Purpose This study aimed to explore the significance of anti-connective tissue antibodies in the clinical diagnosis and evaluation of neuromyelitis optica spectrum disorder (NMOSD). Methods Demographic and clinical data from 205 patients with aquaporin-4 immunoglobulin G (AQP4-IgG)-positive NMOSD were collected. Variables included sex, age, clinical symptoms/signs, connective tissue antibody status, inflammatory markers, cerebrospinal fluid (CSF) cell counts/oligoclonal band status, spinal cord