In relapse-remitting multiple sclerosis (MS), people experience periods of high MS activity where they have more symptoms or imaging tests show inflammation. Between these periods, the condition might be in remission.

Relapse-remitting is one form of MS. The condition might also be characterized as progressive. It’s possible for you to have progressive MS and active MS at the same time.

The main difference between active and inactive MS is the presence of clinical activity. Clinical activity refers to relapses of symptoms.

What is active MS?

Active MS is when you experience relapses, which are a sudden onset of symptoms. “Active” MS might also be when there’s evidence of inflammation or other changes on an MRI. Attacks, relapses, or exacerbations occur in relapse-remitting MS.

What does inactive MS mean?

Inactive MS is when there are no signs of recent activity. You might be between relapses, and your MRI might not show any new activity, like areas of inflammation. You might still experience MS symptoms as a result of previous attacks, but the disease is not considered clinically active.

MS “with progression” is when there’s a slow and steady worsening of symptoms over time. This can occur in primary progressive MS, where a person does not experience attacks, or relapses.

With primary progressive MS, you might experience some symptom relief, but this relief is usually minor and short-lived.

Progression can also happen in secondary progressive MS. Individuals experiencing this usually have relapse-remitting MS, but the condition has evolved into a progressive form where symptoms gradually get worse.

Yes, MS can be both active and “with progression.” A person with progressive MS might experience relapses, indicating the condition is still active. They might have attacks or evidence of new clinical activity on imaging scans. At the same time, their symptoms are still progressing and becoming more severe.

The symptoms of MS and the course of the condition vary a lot between individuals, so it’s challenging to give a specific outlook.

In primary progressive MS and secondary progressive MS, changes associated with the condition gradually and steadily get worse over time. This might cause constant symptoms.

Relapses can also cause you to experience more symptoms for a period of time before symptoms get better. For a doctor to consider a period of new symptom onset as a relapse, it must last at least 24 hours and come no less than 30 days after a previous attack.

Relapses can also have different symptoms each time and vary in severity.

As there’s no cure for MS, doctors recommend treatments that aim to reduce the severity of relapses and to slow progression. There are some treatments that a doctor might prescribe for either active MS or MS with progression.

Active MS

To treat MS attacks, options include:

  • Intravenous (IV) methylprednisolone or oral corticosteroids: This treatment over a few days can help a person to recover more quickly from an attack.
  • Plasmapheresis: This is for people who don’t respond to corticosteroids. It involves removing blood plasma from a person’s body and putting back replacement plasma.

There are other treatments for relapse-remitting MS that aim to help stop the inflammation associated with the condition. These are most effective when started during the early stages of MS and are for long-term management of the condition:

  • Injectable treatments: These include beta interferon drugs (Avonex, Betaseron) or glatiramer acetate (Copaxone).
  • Infusion treatments: These include natalizumab (Tysabri), ocrelizumab (Ocrevus), alemtuzumab (Lemtrada), ofatumumab (Kesimpta), and ublituximab (Briumvi).
  • Oral treatments: These include fingolimod (Gilenya), dimethyl fumarate (Tecfidera), teriflunomide (Aubagio), and cladribine (Mavenclad).

MS with progression

There are a few medications that are Food and Drug Administration (FDA)-approved to treat progressive forms of MS:

  • ocrelizumab (Ocrevus) for primary progressive MS
  • mitoxantrone (Novantrone) for secondary progressive MS
  • diroximel fumarate (Vumerity) for secondary progressive MS and relapsing secondary progressive MS.
  • siponimod (Mayzent) for secondary progressive MS and relapsing secondary progressive MS.
  • glatiramer acetate (Copaxone) for active (relapsing) secondary progressive MS.
  • natalizumab (Tysabri)for active (relapsing) secondary progressive MS.
  • alemtuzumab (Campath and Lemtrada) for active (relapsing) secondary progressive MS.
  • ofatumumab (Kesimpta) for active (relapsing) secondary progressive MS.
  • ublituximab (Briumvi) for active (relapsing) secondary progressive MS.

There are also many treatments and therapies that might help with symptoms of MS, such as prescription dalfampridine (Ampyra) for ataxia and clonazepam (Klonopin) for tremor.

Lifestyle therapies can also have an important role in MS management. Yoga and stretching, for example, can help to manage symptoms like muscle spasticity.

If you already have an MS diagnosis but have new or worsening symptoms, consider seeing a doctor to discuss the possibility that you might be experiencing a relapse or an exacerbation.

A doctor can also discuss whether your type of MS is changing, such as from relapse-remitting MS to secondary progressive MS.

If you’re taking an MS medication and experiencing negative side effects, or don’t think the treatment is working, you might also want to discuss your options with a doctor.

Active MS is when there are periods of clinical activity, such as new symptoms or areas of inflammation on imaging scans. Inactive MS is when there’s no clinical activity. It’s possible for the condition to be active and with progression, where symptoms are gradually becoming worse.

Treatments for MS involve corticosteroids for acute attacks and medications that aim to slow disease activity over the long term.