Description
Multiple sclerosis (MS)
is a chronic neuroinflammatory disease that primarily affects young adults,
leading to neurological impairment and disability. Traditionally, MS has been
categorized into forms such as relapsing-remitting MS (RRMS), primary
progressive MS (PPMS), and secondary progressive MS (SPMS). However, it is now
acknowledged that the disease should be viewed as a continuum, as inflammation
and neurodegeneration coexist from the early phases of the disease.
Disease worsening can
be triggered by both acute and chronic inflammatory processes, or it may occur
independently of inflammation. Consequently, new concepts have recently
emerged, such as smoldering-associated worsening (SAW) and progression
independent of relapse activity (PIRA).
New biomarkers have
been identified to assess smoldering inflammation, including paramagnetic rim
lesions (PRLs) and slowly expanding lesions (SELs) visible on MRI.
Additionally, fluid biomarkers are under evaluation for their potential to
monitor disease evolution and predict progression in advance.
In recent years, a
global effort by researchers has focused on defining the immunopathology,
clinical and radiological metrics, and biomarkers specific to progressive MS.
The goal is to identify, as early as possible, individuals at higher risk of
disability, quantify smoldering damage, and evaluate the effectiveness of new
treatments—such as BTK inhibitors—which can cross the blood-brain barrier and
target the local innate and adaptive immune systems.