Did you know that a third of relapses are triggered by infections, typically non-specific viral infections?
The observation that a relapse is more likely to occur in the so-called ‘at risk’ period, typically 5-6 weeks after infection than at other times predates the disease-modifying therapy era of MS. The mechanism is thought to be that infection boosts the immune system non-specifically, which then trigger relapses. This observation was extrapolated to vaccinations, but most vaccine studies now show that vaccines in general, with the possible exception of the yellow fever vaccine*, are safe and are not associated with an increased risk of relapses nor MRI activity.
* Please note recent data on the live yellow fever vaccine shows that it doesn’t trigger MS relapses.
Once people are on an effective DMT the link between infections and relapses is not observed. This is another, albeit minor, reason to be on a DMT. However, there is an emerging field in basic science and clinical evidence to support it that recurrent infections drive some of the pathological processes that are responsible for smouldering MS. Systemic inflammation activates CNS microglia that then produce cytokines and inflammatory mediators that have a negative effect on neuronal function. This is why people with MS handle infections so poorly and often don’t get back to baseline after a severe systemic infection.
Therefore as part of the holistic management of MS, it is a good idea to prevent chronic or recurrent infections. So if you have recurrent or chronic bladder infections, periodontitis (gum disease), chronic sinusitis or recurrent chest infections you need to do something about it. Don’t just accept recurrent infections as your lot in life ask your MS team for advice and help.
#T4TD = Thought for the Day
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