Motivation: Progression independent of relapse activity (PIRA) is the most frequent manifestation of disability accumulation in multiple sclerosis (MS), but the mechanisms leading to PIRA are currently unknown. Goal(s): To investigate the link between PIRA and white matter degeneration in people with MS. Approach: To compare the integrity of normal-appearing white matter (NAWM) between patients with MS who experienced PIRA versus stable patients using diffusion tensor imaging (DTI) measures from a clinical-compatible protocol. Results: Patients with PIRA exhibited significant differences in DTI-derived measures compared to stable patients: reduced fractional anisotropy and increased mean and radial diffusivity in NAWM. Impact: This study sheds light on the relationship between progression independent of relapse activity (PIRA) and white matter degeneration in people with multiple sclerosis. The results have important implications for understanding the mechanisms of disability progression in relapsing-remitting multiple sclerosis.

Diffusion tensor imaging of multiple sclerosis patients with progression independent of relapse activity show increased white matter damage