When MS and RA Co-Occur: How to Cope

In MS, the immune system attacks myelin, the protective coating on nerves in the brain and spinal cord. The damage disrupts communication between the brain and the rest of the body, affecting vision, movement, sensation, balance, and thinking.

Rheumatoid arthritis is a systemic autoimmune disease that causes persistent inflammation in the joints but can also cause symptoms that impact the eyes, lungs, heart, and skin, as well as a person’s overall health.

Although these conditions behave differently, MS and RA share enough biological and environmental influences that some people develop both. “People with MS do seem to have a higher risk of developing RA,” says Dr. Carlson.

Keep reading to learn why MS and RA may occur together, what symptoms overlap, which signs point more clearly to RA rather than a worsening of MS, and how to manage both conditions with confidence.

“MS and RA share several common threads, most notably genetic susceptibility, immune dysregulation, and overlapping pathogenic mechanisms,” says Carlson.

Genetics Play a Role

Large population studies have identified “genetic loci” associated with both conditions, says Carlson. That means when researchers have scanned people’s DNA, they’ve found specific spots on certain genes that seem to raise the risk for both MS and RA.

Shared Environmental or Lifestyle Factors

Environmental factors don’t cause autoimmune diseases on their own, but some experts believe that they may interact with genetic susceptibility and shift the immune system toward dysregulation.

MS and RA share some environmental risk factors including:

• Vitamin D Deficiency People with MS and RA consistently have low levels of vitamin D. Research suggests that supplementing with vitamin D may help reduce the risk of developing MS or even help manage MS after diagnosis, and it may help control RA.

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• Smoking Smoking is associated with an increased risk of developing both conditions and an increased risk of flare-ups and poorer outcomes.

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• Obesity A person’s chances of developing MS or RA are higher if they have obesity.

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When you already have MS, it’s easy to attribute new or worsening symptoms to MS, which could cause you to overlook signs of early RA. Here’s how these symptoms overlap and some subtle differences, depending on their root causes.

Fatigue

In people with MS and RA, fatigue is often caused by chronic inflammation, says Carlson.

Muscle and Joint Pain

Widespread pain and central pain sensitization are also common in both diseases.

“Joint pain and swelling are hallmark features of RA; MS can also present with musculoskeletal pain and spasticity,” says Carlson.

Muscle Weakness

Weakness is another shared symptom, says Daniel Kurz Jr., MD, assistant professor neurology and neurologist at UChicago Medicine in Illinois.

“I often see weakness as a symptom in my MS patients, though like fatigue, it’s a multifactorial symptom. Weakness can occur in the setting of pain, which is something that I hear from our RA patients as well,” he says.

Limited range of motion, or how much an extremity can move, can be a sign or symptom of weakness, says Dr. Kurz.

A neurological exam can help distinguish between weakness that has a neurological cause and weakness that is due to joint pain and muscle loss, which would be more RA related, says Kurz.

Numbness and Tingling

“It becomes a question of whether or not it’s inflammation from the central nervous system or the peripheral nervous system or more localized to the joint itself, which would mean it’s related to rheumatoid arthritis,” says Kurz.

Eye Inflammation

Both MS and RA can cause eye inflammation — but for different reasons.

Because untreated inflammation can damage the cornea or other eye structures, new eye symptoms should be evaluated by an eye doctor right away.

While MS and RA share some nonspecific symptoms, there are a few hallmark or classic symptoms of RA that are different and suggest you may have both MS and RA.

• Joint swelling, warmth, and tenderness
• Symmetrical joint symptoms (for example, both wrists, both hands, or both knees)
• Morning stiffness lasting an hour or longer

Managing two autoimmune disorders can feel overwhelming, but coordinated care can help you stay ahead of symptoms and reduce complications.

Work With Both a Neurologist and a Rheumatologist

Experts emphasize the need for comanagement. Managing MS and RA together really requires both a neurologist and a rheumatologist, says Kurz.

Clearly Communicate Your Treatment Goals and Symptoms

When possible, tell your provider about your experience of the disease processes and what your treatment goals are, says Craig Smuda, MD, PhD, an assistant professor of medicine and rheumatologist at UChicago Medicine in Illinois.

“This can help us work to preserve the things that are most important to a patient,” says Dr. Smuda.

Tell your provider about what’s going on with your symptoms and how you feel — don’t worry about it not being relevant, he says.

“This can help us catch things that may indicate that the therapy is not working well or that there’s something else going on that is preventing you from having the best experience in your life, despite your conditions that need management,” says Smuda.

Keep Every Provider Updated on Your Medications

The coexistence of MS and RA presents unique treatment challenges, says Carlson.

“TNF-alpha inhibitors, commonly used in RA, are generally contraindicated in MS due to the risk of exacerbating demyelinating disease,” she says.

Ask Your Doctors About Treatments That May Help Both Conditions

Take Care of Your Mental Health

Tell Your Care Team if You’re Overwhelmed

Symptom management, appointments, and lifestyle adjustments can be stressful. Don’t hesitate to tell your providers if you’re struggling. There may be ways to simplify your routine or get additional support.

• MS and RA can occur together: The two autoimmune conditions share genetic, immune, and environmental influences.
• Fatigue, pain, weakness, and eye inflammation can overlap in MS and RA, but classic RA symptoms such as joint swelling, warmth, and prolonged morning stiffness are key signs that something other than MS may be going on.
• Managing both conditions works best when you have a neurologist and rheumatologist who coordinate your care, review your medications for safety, and help you find treatment options that work for both MS and RA.
• Living with two autoimmune diseases can be physically and emotionally challenging, but communicating openly with your healthcare team can help you get timely support and stay on top of your health.