Progression independent of relapse activity and relapse-associated worsening in adult patients with secondary progressive multiple sclerosis | ||
| Journal of Recent Advances in Medicine | ||
| Volume 4, Issue 2, July 2023, Pages 162-168 PDF (740.12 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/jram.2023.234982.1224 | ||
| Authors | ||
| Manar A. Shawky* 1; Tarek I. Menecie2; Eman M. Saif El Deen3; Mohamed H. Rashad2 | ||
| 1Multiple Sclerosis Unit, Neurology Department, Nasser Institute Hospital For Research and Treatment, Cairo, Egypt. | ||
| 2Neurology Department, Faculty of Medicine For boys, Cairo, Al-Azhar University, Egypt. | ||
| 3Neurology Department, Faculty Of Medicine For Girls, Cairo, Al-Azhar University, Egypt. | ||
| Abstract | ||
| Background: In multiple sclerosis (MS), disability may accumulate in the form of deterioration linked to relapses, known as Relapse-Associated Worsening (RAW), or through a continuous progression unaffected by relapse activity, termed Progressive Independent of Relapse Activity (PIRA). Objectives: To investigate PIRA's baseline predictors at the time of MS diagnosis and the contributions of PIRA versus RAW to the long-term clinical outcomes in secondary progressive MS (SPMS) patients. Methodology: A retrospective cohort study was conducted at Nasser institute hospital on 150 patients with SPMS. Baseline and clinical data were collected during MS diagnosis, progression data during the disease course, and further outcome data. Also, different disability scores associated with PIRA and RAW were performed. Results: Of 150 SPMS patients, 90 had PIRA, and 60 had RAW. Only age and type of relapses before starting disease modifying drugs (DMDs) showed significant differences between the groups. Patients with PIRA had higher mean age (40.1 ± 5.1 vs. 38.3 ± 5.43, p = 0.04) and fewer vision relapses than patients with RAW (34.4% vs. 51.7%, respectively p = 0.036). Moreover, no differences were found in magnetic resonance imaging (MRI) findings, including lesions and oligoclonal bands. There were significant associations between PIRA and poor long-term outcomes indicated by expanded disability status scale (EDSS), simple digit modalities test (SDMT), and 25-foot timed walk test (25FWT). Conclusion: After the initial diagnosis of PIRA manifesting multiple sclerosis is prevalent among patients who develop secondary progression and indicates an unfavorable long-term prognosis. However, the prediction of PIRA is challenging, and further prospective research is warranted. | ||
| Keywords | ||
| Expanded disability status scale (EDSS ); multiple sclerosis (MS); relapse-associated worsening (RAW); secondary progressive MS (SPMS); progression independent of relapse activity (PIRA) | ||
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