Negative prognostic impact of MRI spinal lesions in the early stages of relapsing–remitting multiple sclerosis

BACKGROUND: The presence of spinal cord (SC) magnetic resonance imaging (MRI) lesions can be expected to affect the mobility of people with relapsing–remitting MS (pwRRMS), but reports are ambiguous. OBJECTIVE: The objective of this paper is to determine whether the presence of SC MRI lesions in early diagnosed pwRRMS could be considered a predictor of long-term disability. METHODS: pwRRMS with an SC MRI performed within two years from the onset of symptoms and followed up for at least seven years were included. Patients were grouped into: (a) pwRRMs with at least one SC T2 MRI lesion, and (b) pwRRMs without SC T2 MRI lesions. The primary end point was to evaluate the effects of independent factors on reaching an Expanded Disability Status Score (EDSS) of 4.0. RESULTS: A total of 239 pwRRMS matched the required criteria: 116 in the group with SC lesions and 123 in the group without SC lesions. At baseline, there were no statistical differences between the two groups. The presence of SC lesions (Exp(b) 4.4, CI 2.1–9.0, p < 0.001) and higher basal EDSS (Exp(b) 3.3, CI 2.3–4.8, p < 0.001) proved to be the best predictors of reaching EDSS 4.0. CONCLUSION: The presence of T2 SC MRI lesions detected early from MS onset of RRMS predicts a worse prognosis.