Relapsing-Remitting Multiple Sclerosis (RRMS)

What is RRMS?

RRMS, or relapsing-remitting multiple sclerosis, is a type of multiple sclerosis (MS) that occurs when you have flare-ups (also called relapses or exacerbations) of symptoms followed by periods of partial or complete recovery (remission). Relapses are episodes of new or worsening symptoms. Your symptoms can last for a couple of days up to a couple of weeks.

Is RRMS the same as MS?

RRMS is a type of multiple sclerosis. MS is an autoimmune condition that affects your central nervous system. Symptoms for each type of MS are similar but the onset of symptoms can vary by type.

The description or label of relapsing-remitting (RR) helps you know what to expect over the disease course. The classification also helps you and your healthcare provider determine what type of treatment might be best for you.

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.

What are the most common symptoms in RRMS?

The symptoms of RRMS vary from person to person, but can include:

• Vision changes, including blurry vision, impaired color vision, painful eye movement or double vision.
• Tingling or numbness in various parts of your body.
• A squeezing sensation around your chest or abdomen that feels like a hug (sensory level).
• Fatigue.
• Bladder or bowel problems, including difficulty (or hesitation) when trying to urinate (pee), or a feeling of urgency (when you have to go, you have to go).
• Electrical tingling or shocks down your back, when you bend your neck forward.
• Difficulty walking.
• Muscle weakness or stiffness.
• Cognitive difficulties (brain fog) that some describe as difficulty with memory and concentration.

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. For others, they’ll have incomplete recovery and will have persistent symptoms, which a healthcare provider can usually manage. For example, a person with severe stiffness or spasticity usually finds relief with a daily stretching program (managed by a physical therapist) with additional medications or Botox® injections.

What can worsen RRMS symptoms?

You might notice certain things in your environment trigger RRMS symptoms. These could include:

• Stress.
• Heat or certain temperatures.
• Infections (even mild infections such as a sinus infection or urinary tract infection can cause old MS symptoms to reappear).
• Smoking tobacco products.
• Vitamin D deficiency.

Triggers for one person diagnosed with RRMS may not affect another person with the same condition.

What causes MS?

The exact cause of MS is unknown. Research suggests it relates to a genetic predisposition (changes in your DNA) that make you more likely to have an autoimmune condition like MS. 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.

Environmental factors can also cause MS, like exposure to bacteria or viruses like Epstein–Barr virus.

When you have multiple sclerosis, your immune system mistakenly attacks healthy areas of your central nervous system. Specifically, MS attacks myelin, which is a 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.

What are the complications of RRMS?

Complications of RRMS are worsening symptoms that lead to:

• Spasticity or muscle tightness.
• Vision loss or difficulty focusing.
• Difficulty controlling your bladder or bowel function.
• Sexual dysfunction.
• Problems with cognitive function.
• Changes to your mood such as anxiety and/or depression.

How is RRMS diagnosed?

The diagnosis of MS is challenging because there isn’t one single test or procedure that can confirm or rule out the condition. It requires collecting information from a variety of sources, including your medical history and a physical examination along with test results, which can include:

• An MRI to look for damage to your brain and spinal cord.
• A lumbar puncture (spinal tap) to find characteristics of MS, which can include oligoclonal bands. Oligoclonal bands are commonly found in MS but can also be seen in other conditions. They can represent evidence of inflammation involving your brain and/or spinal cord.
• Blood tests to rule out conditions with similar symptoms.
• An optical coherence tomography (OCT), which is a painless test that scans the nerves in the back of your eye (retina) to detect damage, possibly caused by MS.

When do people receive an RRMS diagnosis?

It’s common to receive an RRMS diagnosis in your 20s to 40s. However, an RRMS can be present at any age.

How is RRMS treated?

RRMS treatment usually involves taking medications to change the course of the condition. These medications come in different forms, including:

• An injection: A small needle will poke through your skin to give you a dose of a medication.
• An oral medication: This is a pill that you take by mouth and swallow whole with a glass of water.
• An infusion: A healthcare provider will place a small needle into a vein in your arm and the medication slowly enters your bloodstream.

There are several U.S. Food and Drug Administration (FDA)-approved medications for RRMS that focus on:

• Reducing how many relapses you have.
• Reducing damage (scarring) to your central nervous system.
• Slowing the progression of your symptoms.

It’s important to note that current treatments can’t remove or repair the previous areas of damage (demyelination), but there’s ongoing research to find ways to do this. That being said, it’s important to start these medications (called disease-modifying agents or DMTs), which can help prevent further damage to your nervous system.

What medications treat RRMS?

Medications that treat RRMS are constantly changing. Talk to your healthcare provider about the medications currently available to treat your symptoms. Your healthcare provider can also discuss any possible side effects from the medications to look out for.

RRMS doesn’t cause much inflammation in your body, so medications, which are primarily anti-inflammatory medications, seem to be less effective in this phase of the condition.

Can MS be prevented?

There’s no known way to prevent MS. To reduce relapses of symptoms, continue treatment as directed and avoid triggers in your environment.

Is RRMS curable?

There’s no known cure available for RRMS yet. Research is ongoing to learn more about the condition. Treatment options can delay the progress of the condition and prevent relapses.

What is the life expectancy for MS?

People diagnosed with MS can live long and fulfilling lives. In some rare cases, either because of MS or complications related to other medical conditions, some people may have a shortened life expectancy. But many of these complications are preventable or manageable. For example, it’s important to manage any comorbidities such as heart disease and stroke with your primary care team.

What’s the outlook for RRMS?

The prognosis varies widely for RRMS. Some people rarely have attacks and can go years without having new symptoms. Others may have frequent attacks and require more intensive treatment. Given the rapid evolution in available treatments, the prognosis for MS has improved dramatically over time.

Does RRMS lead to other forms of MS?

Many people who have an RRMS diagnosis later develop another type of multiple sclerosis called secondary progressive multiple sclerosis (SPMS). SPMS occurs after having RRMS when your symptoms progressively get worse but the risk for relapses seems to decrease. The exact cause of SPMS isn’t clear. Early and aggressive treatment may reduce or prevent the onset of SPMS.

When should I see a healthcare provider?

Visit a healthcare provider if you have new or worsening symptoms of RRMS. If you experience side effects of treatment, talk to your healthcare provider.

What questions should I ask my healthcare provider?

• What form of MS do I have?
• What type of treatment do you recommend?
• Are there side effects of the treatment?
• How do I manage my symptoms when they relapse?
• How do I identify triggers?

A note from Cleveland Clinic

Relapsing-remitting multiple sclerosis (RRMS) can have a significant impact on your life. A healthcare provider can help you navigate treatment to prevent or reduce attacks. It can be challenging living with a chronic condition, and many people find comfort in speaking with a mental health professional. Your care team is available to answer your questions and help you feel better with an RRMS diagnosis.