Where there's one...
there may be many.
One of the many ways that the Diagnostic Process by Body System fails people with autoimmune signs and symptoms is when Polyautoimmunity (Poly means many) or Multiple autoimmune syndrome is present or suspected. I have come across Multiple autoimmune syndrome before, but Polyautoimmunity is new to me. So when I first came across the term, I thought surely Polyautoimmunity and Multiple autoimmune syndrome are the same thing. Nope, I was wrong—they are different things. At first, I thought they were slightly different things. Now, I think Polyautoimmunity just might be a paradigm shift away from Multiple autoimmune syndrome. Before I get ahead of myself, I’ll start with the foundational concepts.
Polyautoimmunity
Overt polyautoimmunity
Rojas et. al defines “overt polyatuoimmunity” as “the clinical coexistence of two or more autoimmune diseases fulfilling classification criteria.”
Latent polyautoimmunity
Rojas et. al defines “latent polyautoimmunity” as the presence of autoantibodies unrelated to a defined autoimmune disease, which does not fulfill clinical criteria for any autoimmune disease.
Multiple autoimmune syndrome
Cojocaru et. al define Multiple autoimmune syndrome as the combination of at least three autoimmune diseases in the same patient. {Emphasis in bold is mine.} An NIH database search for “multiple autoimmune syndrome” returned 163 results. The first 20 results were mainly concerned with grouping autoimmune disorders into groups of three that tend to co-occur.
Discussion
The straightforward difference between Polyautoimmunity and Multiple autoimmune syndrome is the difference between two or more autoimmune disorders occurring in one human body versus three or more autoimmune disorders occurring in one human body. Obviously, the names are different, too. Polyautoimmunity is a more precise, Latin-derived medical term that is based specifically on the presence of clinically-detectable autoantibodies, which may or may not meet the diagnostic criteria for a particular autoimmune diagnosis. This makes the term Polyautoimmunity more flexible and applicable to patients with autoimmune signs and symptoms that may not fit neatly into the current autoimmune diagnostic slots.
The name Multiple autoimmune syndrome is more vernacular and accessible, but the clinical definition relies more heavily on meeting the current diagnostic criteria for three or more known autoimmune disorders. It’s possible that there’s an evolution happening from one definition to the other. Cojocaru et. al are attempting to define Multiple autoimmune syndrome in 2010, and note limitations in the methods available for studying the co-occurrence of autoimmune diseases. Rojas et. al first publish in 2021 with testing recommendations, and conclude that evaluation for Polyautoimmunity be considered in all studies dealing with autoimmune diseases. This suggests a change in the technology available in the intervening 11 years.
Going Forward
Review New insights into the taxonomy of autoimmune diseases based on polyautoimmunity.
Review Multiple autoimmune syndrome…try to answer the question Why are psychological factors “implicated in the development of MAS”?
Research the tests used in New insights… try to answer the questions Are Polyautoimmunity testing recommendations clinically useful outside of medical research at this time? Are they available?
Review 163 NIH search results for “multiple autoimmune syndrome” to determine the extent of groups of three or more, the overlap between groups, and present findings here, ideally in graphic form.
Research the available studies/literature on Polyautoimmunity.
References
Cojocaru M, Cojocaru IM, Silosi I. Multiple autoimmune syndrome. Maedica (Bucur). 2010 Apr;5(2):132-4. PMID: 21977137; PMCID: PMC3150011.
Rojas M, Ramírez-Santana C, Acosta-Ampudia Y, Monsalve DM, Rodriguez-Jimenez M, Zapata E, Naranjo-Pulido A, Suárez-Avellaneda A, Ríos-Serna LJ, Prieto C, Zambrano-Romero W, Valero MA, Rodríguez Y, Mantilla RD, Zhu C, Li QZ, Toro-Gutiérrez CE, Tobón GJ, Anaya JM. New insights into the taxonomy of autoimmune diseases based on polyautoimmunity. J Autoimmun. 2022 Jan;126:102780. doi: 10.1016/j.jaut.2021.102780. Epub 2021 Dec 16. PMID: 34923432.