Does relapsing remitting MS always progress to secondary progressive MS?

Relapsing remitting multiple sclerosis (RRMS) is a type of MS that has episodes of new or worsening symptoms (relapses) followed by periods of recovery or better health (remission). In terms of impact on the individual, relapses can be mild or severe. Recovery from relapses may occur with or without treatments. Approximately 85 percent of people newly diagnosed with MS initially receive a diagnosis of RRMS.

On average, after 10 to 20 years, RRMS typically transitions to become secondary progressive MS (SPMS). This is where symptoms and health issues gradually accumulate – even without relapses.

In times gone past, without any treatment, it was previously estimated that roughly 50 percent of people diagnosed with RRMS would transition to SPMS within ten years of diagnosis. The NHS website says that approximately 66 per cent of people with RRMS eventually develop SPMS.

However, due to the increased use of disease-modifying therapies (DMTs), fewer people living with RRMS now transition from RRMS to SPMS. When there is a change in people’s MS, it is occurring at a later stage in the person’s journey with the condition. The transition from RRMS to SPMS can vary from person to person, but it usually occurs after quite a long time, often several decades.

It is difficult to predict the course of MS – and it is important to note that once known that a person has transitioned to the SPMS stage, some individuals may continue to experience infrequent relapses (if their MS is still inflammatory), while others may not.

Primary progressive MS (PPMS) is called ‘primary progressive’ because it is progressive from the outset. It is a type of MS where symptoms progressively accumulate over time and there are no periods of remission. PPMS usually affects people in their 40s and there are usually (but not always) few or no relapses. From a clinical perspective, little or no inflammation shows up in MRI scans.

Having said that there are no relapses with PPMS, rarely some people are told that they have ‘active PPMS’ or ‘progressive relapsing MS’ (PRMS). Some people will experience early relapses or show inflammation on MRI scans  as new ‘lesions’. In active PPMS, the immune system continues to attack the myelin around nerves, causing inflammation.

MS-UK have a suite of information booklets. Our booklets are called ‘Choices’ as we aim to support people to have as much choice, control and independence as possible. Our booklets cover ‘what is MS?’, ‘MS symptoms’, MS diagnosis’ ‘MS treatments’, and ‘life with MS’. The booklets contain real quotes, insights and experiences of people living with MS. You can find the link for the Choices booklet on types of MS below.

 ‘Types of MS’