Fact – autoimmune disorders affect the young.
Fact – the immune system ages with you as does rest of the body.
Fact – MS is an autoimmune disorder.
This week we find yet another study re-iterating the point that the evolution of MS lesions is an age-dependent phenomenon. This time using MRI head scans, in what is arguably one of the largest series published on the topic.
Gadolinium-enhancement (a marker of active MS) declines with increasing age (see Figure below). This plays out in natural history MS cohorts that demonstrate that relapses decrease with age also (in the British Columbia cohort, the rate of relapse dropped by 17% for every five years of follow-up). Concurrently, those with relapsing-remitting MS (RRMS) also tend to have those most active scans.
If your aim is to achieve the closest thing to a cure in MS – which is freedom of disease activity; it pays to consider the highest tier of targeted immunosupression in this particular cohort of MS.
J Neurol. 2020 May 9. doi: 10.1007/s00415-020-09895-0. [Epub ahead of print]
Gadolinium enhancement on cranial MRI in multiple sclerosis is age dependent.
Epidemiological, pathological and radiological studies suggest that inflammatory demyelination in MS is an age-dependent process, and that the formation of focal inflammatory demyelinating lesions decreases with age. Gadolinium-enhancing lesions are a biomarker of inflammatory disease activity in MS, but little is known about the relation of age and gadolinium enhancement on cranial MRI scans in people with MS. In this study, we investigated the association of age and other risk factors with gadolinium enhancement on cranial MRI in a retrospective cross-sectional clinical MS cohort.
In a cohort including 1543 people with CIS and MS, we investigated the association of the risk factors age, sex, disease course, immunomodulatory drug (IMD) treatment, and disability with gadolinium enhancement on cranial MRI scans using a binary logistic regression model.
Age was the most important factor associated with gadolinium enhancement, with the odds of gadolinium enhancement decreasing with advancing age. Participants with CIS had lower odds of gadolinium enhancement (odds ratio of 0.42, 95% confidence interval of 0.24-0.72 compared to RRMS). Sex, disease course and IMD treatment were not significantly associated with gadolinium enhancement in our cohort.
Our investigation shows that gadolinium enhancement is strongly associated with age. Since gadolinium enhancement is a marker of inflammatory disease activity, our findings suggest that inflammatory disease activity declines with age, and that IMD treatment may be more beneficial in younger and less useful in older people with MS.