{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T04:30:10Z","timestamp":1793939410973,"version":"4.8.0"},"reference-count":82,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease that mostly affects the central nervous system, and Sj\u00f6gren\u2019s disease (SjD) is an autoimmune disease that mostly affects the exocrine glands. Recent evidence indicates that these conditions frequently coexist and may have overlapping immunopathogenic mechanisms. Patients with NMOSD often exhibit serological or clinical features of SjD, and patients with SjD may develop inflammatory demyelinating events resembling NMOSD. This overlap can pose significant diagnostic and therapeutic challenges. Our narrative review synthesizes recent evidence on the epidemiology, clinical characteristics, immunopathogenic links, diagnostic considerations, and therapeutic implications of NMOSD-SjD overlap. This overlap phenotype is characterized by a diverse autoantibody profile, B-cell hyperactivity, cytokine dysregulation (particularly interleukin-6 and type I interferon signaling), and loss of immune tolerance. Blood-brain barrier dysfunction may enable circulating pathogenic antibodies and inflammatory mediators to access the central nervous system, although direct evidence for this in the overlap disease remains limited. We propose a structured diagnostic approach that integrates clinical phenotype, antibody testing, neuroimaging, and systemic autoimmune assessment to distinguish NMOSD-SjD overlap from SjD-related central nervous system involvement and myelin oligodendrocyte glycoprotein antibody-associated disease. We also describe therapeutic strategies that emphasize prevention of NMOSD relapse, selection of biologic treatments, assessment of systemic safety, and avoidance of misclassification. Recognition of NMOSD-SjD overlap has important implications for personalized diagnosis, assessment of systemic risk, and long-term management, and illustrates the relationship of systemic autoimmunity with organ-specific antibody-mediated central nervous system disease.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1931729","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T08:56:58Z","timestamp":1786957018000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Neuromyelitis optica spectrum disorder overlapping with Sj\u00f6gren\u2019s disease: immunopathological links and therapeutic implications"],"prefix":"10.3389","volume":"17","author":[{"given":"Wanfeng","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoyue","family":"Xing","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1458556","article-title":"Effects of early intervention in neuromyelitis optica spectrum disorder patients with seropositive AQP4 antibodies","volume":"15","author":"Xue","year":"2024","journal-title":"Front Immunol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1212\/nxi.0000000000000978","article-title":"Disability outcomes in the N-MOmentum trial of inebilizumab in neuromyelitis optica spectrum disorder","volume":"8","author":"Marignier","year":"2021","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(07)70216-8","article-title":"The spectrum of neuromyelitis optica","volume":"6","author":"Wingerchuk","year":"2007","journal-title":"Lancet Neurol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000001729","article-title":"International consensus diagnostic criteria for neuromyelitis optica spectrum disorders","volume":"85","author":"Wingerchuk","year":"2015","journal-title":"Neurology"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(04)17551-x","article-title":"A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis","volume":"364","author":"Lennon","year":"2004","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(12)70133-3","article-title":"Aquaporin 4 and neuromyelitis optica","volume":"11","author":"Papadopoulos","year":"2012","journal-title":"Lancet Neurol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1177\/0961203318801673","article-title":"Primary Sj\u00f6gren's syndrome","volume":"27","author":"Bowman","year":"2018","journal-title":"Lupus"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205375","article-title":"Epidemiology of primary Sj\u00f6gren's syndrome: a systematic review and meta-analysis","volume":"74","author":"Qin","year":"2015","journal-title":"Ann Rheum Dis"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000216139.44259.74","article-title":"Revised diagnostic criteria for neuromyelitis optica","volume":"66","author":"Wingerchuk","year":"2006","journal-title":"Neurology"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2023.120742","article-title":"Associations between neuromyelitis optica spectrum disorder, Sj\u00f6gren's syndrome, and conditions with electrolyte disturbances","volume":"452","author":"Akaishi","year":"2023","journal-title":"J Neurol Sci"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2018.11.008","article-title":"Autoimmune diseases associated with neuromyelitis optica spectrum disorders: A literature review","volume":"27","author":"Shahmohammadi","year":"2019","journal-title":"Mult Scler Relat Disord"},{"key":"B12","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1038\/s41572-020-0214-9","article-title":"Neuromyelitis optica","volume":"6","author":"Jarius","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.31083\/j.jin2302035","article-title":"Systemic connective tissue disease and neuromyelitis optica spectrum disorder coexistence: A systematic review and meta-analysis","volume":"23","author":"Esposito","year":"2024","journal-title":"J Integr Neurosci"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/cei.12271","article-title":"Neuromyelitis optica: clinical features, immunopathogenesis and treatment","volume":"176","author":"Jarius","year":"2014","journal-title":"Clin Exp Immunol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13010014","article-title":"Central nervous system involvement in primary Sj\u00f6gren's syndrome: Narrative review of MRI findings","volume":"13","author":"M\u00f3dis","year":"2022","journal-title":"Diagnostics (Basel)"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjno-2025-001227","article-title":"Neurological involvement in primary Sj\u00f6gren's syndrome: a retrospective analysis of clinical, radiological, laboratory and therapeutic correlations","volume":"7","author":"Elshony","year":"2025","journal-title":"BMJ Neurol Open"},{"key":"B17","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s13075-025-03538-3","article-title":"Concomitant Sj\u00f6gren's disease in patients with NMOSD: impacts on neurologic disease severity and recurrence","volume":"27","author":"Wu","year":"2025","journal-title":"Arthritis Res Ther"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e3181b76ab5","article-title":"Hematologic manifestations and predictors of lymphoma development in primary Sj\u00f6gren syndrome: clinical and pathophysiologic aspects","volume":"88","author":"Baimpa","year":"2009","journal-title":"Med (Baltimore)"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1590\/0004-282x20140097","article-title":"Sj\u00f6gren syndrome and neuromyelitis optica spectrum disorder co-exist in a common autoimmune milieu","volume":"72","author":"Carvalho","year":"2014","journal-title":"Arq Neuropsiquiatr"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/ene.70214","article-title":"Comorbidities are associated with unfavorable outcome in aquaporin-4 antibody positive neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody-associated disease: Exploratory study from the CROCTINO cohort","volume":"32","author":"Samadzadeh","year":"2025","journal-title":"Eur J Neurol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2024-001491","article-title":"Clinical and immunological differences between primary and autoimmune-associated neuromyelitis optica spectrum disorders: a retrospective study","volume":"12","author":"Tsai","year":"2025","journal-title":"Lupus Sci Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00415-013-7169-7","article-title":"Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group (NEMOS)","volume":"261","author":"Trebst","year":"2014","journal-title":"J Neurol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-014-0483-3","article-title":"Neuromyelitis optica spectrum disorders","volume":"14","author":"Flanagan","year":"2014","journal-title":"Curr Neurol Neurosci Rep"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2023.103465","article-title":"A comprehensive review of the advances in neuromyelitis optica spectrum disorder","volume":"22","author":"Siriratnam","year":"2023","journal-title":"Autoimmun Rev"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0b013e32833de6ab","article-title":"Neurological manifestations of primary Sjogren's syndrome","volume":"23","author":"Chai","year":"2010","journal-title":"Curr Opin Neurol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-1777105","article-title":"Sjogren's syndrome: a neurological perspective","volume":"81","author":"Barsottini","year":"2023","journal-title":"Arq Neuropsiquiatr"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-11910-z","article-title":"Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) - revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part II: Attack therapy and long-term management","volume":"271","author":"K\u00fcmpfel","year":"2024","journal-title":"J Neurol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2025.2548947","article-title":"Advances in the therapeutic landscape for neuromyelitis optica spectrum disorder","volume":"25","author":"Chamberlain","year":"2025","journal-title":"Expert Rev Neurother"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2020.35.e115","article-title":"Prevalence and incidence of neuromyelitis optica spectrum disorder in Korea: Population based study","volume":"35","author":"Lee","year":"2020","journal-title":"J Korean Med Sci"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1093\/braincomms\/fcaf293","article-title":"Epidemiology and diagnostic challenges in neuromyelitis optica spectrum disorder in Taiwan: a hospital-based surveillance accompanied by a nationwide study","volume":"7","author":"Hsu","year":"2025","journal-title":"Brain Commun"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-023-05397-0","article-title":"Overlap syndrome of anti-aquaporin 4 positive neuromyelitis optica spectrum disorder and primary Sj\u00f6gren's syndrome: a systematic review of individual patient data","volume":"44","author":"Prasad","year":"2024","journal-title":"Rheumatol Int"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000001145","article-title":"The clinical characteristics of primary Sjogren's syndrome with neuromyelitis optica spectrum disorder in China: A STROBE-compliant article","volume":"94","author":"Qiao","year":"2015","journal-title":"Med (Baltimore)"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2022.103494","article-title":"Clinical significance of anti-SSA\/Ro antibody in neuromyelitis optica spectrum disorders","volume":"58","author":"Lin","year":"2022","journal-title":"Mult Scler Relat Disord"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-024-01135-3","article-title":"Update on the pathophysiology and treatment of primary Sj\u00f6gren syndrome","volume":"20","author":"Baldini","year":"2024","journal-title":"Nat Rev Rheumatol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-11634-0","article-title":"Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) - revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis","volume":"270","author":"Jarius","year":"2023","journal-title":"J Neurol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-11613-5","article-title":"Sj\u00f6gren's syndrome with and without neurological involvement","volume":"270","author":"Seeliger","year":"2023","journal-title":"J Neurol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1007\/s00296-024-05753-8","article-title":"Diversity of central nervous system manifestations in Sjogren's disease: a case-based review","volume":"45","author":"Jask\u00f3lska","year":"2025","journal-title":"Rheumatol Int"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000001367","article-title":"MRI characteristics of neuromyelitis optica spectrum disorder: an international update","volume":"84","author":"Kim","year":"2015","journal-title":"Neurology"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2014.3602","article-title":"Antibodies to aquaporin 4, myelin-oligodendrocyte glycoprotein, and the glycine receptor \u03b11 subunit in patients with isolated optic neuritis","volume":"72","author":"Martinez-Hernandez","year":"2015","journal-title":"JAMA Neurol"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.969762","article-title":"Comparative analysis of clinical and imaging data of first-attack neuromyelitis optica spectrum disorders with and without connective tissue disease","volume":"13","author":"Yao","year":"2022","journal-title":"Front Neurol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1260358","article-title":"Epidemiology of myelin oligodendrocyte glycoprotein antibody-associated disease: a review of prevalence and incidence worldwide","volume":"14","author":"Hor","year":"2023","journal-title":"Front Neurol"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000000101","article-title":"Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders","volume":"82","author":"Sato","year":"2014","journal-title":"Neurology"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-023-06611-4","article-title":"Neuromyelitis optica spectrum disorders with and without associated autoimmune diseases","volume":"44","author":"Carnero Contentti","year":"2023","journal-title":"Neurol Sci"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awm047","article-title":"Loss of aquaporin 4 in lesions of neuromyelitis optica: distinction from multiple sclerosis","volume":"130","author":"Misu","year":"2007","journal-title":"Brain"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(13)70076-0","article-title":"Eculizumab in AQP4-IgG-positive relapsing neuromyelitis optica spectrum disorders: an open-label pilot study","volume":"12","author":"Pittock","year":"2013","journal-title":"Lancet Neurol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.ncl.2023.06.009","article-title":"Updates in NMOSD and MOGAD diagnosis and treatment: A tale of two central nervous system autoimmune inflammatory disorders","volume":"42","author":"Cacciaguerra","year":"2024","journal-title":"Neurol Clin"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1128315","article-title":"CNS demyelinating events in primary Sj\u00f6gren's syndrome: A single-center case series on the clinical phenotype","volume":"14","author":"Afzali","year":"2023","journal-title":"Front Neurol"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev420","article-title":"Exploring BAFF: its expression, receptors and contribution to the immunopathogenesis of Sj\u00f6gren's syndrome","volume":"55","author":"Thompson","year":"2016","journal-title":"Rheumatol (Oxford)"},{"key":"B49","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1136\/annrheumdis-2019-216114","article-title":"EULAR recommendations for the management of Sj\u00f6gren's syndrome with topical and systemic therapies","volume":"79","author":"Ramos-Casals","year":"2020","journal-title":"Ann Rheum Dis"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbamem.2021.183772","article-title":"Pathogenic antibodies to AQP4: Neuromyelitis optica spectrum disorder (NMOSD)","volume":"1863","author":"Wright","year":"2021","journal-title":"Biochim Biophys Acta Biomembr"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1901747","article-title":"Trial of satralizumab in neuromyelitis optica spectrum disorder","volume":"381","author":"Yamamura","year":"2019","journal-title":"N Engl J Med"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2016.186","article-title":"New insights into the immunopathogenesis of systemic lupus erythematosus","volume":"12","author":"Tsokos","year":"2016","journal-title":"Nat Rev Rheumatol"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1406409","article-title":"The relationship between neuromyelitis optica spectrum disorder and autoimmune diseases","volume":"15","author":"Lin","year":"2024","journal-title":"Front Immunol"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(20)30078-8","article-title":"Safety and efficacy of satralizumab monotherapy in neuromyelitis optica spectrum disorder: a randomised, double-blind, multicentre, placebo-controlled phase 3 trial","volume":"19","author":"Traboulsee","year":"2020","journal-title":"Lancet Neurol"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.0803588","article-title":"Ectopic germinal centers are rare in Sjogren's syndrome salivary glands and do not exclude autoreactive B cells","volume":"182","author":"Le Pottier","year":"2009","journal-title":"J Immunol"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.4103\/nrr.Nrr-d-23-01325","article-title":"Aquaporin-4-IgG-seropositive neuromyelitis optica spectrum disorders: progress of experimental models based on disease pathogenesis","volume":"20","author":"Xu","year":"2025","journal-title":"Neural Regener Res"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-021-00568-8","article-title":"Hope for patients with neuromyelitis optica spectrum disorders - from mechanisms to trials","volume":"17","author":"Pittock","year":"2021","journal-title":"Nat Rev Neurol"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awp309","article-title":"Intra-cerebral injection of neuromyelitis optica immunoglobulin G and human complement produces neuromyelitis optica lesions in mice","volume":"133","author":"Saadoun","year":"2010","journal-title":"Brain"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1109980108","article-title":"Molecular outcomes of neuromyelitis optica (NMO)-IgG binding to aquaporin-4 in astrocytes","volume":"109","author":"Hinson","year":"2012","journal-title":"Proc Natl Acad Sci USA"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.3390\/ijms251910625","article-title":"Blood-brain barrier disruption in neuroimmunological disease","volume":"25","author":"Shimizu","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0238301","article-title":"Purified IgG from aquaporin-4 neuromyelitis optica spectrum disorder patients alters blood-brain barrier permeability","volume":"15","author":"Cobo-Calvo","year":"2020","journal-title":"PloS One"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1423107","article-title":"Scientific issues with rodent models of neuromyelitis optic spectrum disorders","volume":"15","author":"Huang","year":"2024","journal-title":"Front Immunol"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-014-0200-5","article-title":"Sj\u00f6gren's syndrome and neuromyelitis optica spectrum disorders (NMOSD)--a case report and review of literature","volume":"14","author":"Jayarangaiah","year":"2014","journal-title":"BMC Neurol"},{"key":"B64","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1002\/art.39859","article-title":"2016 American College of Rheumatology\/European League Against Rheumatism Classification Criteria for Primary Sj\u00f6gren's Syndrome: a consensus and data-driven methodology involving three international patient cohorts","volume":"69","author":"Shiboski","year":"2017","journal-title":"Arthritis Rheumatol"},{"key":"B65","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1016\/s0889-857x(21)00211-8","article-title":"Neurologic disease in Sj\u00f6gren's syndrome: mononuclear inflammatory vasculopathy affecting central\/peripheral nervous system and muscle. A clinical review and update of immunopathogenesis","volume":"19","author":"Alexander","year":"1993","journal-title":"Rheum Dis Clin North Am"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000209321","article-title":"Validation of the 2023 International Diagnostic Criteria for MOGAD in a selected cohort of adults and children","volume":"103","author":"Varley","year":"2024","journal-title":"Neurology"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2022-249915","article-title":"Myelin oligodendrocyte glycoprotein (MOG) antibody-associated longitudinally extensive transverse myelitis (LETM) and primary Sjogren syndrome: a rare association","volume":"15","author":"Sahoo","year":"2022","journal-title":"BMJ Case Rep"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2017-001787","article-title":"Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease: practical considerations","volume":"19","author":"Jury\u0144czyk","year":"2019","journal-title":"Pract Neurol"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(22)00520-8","article-title":"MOGAD comes of age with new criteria","volume":"22","author":"Graus","year":"2023","journal-title":"Lancet Neurol"},{"key":"B70","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000209682","article-title":"Investigating the 2023 MOGAD criteria in children and adults with MOG-antibody positivity within and outside attacks","volume":"103","author":"Fonseca","year":"2024","journal-title":"Neurology"},{"key":"B71","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24017","article-title":"Incorporation of salivary gland ultrasonography into the American College of Rheumatology\/European League Against Rheumatism criteria for primary Sj\u00f6gren's syndrome","volume":"72","author":"van Nimwegen","year":"2020","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"B72","doi-asserted-by":"publisher","DOI":"10.1177\/1352458515581438","article-title":"Treatment of acute relapses in neuromyelitis optica: steroids alone versus steroids plus plasma exchange","volume":"22","author":"Abboud","year":"2016","journal-title":"Mult Scler"},{"key":"B73","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1900866","article-title":"Eculizumab in aquaporin-4-positive neuromyelitis optica spectrum disorder","volume":"381","author":"Pittock","year":"2019","journal-title":"N Engl J Med"},{"key":"B74","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102641","article-title":"Benefits of eculizumab in AQP4+ neuromyelitis optica spectrum disorder: subgroup analyses of the randomized controlled phase 3 PREVENT trial","volume":"47","author":"Palace","year":"2021","journal-title":"Mult Scler Relat Disord"},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26626","article-title":"Ravulizumab in aquaporin-4-positive neuromyelitis optica spectrum disorder","volume":"93","author":"Pittock","year":"2023","journal-title":"Ann Neurol"},{"key":"B76","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(19)31817-3","article-title":"Inebilizumab for the treatment of neuromyelitis optica spectrum disorder (N-MOmentum): a double-blind, randomised placebo-controlled phase 2\/3 trial","volume":"394","author":"Cree","year":"2019","journal-title":"Lancet"},{"key":"B77","doi-asserted-by":"publisher","DOI":"10.1177\/13524585211047223","article-title":"Long-term efficacy and safety of inebilizumab in neuromyelitis optica spectrum disorder: analysis of aquaporin-4-immunoglobulin G-seropositive participants taking inebilizumab for \u2267\u03384\u2009years in the N-MOmentum trial","volume":"28","author":"Rensel","year":"2022","journal-title":"Mult Scler"},{"key":"B78","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1016\/s1474-4422(24)00077-2","article-title":"Safety and efficacy of inebilizumab for the treatment of neuromyelitis optica spectrum disorder: end-of-study results from the open-label period of the N-MOmentum trial","volume":"23","author":"Cree","year":"2024","journal-title":"Lancet Neurol"},{"key":"B79","doi-asserted-by":"publisher","DOI":"10.3988\/jcn.2024.0485","article-title":"Evaluating rituximab failure rates in neuromyelitis optica spectrum disorder: a nationwide real-world study from South Korea","volume":"21","author":"Kim","year":"2025","journal-title":"J Clin Neurol"},{"key":"B80","doi-asserted-by":"publisher","DOI":"10.1002\/ibra.12175","article-title":"Severe relapse after cessation of immunosuppressive therapy in a patient with co-occurrence of neuromyelitis optica spectrum disorder and Sj\u00f6gren's syndrome: a case report","volume":"11","author":"Zhu","year":"2025","journal-title":"Ibrain"},{"key":"B81","doi-asserted-by":"publisher","DOI":"10.1212\/nxi.0000000000000947","article-title":"Discontinuation of immunosuppressive therapy in patients with neuromyelitis optica spectrum disorder with aquaporin-4 antibodies","volume":"8","author":"Kim","year":"2021","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"B82","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-1761432","article-title":"Neuromyelitis optica spectrum disorders: a review with a focus on children and adolescents","volume":"81","author":"Paolilo","year":"2023","journal-title":"Arq Neuropsiquiatr"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1931729\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T08:57:00Z","timestamp":1786957020000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1931729\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":82,"alternative-id":["10.3389\/fimmu.2026.1931729"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1931729","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]},"article-number":"1931729"}}