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Published on: December 9, 2015
Progression Independent of Relapse Activity in Multiple Sclerosis: Closer to Solving the Pathologic Puzzle
1From the Multiple Sclerosis Centre of Catalonia (Cemcat) (C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Unit, Queen Square MS Centre (C.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Neuroimaging Research Unit (M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.A.R.), Milan, Italy.
Abstract:
Progression independent of relapse activity (PIRA) is one of the main mechanisms of disability accrual in multiple sclerosis (MS) even in people with relapsing-remitting MS (RRMS).1 PIRA can occur at any stage of the disease and is associated with unfavorable long-term outcomes, especially if PIRA occurs early in the disease course.2 The pathologic substrates of PIRA are not yet well understood, although there is growing evidence suggesting that PIRA may occur mainly in a predominant neurodegenerative context,3-6 sometimes in combination with an acute inflammatory activity.2,5 A deeper understanding of the pathologic processes underlying PIRA represents a vital initial stride toward averting the accumulation of irreversible disability in MS.
Insights
Progression independent of relapse activity (PIRA) is a key driver of disability in multiple sclerosis (MS), even in relapsing-remitting forms. Understanding PIRA
Area of Science:
- Neuroimmunology
- Neurodegeneration
- Multiple Sclerosis Pathophysiology
Background:
- Progression independent of relapse activity (PIRA) contributes significantly to disability accumulation in multiple sclerosis (MS).
- PIRA affects individuals with relapsing-remitting MS (RRMS) and can occur at any disease stage.
- Early PIRA onset is linked to poorer long-term prognoses in MS patients.
Discussion:
- The precise pathological mechanisms underlying PIRA remain incompletely understood.
- Emerging evidence suggests PIRA predominantly involves neurodegenerative processes.
- PIRA may also be influenced by concurrent acute inflammatory activity in some MS cases.
Key Insights:
- PIRA is a critical factor in MS disability accrual, distinct from relapse activity.
- Neurodegeneration is increasingly recognized as a primary driver of PIRA.
- Understanding PIRA's pathology is essential for developing effective MS treatments.
Outlook:
- Further research into PIRA's pathological substrates is crucial.
- Identifying PIRA mechanisms may lead to strategies to prevent irreversible disability in MS.
- Targeting neurodegenerative pathways could offer new therapeutic avenues for MS management.
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