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People living with multiple sclerosis (MS) have a higher risk of developing other health conditions compared with the general population. Among these potential comorbidities (co-occurring health conditions) is rheumatoid arthritis (RA), a disease in which the autoimmune system attacks the joints.
A 2016 study found that people with MS had a 78 percent higher incidence of RA than did the general population.
More than 600 MyMSTeam members have reported living with both conditions, and some have described their experiences. “I was diagnosed with RRMS in 2008, then rheumatoid arthritis in 2013,” shared a member who has relapsing-remitting MS (RRMS). “I manage both diseases through exercise and diet in conjunction with DMDs.” Disease-modifying drugs (DMDs), also called disease-modifying therapies (DMTs), are discussed below.
“I have rheumatoid arthritis along with MS. Mornings are hard. I do stretching in the morning. It helps,” another member said.
Knowing some of the similarities and differences between RA and MS may help you and your doctor determine a potential cause of newly arising symptoms, such as joint pain. Paying close attention to symptoms and reporting them to your health care team can help ensure that one condition isn’t mistaken for another.
It can be useful to understand what these autoimmune conditions have in common and how similar treatments may help reduce inflammation and suppress the immune system.
MS and RA have a number of similar characteristics, including symptoms, treatment options, and disease mechanisms.
MS and RA are both classified as autoimmune diseases. In autoimmune disorders, the immune system attacks healthy tissue and can cause a range of symptoms throughout the body that are sometimes difficult to diagnose.
Risk factors for autoimmune diseases include family history, environmental factors, and lifestyle factors. Autoimmune diseases such as MS and RA have been linked to vitamin D deficiency, and some research has shown that vitamin D supplementation may reduce the risk of autoimmune disorders. However, before starting any type of dietary supplement, it’s important to speak with your health care provider. Some supplements can cause unwanted side effects.
People with MS can also develop autoimmune diseases beyond RA. Other co-occurring conditions include diabetes, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), and thyroid disease.
As progressive diseases, both MS and RA can lead to some form of disability. In a 2013 study of more than 27,000 people with MS, about 50 percent reported experiencing disability that interfered with daily activities 15 years after diagnosis. The risk of disability tends to rise as MS disease activity progresses, highlighting the value of starting treatment as soon as possible. Studies show that early use of DMTs can delay major disability by several years.
There’s also a high prevalence of disability in people with RA. Some research suggests that people with RA experience disability at significantly higher rates compared to those without the condition.
Some symptoms are common among various autoimmune diseases. Symptoms of MS that also occur in RA include joint pain, muscle spasms, major depressive disorder (also called clinical depression), and fatigue. Some of these symptoms may interfere with quality of life.
RA is commonly associated with joint stiffness and pain caused by inflammation and damage to the lining of joints. However, people with MS can also experience joint pain caused by spasticity (muscle stiffness or tightness) and mobility problems, which can put added stress on joints.
Although muscle spasms are often associated with MS, rheumatoid arthritis and muscle spasms are also linked. Muscle weakness or joint-related changes in RA may trigger spasms.
People with MS have an increased risk of major depression, defined as having one or more episodes of intense psychological depression — loss of interest or pleasure that lasts two or more weeks.
Some research indicates that depression rates may be higher among people with MS than in the general population. Depression in MS is linked to the emotional stress and disability that come with disease progression. Research also suggests that depression in MS may be associated with demyelination — damage to the myelin sheath (protective tissue) around nerves — that can occur in the brain.
As with MS, depression in RA can occur due to the burden of the disease and symptoms that affect physical well-being and functioning. Researchers have also linked depression to chronic inflammation from RA.
Fatigue is one of the most common symptoms of both conditions, reported by about 80 percent of people with MS. Scientists don’t fully understand the exact cause of fatigue in MS. Still, it’s thought to stem from a combination of factors, including the disease process itself and other effects such as spasticity or poor sleep.
Fatigue is also common among people with RA. Like MS, RA can lead to fatigue that’s believed to be linked to chronic (ongoing) inflammation.
There’s no cure for MS or RA, but both conditions can often be managed with special medications called biologics. For MS, these medications are known as disease-modifying therapies, and for RA, they’re called disease-modifying antirheumatic drugs (DMARDs). Biologics are given through an injection under the skin (subcutaneous shot) or directly into a vein (intravenous infusion). Biologics can’t be taken in pill form because they’re made of large molecule proteins that the digestive system can’t properly absorb.
Biologic drugs are made using parts of animal and human cells. This type of immunological drug works by targeting certain proteins in the immune system that cause inflammation and mistakenly attack healthy tissue in people with autoimmune diseases. Many biologic drugs for MS and RA are a type of medication called monoclonal antibodies. That’s why the names of biologic drugs often end with “-mab.”
Rituximab (Rituxan), a biologic drug for treating RA, is sometimes prescribed off-label for MS. Rituximab has been found to be effective for RRMS and progressive MS in particular.
Other common treatments for both conditions include corticosteroids and physical therapy.
Though MS and RA have similarities, they’re distinct health conditions with notable differences.
MS is a disease of the central nervous system, caused by the autoimmune system damaging nerve fibers in the spinal cord and brain. This can result in painful and disabling symptoms throughout the body, such as mobility issues, vision problems, and bladder and sexual dysfunction.
In RA, the autoimmune system attacks the linings of joints. The joint damage can be severe and sometimes requires joint replacement surgery. Inflammation from RA can also affect the lungs, heart, blood vessels, eyes, skin, and other parts of the body.
Each case of MS or RA is unique. Some people experience mild symptoms, while others face more serious challenges, including disability. These two conditions affect different parts of the body, so it’s hard to say if one is worse than the other. The severity and impact depend on individual factors, such as how quickly the disease progresses and how it affects a person’s body.
As many as 63 percent of people with MS report experiencing pain, according to a 2023 study in Neuroscience & Biobehavioral Reviews. Much of the pain from MS is characterized as central pain — pain caused by problems in the central nervous system. The short-circuiting of nerves results in burning, stabbing, pins-and-needles, or squeezing sensations.
Other MS symptoms, such as muscle spasticity, can also cause pain. Muscle spasms in the upper or lower body can cause muscles to painfully tighten and cramp.
Pain in rheumatoid arthritis is caused by synovitis — inflammation in the joints’ synovial lining. This thin layer of tissue protects joints by producing lubricating and nourishing fluid for proper joint function. Joint damage in RA can cause pain in hands, fingers, wrists, knees, and other joints, which may also become swollen and discolored.
Up to 65 percent of people with MS develop cognitive changes, according to a 2022 study. Cognitive problems are caused by brain lesions and loss of brain tissue.
Cognitive impairment in MS may include:
Cognitive impairment may worsen with disease progression.
Rheumatoid arthritis can also cause cognitive problems. Research indicates that cognitive impairment from RA is often linked to chronic pain, which can make fatigue, depression, and anxiety worse. Pain can cause psychological distress, making it harder to focus, think clearly, or stay mentally sharp.
People living with MS are treated by neurologists, doctors who specialize in neurology — they diagnose and treat disorders in the brain and nervous system. Neurologists are trained to evaluate brain and nerve function based on tests such as magnetic resonance imaging (MRI) and lumbar puncture (spinal tap). These tests can help determine an MS diagnosis.
Rheumatoid arthritis is treated by rheumatologists, who are specialists in bones, joints, muscles, ligaments, and tendons — all part of the body’s musculoskeletal system. In the past, doctors used the term “rheumatism” to describe swelling, stiffness, or pain in these areas of the body.
Rheumatologists treat various diseases known as systemic autoimmune diseases, connective tissue diseases, and collagen vascular diseases, including RA, systemic lupus erythematosus (also known as lupus), and fibromyalgia. However, they’re not trained to diagnose MS.
Diagnosis of RA may include rheumatology blood tests that look for rheumatoid factor proteins, antinuclear antibodies, and C-reactive protein, among other indicators of RA.
If you’re living with MS, you have a higher risk of developing rheumatoid arthritis — and other conditions — than the general population does. Always watch for any changes in your health that may point to another condition, and discuss any new or worsening symptoms with your doctor.
On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 216,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.
Do you have MS and rheumatoid arthritis? What approaches help you manage these conditions? Share your experiences in the comments below, or start a conversation by posting on your Activities page.
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Luc Jasmin, M.D., Ph.D., FRCS (C), FACS
is a board-certified neurosurgery specialist.
Learn more about him here.
Federica Polidoro, M.D.
a graduate of medical school and neurology residency in Italy, furthered her expertise through a research fellowship in multiple sclerosis at Imperial College London.
Learn more about her here.
Joan Grossman
is a freelance writer, filmmaker, and consultant based in Brooklyn, NY.
Learn more about her here.
Joshua Carlucci
is a writer from Los Banos, California.
Learn more about him here.
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