the damage done.
> But no matter what you decide, keep living.
We decided to stop with dialysis because QoL (Quality of Life) was near 0. My father's body was done. He's always fought the disease, till that point, and he had the mindset you described. He had to adapt to his new limitations all the time. I grew up with a father who was cursing a lot, but had a strong will (I suspect he had autism, like I have).
What I'd argue you need to realize is go carpe diem _without_ doing stupid "YOLO" stuff. If the progression of the disease cannot be stopped) your QoL is going down, and you don't know exactly how it is going down (you may have some ideas though, and you get monitored by doctors). You can use this to plan things you still want to do.
I also want to add that growing up with an ill father affected me in some negative ways, but there's also a clearly positive one. I have compassion for ill people, for weaker people, for minorities, etc. I believe it is because of growing up with an ill father, because the rest of my family on my father's side (cousins most notably) is [IMO] weak in this.
However, don’t underestimate the impact of those side effects. If the drug accelerates heart disease (hypercholesterolaemia and hyperlipidaemia are among the primary side effects) and causes thyroid issues, then it might very well have the effect of worsening quality of life and shortening overall lifespan.
This drug doesn’t appear to treat the root cause of MS, but instead shows some efficacy in reversing one of the downstream manifestations of MS. That implies it would have to be taken indefinitely or at least cycled throughout life.
I know people want to be free to try different medications, but in this case it would be shortsighted to trade one set of serious, life-threatening health complications for another that might actually be worse.
Specifically, the thyroid effects of Bexarotene are so common and significant that one study even recommended that patients be given adjunctive thyroid medication when beginning treatment, even when low doses are used: https://pubmed.ncbi.nlm.nih.gov/30903705/
Likewise, the effects on blood lipids are significant enough that patients are frequently forced to take statins during their course of treatment: https://pubmed.ncbi.nlm.nih.gov/29805374/
Assuming an MS patient would have to take this drug for a lifetime, or at least use it frequently, suggests that these side effects could worsen quality of life or even shorten lifespan more than MS itself.
Promising drug candidate, but no one should be rushing out to find a way to get their hands on a Bexarotene prescription just yet.
The structure is very close to another popular drug, Isotretinoin (Accutane), with similar side effects.
I imagine Accutane probably doesn't have this effect or we'd have caught it, but how wild would it have been if acne medication also ended up being the cure to MS.
It wouldn’t mean it caused it though..
Also: https://en.wikipedia.org/wiki/Flowers_for_Algernon#Synopsis
This [2] completed (results pending) small study will try to verify if supplementing with carnosine will help slow down the progress of or even reverse MS.
Unofficially, I've heard it was a great success. But let's wait.
Edit: Just found another completed study [3]
[1] https://pubmed.ncbi.nlm.nih.gov/29454153/ [2] https://clinicaltrials.gov/ct2/show/NCT03995810 [3] https://www.jns-journal.com/article/S0022-510X(19)32236-1/fu...
I am on Ocrevus myself to treat MS. I have RRMS. I've been on Ocrevus now for a little over 8ish months! I really like Ocrevus... haven't really had any side effects or infusion reactions.
I look FORWARD to more remyelination news and research!!!
It is a phase II, in a phase II the goal is not to test the efficacy of the drug, it is to test the presence or absence of side effects.
A phase III role is needed to test if the drug is helpful to patients. It involves several hundred people to avoid statistical errors. Here there will be no phase III trial.
Another thing is that nerves can repair in the peripheral nervous system (PNS), but (until now) not in the central nervous system (CNS). If a drug can help nerves to repair in the CNS, it is certainly something revolutionary.
No, seriously, it really did take me at least a half second to figure out they’re talking about Multiple Sclerosis. A rather different MS. I would encourage everyone writing and discussing this subject to be more explicit up front, and then they can keep calling it “MS” later in the article.
Is it that the dosages must be higher to treat MS?
[1] https://www.webmd.com/drugs/2/drug-17979/targretin-oral/deta...
“Bexarotene is used to treat skin problems from a certain type of cancer (cutaneous T-cell lymphoma-CTCL).”
Bexarotene is an already-approved cancer drug. Cancer drugs often have worse side effects than normal drugs because they’re taken toward end of life, or taken to delay or prevent death. The difference is that MS patients would presumably need to take this medication over the course of their lifetime, as it doesn’t address the core disease.
If Bexarotene accelerates heart disease and causes thyroid problems, a lifetime of taking this medication might actually worsen quality of life and even shorten lifespan. Unfortunately, many patients desperate to improve the symptoms they know might rush to replace them with side effects they don’t yet know.
Documentary on Emcell on YouTube: https://youtu.be/gYRcmDySFyE
The producer is working on another documentary as part of research Emcell is doing on treating infertility - via injecting certain stem cells into the testes.
Obviously it's easy to label something a scam if you've not actually looked into the details and because "it sounds too good to be true."
Maybe watch some of the videos to see qualitative data from people treated to at least see that part of it if you're not going to dig deep into their research.
Edit to add: or even better for actual experiential learning - find someone with MS who's searching for non-harmful solutions and have them do it, be close to them before to know their quality of life intimately, perhaps go with them for treatment, and then be with them after closely to see how/if they have improvements that you can see + that they report.
I'm guessing you didn't watch the documentary on YouTube yet either - otherwise that's some amazing acting by patients and their local doctors. They have other videos on their site as well.
The fact that they've been running for 30 years proves nothing. See e.g. https://www.mcgill.ca/oss/article/quackery/hoxsey-hoax for another example.
Anything's possible. But without much better evidence than these guys seem to be offering, I wouldn't touch them with a barge pole.
Your "even better" suggestion seems pretty ridiculous to me, by the way. "Want to know whether this thing that seems like a ghoulish fraud preying on people desperate for a cure is real or not? All you have to do is find someone with the disease they claim to be able to cure, persuade them to go and do this costly, risky, probably fraudulent thing, and see what they say about their quality of life is afterwards!" And even if they do manage to persuade someone to do that -- all they get is an n=1 single sample, which is pretty hopeless evidence for anything, especially for a disease like multiple sclerosis which commonly comes and goes in mysterious ways.
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.
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.
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.
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.
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.
If I’m wrong about this then I will accept it, I don’t have an axe to grind.
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.
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.
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.
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.
https://touchneurology.com/multiple-sclerosis/journal-articl...
Well at least 10 years ago a close friend of mine was already being treated with immunomodulators, and it wasn't a cutting edge therapy.
If it only were this simple.