Systemic sclerosis and multiple sclerosis are distinct autoimmune diseases that affect different parts of the body and produce different symptoms.
Multiple sclerosis (MS) causes damage to the myelin sheath, which is the thin membrane that protects the central nervous system (CNS). The CNS consists of the brain and spinal cord.
Systemic sclerosis (SS) causes thickening and hardening of the skin and internal organs, which can prevent these organs from functioning correctly.
This article will examine the key differences between the two diseases, along with their associated symptoms, causes, treatments, and outlooks.
Below is an overview of both MS and SS.
MS is an autoimmune condition in which the body’s immune system attacks the myelin sheath that surrounds and protects the CNS.
In MS, damage to the myelin sheath interrupts signals traveling to and from the brain. This can result in physical, sensory, and cognitive symptoms. The symptoms may flare and recede and may be chronic or short term.
SS is an autoimmune condition that involves the thickening, hardening, and scarring of certain body tissues. This formation of scar tissue is referred to as “fibrosis” and is due to the overproduction of the protein collagen.
There are two types of SS: limited cutaneous SS and diffused SS. Limited cutaneous SS is a milder form affecting only the skin, though it may eventually affect the lungs and digestive system. Diffuse SS is a more severe form affecting both the skin and internal organs.
Although both MS and SS are autoimmune disorders, they are distinct conditions. Multiple sclerosis impacts only the central nervous system, which includes the brain and spinal cord. In contrast, SS is a multisystem disease, meaning it can impact multiple areas of the body.
The following table compares MS and SS:
|Multiple sclerosis||Systemic sclerosis|
Below is an overview of the symptoms of MS compared to those of SS.
The symptoms of MS vary widely from person to person and may also change over time. They may be mild to severe and chronic or intermittent, and they may disappear and reappear. Common symptoms include:
- lack of coordination
- issues with balance
- blurry vision
- double vision
- memory problems
Systemic sclerosis may involve the skin, the internal organs, or both. Symptoms will vary based on the areas affected.
Limited cutaneous SS may cause the following symptoms:
- thickening and swelling of the fingers
- Raynaud’s phenomenon, which is where the fingers turn pale or red and feel numb or tingly due to cold or stress
- areas of skin that appear dark, stretched, or shiny, and do not move as usual
- reduced mobility in the fingers, wrists, or elbows due to skin thickening
- joint pain
Diffuse SS involving both the skin and internal organs may cause the following symptoms:
- sores on the fingertips or knuckles
- calcium bumps on bony areas like the elbows and knees
- grating sounds from inflamed joints
- problems swallowing
- shortness of breath due to lung scarring
- abnormal heart rhythm or heart failure
- high blood pressure that impacts the kidneys
The different treatment approaches for MS and SS are outlined below.
There is currently no cure for MS. Instead, treatment focuses on managing the symptoms and slowing the progression of the disease.
A doctor may prescribe the following drugs to help manage MS:
- dimethyl fumarate
Doctors may also prescribe steroids in the short term to help reduce inflammatory flare-ups and associated symptoms.
The treatment for MS may involve a combination of therapies, such as:
- Physical therapy (PT): The goal of PT is to assist with functional movements and alleviate fatigue and pain. A physical therapist can also help people use mobility aids, such as canes and wheelchairs.
- Occupational therapy (OT): The goal of OT is to establish safety and functionality at home and in the workplace. An occupational therapist can teach people how to use assistive devices and set up plans to make tasks simpler.
- Speech therapy: A speech therapist provides exercises that help train the muscles necessary for talking and swallowing.
The treatment for SS depends on the parts of the body affected. Some examples are outlined below:
- taking medications to slow thickening and hardening of the skin and organ tissues, such as D-penicillamine and colchicine
- taking medications to treat thick, scaly, or itchy skin, such as moisturizing creams and antibiotic ointments
- taking medications called vasodilators to help open blood vessels in Raynaud’s phenomenon
- taking medications to manage symptoms involving the heart, lungs, or kidneys
- undergoing surgery to remove accumulations of calcium salts under the skin or in organs
The relative causes of MS and SS are outlined below.
Medical experts remain unsure as to the exact cause of MS. However, a combination of the following factors likely plays a role in the development of the disease:
- immunologic factors, such as certain cells or cellular processes
- infectious factors, such as certain bacterial or viral infections
- environmental factors, such as vitamin D deficiency, smoking, and obesity
- genetic factors, such as certain genes that could contribute to MS
Medical experts have not yet identified the exact cause of SS. However, there may be a link between SS and inflammation of the cells that line blood vessels. Such inflammation may trigger an overproduction of collagen.
Systemic sclerosis does not pass from parents to children. However, the risk of SS is higher for those who have a relative with the disease. This indicates that certain gene variations may play a role in the development of SS.
Some gene variations that could increase the risk of SS include:
- variations in several human leukocyte antigen (HLA) complex genes
- variations in the following genes:
For both MS and SS, diagnosis is a process of exclusion. This means that a doctor must rule out other conditions before diagnosing either of these diseases.
To receive a diagnosis of MS, a person must meet all three of the following criteria:
- There must be evidence of damage to at least two separate areas of the central nervous system (CNS).
- There must be evidence that the CNS damage occurred at different points in time.
- A doctor must rule out all other possible diagnoses.
A doctor will use magnetic resonance imaging (MRI) and cerebrospinal fluid analysis to assist with this evaluation.
A physical examination is an important step when diagnosing SS. A doctor will look for tightening, swelling, or thickening of the skin, as well as symptoms of Raynaud’s phenomenon.
A doctor may also order a blood test called an antinuclear antibody (ANA) test to look for certain blood proteins. However, the results of this test are not conclusive on their own.
Other tests a doctor may order include:
- pulmonary function tests
- chest CT
- motility studies of the gastrointestinal tract
The relative outlooks for MS and SS are outlined below.
Medical advances have greatly improved the quality of life and life expectancy for people with MS.
Complications generally lead to a life expectancy that is around 7 years below that of the general population. Managing overall health can improve general well-being and reduce the risk of developing complications.
Very rarely, MS advances quickly following diagnosis.
The outlook for SS depends partly on the areas of the body affected.
Limited cutaneous SS
Limited cutaneous SS usually improves over the course of years. While the skin will soften and regain flexibility, loss of movement around a joint may remain permanent.
People who develop limited cutaneous SS have a 10-year survival estimate of approximately 90%. However, developing interstitial lung disease (ILD) or pulmonary arterial hypertension (PAH) increases the risk of death dramatically.
People who develop diffuse SS have a 10-year survival estimate of approximately 75%. However, developing any of the following complications dramatically increases the risk of death:
- renal crisis
People with diffuse SS will require long-term medical treatment to help manage their condition and prevent the above complications.
As MS and SS affect different parts of the body, these two diseases progress in different ways. Some examples are outlined below.
MS often begins with an episode of physical or cognitive MS symptoms that have no other identifiable cause. Symptoms are unique to every individual and do not follow a linear path. They will vary in type and intensity and may disappear or reappear.
The first indication of SS is often Raynaud’s phenomenon, which is where the fingers become discolored in response to episodes of cold or stress. Raynaud’s phenomenon can appear weeks to years before other SS symptoms develop. However, not everyone with SS will experience organ involvement.
Although there are cases of MS and SS occurring together, this combination of diseases is
Both MS and SS are autoimmune diseases. Whereas MS impacts only the central nervous system (CNS), SS can impact multiple organs and organ systems throughout the body. There are two types of SS: localized cutaneous SS, affecting only the skin, and diffuse SS, affecting both the skin and organs.
MS involves damage to the myelin sheaths that protect the cells of the CNS. This damage disrupts brain signaling, resulting in a range of physical and cognitive symptoms. Treatment involves a combination of drugs and therapies to help reduce the damage to the CNS and alleviate symptoms.
Systemic sclerosis involves the overproduction of collagen, which results in the thickening and scarring of body tissues. Scarring of the skin around joints can cause mobility issues, while scarring of the organs can result in organ dysfunction. Treatment involves medications to help manage the symptoms and prevent potentially life threatening complications.