Multiple sclerosis and ulcerative colitis: The link

Is there a link between MS and UC?

Yes, there may be a link between multiple sclerosis (MS) and ulcerative colitis (UC).

Although MS and UC affect different parts of the body, they are both autoimmune conditions. This means they happen because the immune system is mistakenly attacking healthy cells.

A 2023 review of researchTrusted Source indicates that individuals with UC have more than a 50% higher risk of developing MS than the general population. However, MS does not increase the risk of UC occurrence.

How is UC related to MS?

Scientists are still learning about the relationship between UC and MS. However, both conditions share genetic factors that may increase the likelihood of both conditions.

Specifically, changes inTrusted Source human leukocyte antigens (HLAs) have linksTrusted Source to both MS and UC. HLAs are genes that allow the immune system to differentiate between the self and non-self. In other words, they help the immune system identify what to attack and what not to attack.

There is also some evidence that an imbalance of gut microbes, or dysbiosis, plays a role in both MSTrusted Source and UCTrusted Source. Dysbiosis, chronic inflammation, and interactions between the gut and the brain may influence the risk for both conditions, but more research on this is necessary.

Risk factors for UC and MS

Aside from a potential genetic link, UC and MS have distinct risk factors.

The National Multiple Sclerosis Society reports that MS is more common in people who:

• are between 20 and 40 years oldTrusted Source
• are female
• live in colder climatesTrusted Source
• have low vitamin D levels
• had overweight or obesity in childhood
• have had exposure to certain viruses and bacteria, such as the Epstein-Barr virus

UC is more common in people who:

• are between 30 to 40 years oldTrusted Source
• have a family history of UC
• have a personal history of gastroenteritis
• take certain medications, such as nonsteroidal anti-inflammatory drugs

Research also indicates that UC is more prevalent in people of Ashkenazi Jewish ancestry compared with people of other ethnic backgrounds.

Smoking has associations with both UC and MS. However, in UC, only past smoking has a link to the condition. Current smoking does not appear to correlate to UC, but researchers are still trying to understand why.

Symptoms of UC and MS

UC and MS have distinct symptoms due to their effects on different body systems, but both share symptoms of fatigue and inflammation.

UC symptoms include:

• chronic diarrhea
• abdominal pain
• a constant urge to pass stool
• weight loss and malnutrition
• anemia

Symptoms of MS include:

• numbness and tingling, typically in the limbs or face
• muscle weakness
• blurred vision or double vision
• coordination and balance difficulties
• trouble concentrating

Diagnosing MS and UC

To diagnose MS or UC, a doctor will start by asking about a person’s symptoms. They will ask about their medical history, and whether they have a family history of any autoimmune diseases, such as IBD.

Next, a doctor may perform a physical examination to look for symptoms, such as abdominal tenderness in UC, or tremors in MS.

To confirm a UC diagnosis, a doctor may recommend several tests, such as:

• tests for anemia, which can indicate bleeding in the colon
• stool samples, which can detect inflammation in the gut
• sigmoidoscopy or colonoscopy to see inside the colon
• medical imaging tests, such as a barium enema, CT scan, or MRI

If they suspect MS, doctors may recommend a full neurological exam. They may also order:

• an MRI scan to look for lesions on the brain
• a spinal fluid analysis
• an evoked potential test

No single test can confirm MS or UC with certainty, so doctors will use a combination of results and a person’s symptoms to make a diagnosis.

Treatment for MS and UC

Treatment for both UC and MS involves managing symptoms, reducing inflammation, and preventing disease progression.

Although the specific treatments for each condition differ, there is some overlap. In treatment for either UC or MS, a doctor may prescribe:

• corticosteroids, which reduce inflammation
• immunomodulators, which regulate the immune system
• immunosuppressants, which reduce immune activity

Scientists are also researchingTrusted Source other drugs that may be useful for both conditions, such as monoclonal antibodies. These drugs may target specific antigens in the immune system that contribute to UC or MS.

Other treatments for UC

Other treatments specific to UC include aminosalicylates, which target inflammation in the lining of the colon. If necessary, a person may also need surgery.

Doctors sometimes use certain biologic drugs, such as TNF inhibitors, for UC. However, while TNF inhibitors are effective for UC, they may exacerbate MS symptoms.

A 2021 study found that people with IBD who took TNF inhibitors had a 43%Trusted Source higher risk of developing MS than those without exposure.

Learn more about UC treatments.

Other treatments for MS

Other treatments specific to MS include:

• disease-modifying therapies
• muscle relaxants, which may relieve cramps and stiffness
• medications for other specific symptoms, such as pain
• physical therapy
• assistive equipment and devices to help with walking and other tasks

Learn more about treatment for MS.

Summary

While ulcerative colitis (UC) and multiple sclerosis (MS) affect different systems in the body, there may be a connection between the two.

People with UC are more likely to develop MS. Some genetic changes can increase the likelihood of either condition, and both may have connections to gut health.

People with both UC and MS will need personalized care to help make sure their treatments work to address both conditions effectively.