008 Systemic inflammatory response in relapsing-remitting multiple sclerosis

Abstract

Multiple sclerosis (MS) is often described as an inflammatory disease of the central nervous system (CNS). However, the aberrant immune response may not be fully compartmentalised within the CNS. Here we present two strands of evidence for an active systemic inflammatory process in MS. First, we describe a case series of six individuals with relapsing-remitting MS (RRMS) and sustained raised serum inflammatory markers. All displayed persistent leucocytosis and/or raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), with no evidence of any other systemic or alternative neuro-inflammatory condition on long-term follow-up. All but one met criteria for rapidly-evolving severe (RES) RRMS. We hypothesised that these cases reflect the extreme end of a systemic inflammatory response spectrum in MS. Therefore, we sought to further investigate the systemic inflammatory response in RRMS by a more sensitive method, namely liquid chromatography-mass spectrometry to detect urinary neopterin, a molecular product of activated macrophages and a non-specific marker of systemic inflammation. A separate group of individuals with RRMS showed significantly higher concentrations of urinary neopterin compared to age- and gender- matched healthy controls.a.varatharaj@soton.ac.uk