Understanding Relapsing-Remitting vs. Progressive MS: Key Differences

Introduction

Multiple Sclerosis (MS) is a chronic neurological condition that affects the central nervous system (CNS). But did you know there’s more than one type of MS — and each behaves very differently?

In this post, we’ll dive into the two main types of MS — Relapsing-Remitting MS (RRMS) and Progressive MS, which includes Primary Progressive MS (PPMS) and Secondary Progressive MS (SPMS). We’ll explore what makes them different, how they’re diagnosed, and what treatment and life might look like for each form 💡.

🔍 What Is Multiple Sclerosis?

Multiple Sclerosis is an autoimmune disease where the body’s immune system mistakenly attacks the protective covering of nerves (called myelin). This disrupts communication between the brain and the rest of the body.

Common symptoms include:

Fatigue
Vision problems
Muscle weakness
Balance and coordination issues
Numbness or tingling
Cognitive changes

But not everyone experiences MS the same way. That’s where disease types come into play.

🌀 The Four Main Types of MS

According to the National MS Society, MS is generally classified into these main categories:

Relapsing-Remitting MS (RRMS) — the most common type
Primary Progressive MS (PPMS)
Secondary Progressive MS (SPMS)
Progressive-Relapsing MS (PRMS) — now often grouped under progressive MS

Let’s focus on the two major "umbrella" groups — Relapsing-Remitting and Progressive MS — and understand what sets them apart.

⏱️ What Is Relapsing-Remitting MS (RRMS)?

🔄 Definition

RRMS is characterized by clearly defined attacks (relapses) of new or worsening symptoms followed by periods of partial or complete recovery (remissions).

Relapses = New inflammation and nerve damage.
Remissions = No disease progression during this time, and some or all symptoms may fade.

📊 How Common Is It?

RRMS accounts for approximately 85% of all MS diagnoses at onset — making it the most common form of the disease.

🔬 How Is RRMS Diagnosed?

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Diagnosis typically involves:

MRI scans showing lesions on the brain or spinal cord
Neurological exams
Lumbar puncture (sometimes)

Doctors look for evidence of at least two different episodes affecting different areas of the CNS, separated by time.

⚡ Symptoms of RRMS

Sudden onset of blurred vision
Tingling or numbness
Muscle spasms
Fatigue
Mobility issues during a relapse

Symptoms may vary drastically from one relapse to another — and can disappear entirely in remission.

📈 What Is Progressive MS?

“Progressive” means that the disease gets steadily worse over time, without distinct relapses or remissions.

There are two key subtypes:

1. Primary Progressive MS (PPMS)

Symptoms gradually worsen from the beginning.
There are no distinct relapses or remissions, though plateaus may occur.
Diagnosed in about 10-15% of MS patients.

2. Secondary Progressive MS (SPMS)

Begins as RRMS, but transitions over time into a steadily worsening condition.
The relapsing pattern stops, and symptoms become more permanent.
Around 50-60% of people with RRMS will eventually develop SPMS within 10–20 years.

⚖️ Key Differences Between RRMS and Progressive MS

Feature	Relapsing-Remitting MS (RRMS)	Progressive MS (PPMS & SPMS)
Disease Pattern	Flare-ups with recovery periods	Gradual worsening, no full remissions
Onset Age	Typically 20s–30s	Often later (30s–40s for SPMS, 40s–50s for PPMS)
Symptoms	Vary between relapses	Slowly accumulate
Recovery	Partial or complete after attacks	Limited recovery; symptoms often remain
MRI Activity	Often active with new lesions	Less inflammatory activity, more atrophy
Gender Distribution	2–3x more common in women	More equal (PPMS almost 50/50)
Treatment Response	Often responds well to DMTs	Harder to treat; fewer approved drugs

🧪 What Causes the Difference?

While both forms involve immune system dysfunction and nerve damage, researchers believe:

RRMS has more inflammation, leading to active attacks and visible lesions.
Progressive MS involves more neurodegeneration, with fewer active immune responses and more nerve fiber loss.

Genetics, age, and environment likely influence which type of MS develops.

💊 Treatment Options: RRMS vs. Progressive MS

RRMS Treatments

There are over 20 FDA-approved disease-modifying therapies (DMTs) for RRMS, including:

Interferon beta (Avonex, Rebif)
Glatiramer acetate (Copaxone)
Fingolimod (Gilenya)
Ocrelizumab (Ocrevus)
Natalizumab (Tysabri)

These aim to:

Reduce relapse frequency
Lessen lesion development
Slow disability progression

Progressive MS Treatments

Options are more limited:

Ocrelizumab is approved for PPMS.
Siponimod is used for SPMS with active inflammation.
Supportive therapies like physical therapy, mobility aids, bladder control meds, and pain management are crucial.

There’s also a growing interest in stem cell therapies, neuroprotective agents, and remyelination drugs for progressive types, though many are still in trial phases.

🧠 MRI and Disease Monitoring

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MRI scans help visualize disease activity and progression.

RRMS patients often show new enhancing lesions during relapses.
Progressive MS patients may have brain atrophy and spinal cord shrinkage without new lesions.

Tracking these changes helps neurologists decide on treatment strategy and monitor disease evolution.

🧬 Can RRMS Become Progressive?

Yes. Many people with RRMS transition to SPMS over time — this transition can be hard to pinpoint but typically involves:

Fewer relapses
More steady worsening
Persistent disability (e.g., trouble walking, bladder issues)

This doesn’t mean treatment stops — but it may shift toward symptom management and rehabilitation.

🧘Coping and Lifestyle Tips

Regardless of MS type, a proactive lifestyle can slow progression and improve quality of life. Here are a few tips:

✅ For All MS Types:

Exercise regularly: Low-impact activities like swimming, Pilates, and walking can help. Yoga can also help.
Anti-inflammatory diet: Omega-3s, leafy greens, turmeric, and fiber-rich foods. Want supplements for people with MS? Click here.
Sleep and rest: Manage fatigue with good sleep hygiene and naps.
Stress reduction: Mindfulness, therapy, or breathwork can improve resilience.
Track symptoms: Use an app or journal to identify triggers and monitor changes.

🧊 Bonus for Progressive MS:

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Try cold therapy (ice baths or cooling vests) to reduce inflammation and fatigue. Cold plunges can help.
Consider adaptive tools: mobility aids, ergonomic chairs, voice-controlled devices. Want tools for people with MS? Click here and here.

❤️ Living With MS: A Message of Hope

Although progressive MS can sound more daunting, many people live full, active lives with either form. The key lies in:

Early and appropriate treatment
Lifestyle adjustments
Building a strong support system

New therapies and research offer hope for repair and recovery — especially in remyelination and neuroregeneration.

✨ Final Thoughts

Whether you or someone you love is navigating RRMS or a progressive form of MS, understanding the difference is the first step in taking control. Knowledge empowers you to make informed treatment choices, build the right care team, and adopt a lifestyle that supports long-term brain health 🧠💪.

Stay curious, stay hopeful — and remember, your MS journey is unique, and so is your path forward ❤️.

Want an online therapist? Click here.

📚 References

National Multiple Sclerosis Society. Types of MS
Lublin, F.D., et al. (2014). "Defining the clinical course of multiple sclerosis." Neurology, 83(3), 278–286.
Reich, D.S., Lucchinetti, C.F., & Calabresi, P.A. (2018). "Multiple Sclerosis." New England Journal of Medicine, 378, 169–180.
Cree, B.A.C., et al. (2019). "Long-term evolution of multiple sclerosis disability." Annals of Neurology, 85(6), 829–839.
Montalban, X., et al. (2017). "Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis." New England Journal of Medicine, 376, 209–220.