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The importance of MS progression independent of relapses

Confirmed disability accumulation (CDA) in MS may occur as Relapse-Associated Worsening (RAW) or Progression Independent of Relapse Activity (PIRA). Three presentations focused on the role and importance of PIRA during a symposium on MS progression. PIRA is present from disease onset, predominates in later-onset MS, and is associated with increased brain atrophy rates in patients with relapsing MS [1–3]. A Spanish study assessed clinical and MRI features of patients who develop PIRA early on after the first attack of MS, or in the absence of recent inflammatory activity [1]. In a cohort of 754 patients with a clinically isolated syndrome (CIS) or early MS that were followed for >20 years, 209 (28%) developed PIRA after a median of 7.2 years. Presenting with PIRA after a CIS is not uncommon and implies an unfavourable, long-term prognosis, concluded Dr Carmen Tur (Vall d'Hebron University Hospital, Spain). Among all patients with PIRA, one third develope...

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