Relapsing-Remitting Multiple Sclerosis
Relapsing-remitting multiple sclerosis is the most common form of multiple sclerosis, affecting about 80% to 85% of people diagnosed with MS. This type of MS follows a pattern of symptom flare-ups followed by periods of partial or complete recovery, making it distinct from other forms of the disease.
Table of contents
- What is relapsing-remitting multiple sclerosis?
- How common is RRMS?
- Symptoms of RRMS
- What causes RRMS?
- What can trigger symptoms?
- Understanding relapses and remissions
- How is RRMS diagnosed?
- Treatment options
- Lifestyle considerations
- What to expect over time
What is relapsing-remitting multiple sclerosis?
Relapsing-remitting multiple sclerosis (RRMS) is a type of multiple sclerosis, which is an autoimmune condition that affects your central nervous system (the brain and spinal cord). An autoimmune condition means your immune system mistakenly attacks your own body instead of protecting it.[1]
In RRMS, your immune system attacks myelin, a protective layer around the nerves in your brain and spinal cord. When this protective covering is damaged, nerves cannot correctly pass along their signals. The damage creates scar tissue called sclerosis, which gives the disease its name.[3]
The name “relapsing-remitting” describes what to expect over the course of the disease. You experience flare-ups, also called relapses or exacerbations, of symptoms followed by periods of partial or complete recovery called remission. During remission, you may have few or no symptoms, or your symptoms are relatively stable. The disease doesn’t get worse during these breaks.[1]
The description of relapsing-remitting helps you and your healthcare provider know what to expect over the disease course. The classification also helps determine what type of treatment might be best for you.[1]
How common is RRMS?
Approximately 1 million people are living with multiple sclerosis in the United States. An estimated 80% to 85% of people diagnosed with MS have RRMS, making it the most common form of MS.[1]
Most people with MS, roughly 85% of patients, are initially diagnosed with relapsing-remitting MS. The disease most often develops in people in their 20s and 30s. Women are twice as likely to have MS as men.[3]
Symptoms of RRMS
The symptoms of RRMS vary from person to person. Different people may experience different combinations of symptoms, and symptoms can affect you in different ways depending on where the damage occurs in your brain or spinal cord.[1]
Common symptoms include vision changes, such as blurry vision, impaired color vision, painful eye movement, or double vision. These eye problems may be the first sign you have RRMS. Many people experience tingling or numbness in various parts of the body.[1]
Other symptoms include a squeezing sensation around your chest or abdomen that feels like a hug, and fatigue (severe tiredness). You might have bladder or bowel problems, including difficulty when trying to urinate, or a feeling of urgency.[1]
Some people experience electrical tingling or shocks down the back when bending the neck forward. Difficulty walking, muscle weakness or stiffness, and problems with balance and coordination are also common. Cognitive difficulties, which some describe as “brain fog,” can include difficulty with memory and concentration.[1]
It’s common to have a combination of symptoms during a relapse or attack. For some people who have complete recovery, they won’t have any symptoms between relapses. For others, they’ll have incomplete recovery and will have persistent symptoms that a healthcare provider can usually manage.[1]
What causes RRMS?
The exact cause of MS is unknown. Research suggests it relates to a genetic predisposition, meaning changes in your DNA that make you more likely to have an autoimmune condition like MS. However, as for most autoimmune conditions, genetics play only a small part in MS, so the risk of passing the condition to your children is relatively low.[1]
Scientists think MS may be caused by an infection that remains in the body, such as Epstein-Barr virus (the virus that causes infectious mononucleosis). Environmental factors can also contribute to causing MS, like exposure to certain bacteria or viruses.[3]
When you have multiple sclerosis, your immune system mistakenly attacks healthy areas of your central nervous system. Specifically, MS attacks myelin, the protective layer around the nerves in your brain and spinal cord. When your immune system attacks this area, you’ll experience a flare-up of symptoms.[1]
What can trigger symptoms?
You might notice certain things in your environment trigger RRMS symptoms. These triggers can vary from one person to another, and what affects one person may not affect another with the same condition.[1]
Common triggers include stress, heat or certain temperatures, and infections. Even mild infections such as a sinus infection or urinary tract infection can cause old MS symptoms to reappear. Smoking tobacco products and vitamin D deficiency can also worsen symptoms.[1]
It’s important to distinguish between a true relapse and a pseudoexacerbation, which is a temporary worsening of symptoms without actual myelin inflammation or damage. Pseudoexacerbations can be brought on by factors like infection, fever, exercise, a warm environment, depression, exhaustion, and stress. When these factors are resolved, your symptoms should improve.[8]
Understanding relapses and remissions
A relapse is where symptoms suddenly appear or become significantly worse for a period of time. The symptoms usually come on very quickly over a period of hours or days. Relapses can last anywhere between a few days, up to weeks or even months.[15]
During a relapse, you may experience new or worsening symptoms. An attack can last anywhere from 24 hours to several weeks. It can involve one or many symptoms, an existing problem that gets worse, or a new symptom appearing.[11]
In between relapses are periods of remission where you may have no symptoms, or your symptoms are relatively stable. Periods of remission can last from months to years until they’re interrupted by a relapse. At first, 12 to 18 months may pass between MS relapses.[4]
To be considered a new MS relapse, old MS symptoms must have become worse or new symptoms appeared. Symptoms must last for at least 24 hours, and they must occur at least 30 days from the start of the last relapse. There must also be no other explanation for the symptoms, such as heat, stress, or infections.[15]
Some relapses are silent, especially early in the course of the disease. These relapses may damage the myelin and cause new lesions without perceived symptoms or disability. Silent relapses can be detected by magnetic resonance imaging (MRI).[13]
How is RRMS diagnosed?
Diagnosing relapsing-remitting multiple sclerosis is difficult because symptoms aren’t always present. When they are, there isn’t a single test that can confirm or rule out the condition. Instead, doctors use a combination of tests and information to diagnose RRMS.[4]
Healthcare providers use many tests to help diagnose MS. Your healthcare provider will ask you questions about your symptoms and medical history. It’s important to rule out other diseases that can cause similar symptoms. Your healthcare provider will also check to see how well your vision, your sense of balance, and other functions are working.[3]
You will need an MRI of your brain and spine. This may find areas of damage in your brain or spinal cord. Blood tests are performed to rule out other conditions. Eye scans called OCT can look for damage in the back of the eye. Spinal taps may be done to look for signs of damage to your nervous system.[4]
Doctors pair their findings from these tests with your medical history and symptoms to determine whether you have RRMS. A person diagnosed with MS has damage in at least two separate areas of the central nervous system which occurred at different points in time, and all other possible diagnoses have been ruled out.[6]
When you’re first diagnosed with MS it can be difficult to work out if you’re having a relapse or not. Keeping a diary with notes on any new or worsening symptoms can help your MS team determine which type of MS you have if it’s not initially clear.[2]
Treatment options
Unfortunately, treatment of MS relapse can’t reverse the damage that a flare-up does or remove the scar tissue that’s already formed. Instead, treatment for RRMS focuses on reducing the severity and frequency of flare-ups to prevent further damage to your nervous system.[4]
Most people with RRMS manage the disease with medication, physical therapy, occupational therapy, and other forms of rehabilitation, along with healthy habits. For most people with RRMS, it’s best to start treatment as soon as they’re diagnosed to avoid lasting nerve damage.[11]
Disease-modifying drugs
Some medications for RRMS fight the disease by turning down the body’s immune system so that it doesn’t attack nerves. These are called disease-modifying drugs (DMDs) or disease-modifying therapy (DMT). These drugs make relapses happen less often and make them less severe. They may keep the disease from getting worse for a while.[11]
Depending on the course of treatment your doctors deem best, you may receive RRMS medication as a pill, a shot (injection), or an infusion (released into your bloodstream through an IV). Some DMDs taken by injection include glatiramer, interferon beta-1a, interferon beta-1b, ofatumumab, and peginterferon beta-1a.[11]
Some DMDs need to be taken through an IV at a clinic or hospital. These include alemtuzumab, mitoxantrone, natalizumab, and ocrelizumab. Several types of DMDs come in pill form, including cladribine, dimethyl fumarate, diroximel fumarate, fingolimod, and monomethyl fumarate.[11]
The oldest and most frequently used medication for MS is interferon beta, either used alone or as add-on therapy with other drugs. Newer treatment options that have been recently approved to control MS symptoms and suppress the inflammation are glatiramer acetate and siponimod.[9]
Newer MS treatments can help patients experience fewer relapses and less disability. Medicines that deplete circulating B cells, such as ocrelizumab and ofatumumab, can prevent relapses and are thought to slow the progression of the disease.[13]
Treatment for relapses
When treatment is necessary, relapses are usually treated with a high-dose course of powerful corticosteroids (a type of steroid) over a period of three to five days. These are given by intravenous (IV) infusion, providing the drug directly into the bloodstream for a quicker response. As an alternative to IV steroids, treatment for a moderate to severe relapse also includes an equivalent high-dose oral regimen of steroids.[8]
Corticosteroids work by reducing inflammation in the central nervous system. While they usually lessen the severity and duration of a relapse, they do not appear to affect the long-term progression of the disease. Less-severe relapses are usually not treated with steroids.[8]
Tell your doctor about signs of a relapse as soon as possible. If you treat it quickly, you might be able to reduce lasting damage and disability.[11]
Lifestyle considerations
Living with RRMS may require some lifestyle changes to manage your symptoms effectively. A few simple lifestyle changes can help you stay mobile and have a good quality of life for a long time.[16]
Exercise
Exercise strengthens the muscles that help you walk. It also eases fatigue, boosts mood, and improves quality of life in people with MS. There’s even some evidence that strength training might help slow MS damage in the brain. An exercise program for MS includes 150 minutes of aerobic activities each week, such as walking or swimming. Work out at your own pace and level.[16]
Diet
A balanced diet is important for your health in general, but especially when you have a long-term disease like MS. Research shows that people with MS who eat a lot of fruits, vegetables, and whole grains have less disability and fewer symptoms like depression and fatigue than those who eat less of these healthy foods. Limit processed foods and animal fats like red meat and butter.[16]
Managing fatigue
Fatigue is a common symptom, so be sure to pace yourself and prioritize rest. Regular physical activity, a balanced diet, and stress management techniques can also help improve your overall well-being and keep your body strong.[17]
Vitamin D
People who have higher levels of vitamin D in their blood are at lower risk of getting MS. You can get your daily vitamin D from foods like fatty fish and fortified milk. Your body also makes its own stores of this vitamin.[16]
Other health conditions
It’s also important to manage any other health problems you have. Heart disease, diabetes, lung disease, and depression can all make your MS progress more quickly. See your primary care doctor or a specialist to get diagnosed and treated.[16]
What to expect over time
After 10 to 20 years, RRMS usually changes to a different type of MS called secondary progressive multiple sclerosis. You won’t have relapses as often, but the disease gets gradually worse. Most people with relapsing-remitting MS have it for about 10 years before it changes to a more progressive type.[11]
However, as time goes on, many patients have relapses that occur more often and last longer. With relapses, inflammation is occurring along the nerves and the myelin. During a remission, your body has a chance to repair the myelin sheath, restoring normal function. However, the repair process produces scar tissue on the nervous system, which can lead to complications over time.[4]
Routine monitoring is an important part of MS management. MRI scans are often used to track brain and spinal cord changes, which helps doctors determine how well your treatment is working. Relapsing-remitting MS tends to create more brain lesions visible on MRIs. Because relapsing-remitting MS can advance to a more progressive type of MS, these MRI scans and routine monitoring can help spot this change.[17]
Building a supportive network is helpful both now and in the future. Support can come from your care team, family, friends, or MS support groups. Connecting with others who have MS can provide emotional support and valuable advice on managing the condition. Having a reliable network will help you cope with the emotional and physical challenges of relapsing-remitting MS.[17]
Being diagnosed with relapsing-remitting multiple sclerosis can feel daunting, but with the right treatment, lifestyle changes, and support, it’s possible to manage the condition and maintain a good quality of life.[17]
