Great question — and it's one that even neurologists are still working to fully understand! Here's a breakdown of how PIRA and SPMS relate to each other.
SPMS (Secondary Progressive MS) is a stage of MS that follows relapsing-remitting MS (RRMS). In SPMS, symptoms gradually worsen over time, and disability can increase Show Full Answer
Great question — and it's one that even neurologists are still working to fully understand! Here's a breakdown of how PIRA and SPMS relate to each other.
SPMS (Secondary Progressive MS) is a stage of MS that follows relapsing-remitting MS (RRMS). In SPMS, symptoms gradually worsen over time, and disability can increase even without obvious relapses. It can be "active" (with some relapses or new MRI lesions) or "nonrelapsing" (worsening without relapses or visible lesion activity).
PIRA (Progression Independent of Relapse Activity) is a newer concept describing slow, silent worsening that happens *outside* of relapses. It's not a separate type of MS — think of it more as a *mechanism* that can occur across different MS types, including SPMS. The key difference is:
- SPMS is a *diagnosis* — a recognized stage of MS
- PIRA is a *process* — a way of describing how progression can happen silently, even without relapses or active lesions on MRI
This is actually very relevant to your situation. Having SPMS without active lesions or visible progression on MRI doesn't mean nothing is happening. PIRA is linked to low-level "smoldering" inflammation deep in the brain and spinal cord that standard MRI scans may not always detect clearly.
Subtle changes worth tracking include:
- Walking ability or stamina
- Balance and coordination
- Memory or concentration (brain fog)
- Fatigue levels
These slow shifts can be easy to dismiss as "just a bad day," but tracking them regularly and sharing them with your neurologist is really important — especially since PIRA can add up quietly over time.
May 26
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