What Is RMS Disease? Symptoms, Causes, & Treatments

Relapsing-Remitting Multiple Sclerosis (RMS) is a condition that impacts lives with its fluctuating and often invisible nature. It can present with sudden symptoms such as vision changes or numbness that may come and go unpredictably.

RMS is the most common form of multiple sclerosis (MS), a chronic disease affecting the central nervous system. It’s characterized by episodes of worsening neurological function, called relapses, followed by periods of remission when symptoms partially or completely disappear. 

This article provides an in-depth exploration of RMS, including its causes, symptoms, treatments, and its impact on daily life, to support patients, caregivers, and those seeking to understand this condition.

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Understanding RMS Disease

RMS is the most common subtype of multiple sclerosis. To understand RMS, we must understand what’s happening in multiple sclerosis, and how changes in the immune system can cause symptoms to flare up and then disappear.

What is Multiple Sclerosis (MS)?

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system (CNS). It causes inflammation, damage to the myelin (the protective coating around nerve fibers), scarring, and loss of nerve cells. 

MS may lead to various symptoms, such as vision changes, numbness, muscle weakness, cognitive challenges, and bladder issues, depending on where the damage occurs in the CNS.

In MS, the immune system mistakenly attacks the myelin sheath, which is the protective wrapping around nerve fibers that helps send signals in the CNS. This attack leads to inflammation and damage, contributing to the formation of plaques or lesions, often around small blood vessels.

Inflammation plays a key role in MS, ultimately leading to nerve cell damage. Immune cells in the brain and spinal cord release inflammatory chemicals that harm myelin and activate other cells, creating oxidative stress, mitochondrial dysfunction, and eventual damage to nerve cells, disrupting their ability to work properly. 

What Is RMS Disease?

Relapsing-remitting multiple sclerosis (RRMS) is the most common type of MS, affecting 70–80% of people when they are first diagnosed. It is defined by cycles of relapses, when symptoms get worse for days or weeks, followed by remissions, when symptoms partially or fully improve. 

Symptoms often appear over days to weeks and last for at least 24–48 hours or longer. Over time, some symptoms may begin to linger, which can lead to long-term problems.

To diagnose RMS, doctors look for at least two episodes of inflammation in the central nervous system (CNS) that happen at different times and in different areas of the brain (this is known as the “Time and Space” rule). 

Starting treatment early with disease-modifying therapies (DMTs) may be associated with reducing the number and severity of relapses, managing symptoms like fatigue and memory issues, and slowing down the disease. Without treatment, studies suggest that up to 20–40% of individuals with RMS may progress to secondary progressive MS after 10–15 years, where symptoms gradually worsen with or without relapses.

What Causes the Relapses in RMS?

Relapses in relapsing-remitting MS (RMS) occur due to immune system-mediated inflammation in the central nervous system (CNS), leading to myelin damage (myelin is the protective coating around nerve fibers).

This damage interrupts nerve signals and causes symptoms to worsen during relapses. 

Several factors can trigger these relapses:

• Inflammation: inflammatory processes in the body make it easier for immune cells to enter the CNS and attack, leading to nerve damage.

• Low Vitamin D Levels: Vitamin D helps regulate the immune system, and research suggests that low levels may be associated with an increased risk of relapses.

• Infections: viral or bacterial infections can activate the immune system, triggering a relapse.

• Hormonal Changes: pregnancy and certain hormones like estrogen and progesterone affect relapse risk. Relapses often decrease during pregnancy but may increase after childbirth.

• Age and Environment: aging affects the immune system, and factors like limited sunlight exposure (which lowers Vitamin D) can increase relapse risk.

• Genetics: specific genes, like HLA-DRB1, are highly associated with disease progression.

• Smoking: Smoking is strongly linked to worse outcomes in MS, including increased risk of developing the disease, faster progression to disability, greater brain lesion activity, and reduced quality of life, but quitting smoking can slow disease progression and improve overall health in MS patients.

• Diet and Nutrition: A diet high in processed foods and low in antioxidants may exacerbate inflammation, although more research is needed.

By understanding these triggers, patients and healthcare providers can take steps to lower relapse risks such as managing infections, improving Vitamin D levels, and starting disease-modifying therapies early.

Who Does RMS Affect?

RMS affects approximately 70-80% of people diagnosed with MS. It typically begins between the ages of 20 and 40, with women being two to three times more likely to develop the disease than men. 

Risk factors for developing MS include:

• Genetics: a family history of MS increases susceptibility. First-degree relatives like parents, siblings, or children are three times more likely to get MS than the general population. Identical twins have a 25-30% chance of both having the disease, showing that genetics play an important role alongside environmental factors.

• Environmental Triggers: factors such as low vitamin D levels, smoking, and exposure to certain viruses like Epstein-Barr may contribute.

• Geography: RMS is more common in regions farther from the equator.

The Emotional and Psychological Toll of RMS

For patients living with RMS, the unpredictability of relapses can lead to anxiety and depression, stress and overwhelm. That emotional experience, coupled with chronic pain, a common symptom of MS, can take a massive toll on their emotional and psychological wellbeing. 

Caregivers and family members may also experience stress as they adapt to the changing needs of their loved ones.

Impact on Daily Life

Living with MS can be emotionally challenging, as many people experience anxiety, depression, stress, fatigue, and chronic pain that affect their quality of life. These issues not only impair daily functioning but are also linked to a worse overall prognosis.

Patients with MS often feel isolated because their physical challenges limit what they can do, which makes it harder to cope with their emotions. Chronic pain, a common and overwhelming symptom of MS, also takes a toll on their mental health and can further encourage isolation.

Mindfulness practices, which focus on staying aware of the present moment, have been shown to help reduce feelings of sadness, stress, and exhaustion. These techniques also help people manage their emotions and build healthier coping skills. 

However, mindfulness works best when combined with other treatments, as researchers are still studying its long-term effects and how it helps improve mental and physical health.

Recognizing RMS Symptoms

Early recognition and treatment for MS is essential to protect brain and nervous system health and reduce the likelihood of relapse.

Early Signs of RMS Disease

Early symptoms can vary but often include:

• Vision Problems: blurred or double vision, or temporary vision loss.

• Weakness, Numbness or Tingling: especially in the face, arms, legs, or trunk. These symptoms, along with vision changes, are often reported as early signs of MS. 

• Fatigue: persistent exhaustion not relieved by rest.

• Muscle Weakness or Spasms: these may be intermittent or persistent.

• Bladder and Bowel Issues: frequent urination, urgency, or constipation.

• Uthoff Phenomenon: Uhthoff phenomenon, also known as Uhthoff sign, happens when people with multiple sclerosis (MS) experience temporary worsening of their symptoms due to increased body temperature from things like exercise, hot showers, or fevers. This happens because heat affects how damaged nerves send signals. Symptoms usually go away within 24 hours after cooling down or resting. To manage it, patients should avoid heat triggers, and in more serious cases, medications like dalfampridine may help improve nerve function. 

Silent Symptoms of RMS

Some symptoms, such as cognitive changes or mood disturbances, may go unnoticed but significantly impact quality of life. These can include:

• Memory and Concentration Problems: difficulty recalling information and inattention can occur.

• Depression and Anxiety: these mental health concerns are common due to both physical and emotional factors, and significantly impact patients’ quality of life.

• Coordination Issues: trouble with balance or walking.

Long-Term Effects of RMS

Without treatment, RMS can progress to secondary progressive MS, characterized by fewer remissions and worsening disability. Early intervention is necessary to delay or even prevent this progression.

Diagnosing RMS Disease

Early diagnosis is essential to access important treatments for MS. 

Medical History and Physical Exam

Diagnosis begins with documenting symptoms and relapses. A neurologist may conduct a physical exam and run tests to assess nerve function.

Diagnostic Tests for RMS

Common tests include:

MRI 

AN MRI identifies areas of demyelination in the brain or spinal cord. MRI is the most accurate tool for diagnosing MS because it helps identify lesions in the central nervous system (CNS) that are spread out in time and location (the “Time and Space” rule), which is required for diagnosis. 

• Time: evidence of lesions from different times can demonstrate a history of flare-ups. An MRI showing both active and older lesions, or a new lesion appearing on follow-up scans, would qualify. 

• Space: lesions in at least two of five areas of the brain, spinal cord, or optic nerve show separation in space.

Gadolinium-enhanced MRI can show active inflammation, and advanced MRI technology can better identify MS plaques as opposed to other types of brain lesions.

Lumbar Puncture

A lumbar puncture is being done less commonly. It is traditionally used to examine cerebrospinal fluid for markers of inflammation or evidence of infection (such as Lyme disease), and may still be used when an MRI is not diagnostic.

Evoked Potentials

Evoked potential tests are painless, noninvasive tests that check how quickly and effectively your nerves send signals to your brain in response to sights, sounds, or touch. They can help diagnose conditions like MS by finding nerve damage that might not show up in other tests.

Blood Tests

Blood tests are used to rule out conditions like lupus or other inflammatory conditions that mimic MS symptoms.

Differential Diagnosis

Conditions like lupus, Lyme disease, or other inflammatory and autoimmune conditions can mimic RMS symptoms.

The diagnostic process will also differentiate MS from a clinically isolated syndrome, where a person has one isolated episode of symptoms, or from a radiologically isolated syndrome, where a person has patterns of MS on an MRI but no symptoms. These conditions can later develop into MS. 

The Importance of Early Diagnosis

Timely diagnosis allows for earlier treatment, potentially slowing disease progression and preserving quality of life. For clinicians, recognizing subtle signs in high-risk patients and acting immediately can be pivotal.

RMS Treatment Options

Treatments may depend on the patient’s presentation and severity of symptoms. 

Medication Options

Your doctor will discuss your options with you to determine the best course of treatment for you. Options may include:

Disease-Modifying Therapies (DMTs)

These powerful drugs reduce the frequency and severity of relapses and slow disease progression. Early initiation of these therapies is often recommended, particularly in RMS, as it may improve long-term outcomes.

While DMTs can be highly effective, they require careful monitoring for side effects and patient adherence for optimal results. 

Common injectable options include interferon beta, glatiramer acetate (Copaxone, Glatopa), and Ofatumumab (Kesimpta, Arzerra).  

Oral medications may include teriflunomide, dimethyl fumarate, diroximel fumarate, monomethyl fumarate, fingolimod, siponimod, ozanimod, ponesimod, or cladribine.

Infusion treatments for MS are given through an IV and help reduce relapses and slow the progression of the disease. They are closely monitored by medical professionals. Common medications include natalizumab, ocrelizumab, ublituximab, and alemtuzumab.

Steroids

High-dose corticosteroids are often used to shorten relapses by reducing inflammation quickly.

Symptom Management Medications

These are used to address specific symptoms like spasticity, pain, or depression, in order to make the patient more comfortable. Examples include baclofen for muscle spasms and antidepressants for mood disturbances.

Advanced Therapies

Advanced treatments like monoclonal antibodies and stem cell transplantation are typically reserved for severe cases, or those that do not respond well to other treatments.

Lifestyle Adjustments

Lifestyle changes can complement medical treatments:

• Diet: a balanced diet rich in anti-inflammatory foods (e.g., fruits, vegetables, and omega-3 fatty acids).

• Exercise: low-impact activities like yoga or swimming can promote mobility and reduce fatigue.

• Stress Management: techniques such as mindfulness, meditation, or therapy may help support emotional well-being and complement medical treatments.

• Sleep Hygiene: maintaining regular sleep patterns can improve energy levels and may reduce relapses.

• Support Networks: joining MS support groups can provide emotional and practical assistance.

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Key Takeaways

• Understanding RMS: relapsing-remitting multiple sclerosis (RMS) is the most common form of MS, marked by cycles of symptom relapses and remissions caused by immune system attacks on the nervous system.

• Diagnosis and Treatment: early diagnosis using MRI and other tests may allow for timely initiation of disease-modifying therapies (DMTs), which can help reduce relapses, slow progression, and potentially improve long-term outcomes.

• Lifestyle and Support: managing RMS includes a combination of medication, healthy lifestyle adjustments (diet, exercise, stress management), and support networks to improve daily life and emotional well-being.