{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T08:55:18Z","timestamp":1790326518336,"version":"4.1.0"},"reference-count":30,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T00:00:00Z","timestamp":1739836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T00:00:00Z","timestamp":1739836800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Reduced quality of life (QoL) is an early feature of multiple sclerosis (MS). The effect of progression independent of relapse activity (PIRA) on QoL is poorly investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To assess the impact of PIRA on QoL using patient-reported outcome measures (PROMs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In a prospective observational study, 125 newly diagnosed persons with relapsing-remitting MS (PwRRMS) were assessed over 5 years with: EuroQoL-5-Dimension-3-level (EQ-5D-3L), EQ-visual-analogous-scale (EQ-VAS) and 29-item-MS-Impact-Scale (MSIS-29). PwRRMS were dichotomized: PIRA (worsening of expanded disability status scale (EDSS), timed-25-foot-walk or 9-hole-peg-test, independent of relapses) versus non-PIRA. PwRRMS were compared at baseline, year 5 (y5) and delta values (baseline scores subtracted from y5 scores) and annually using linear-mixed-effects-models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      At y5, 19.2% had PIRA. PIRA versus non-PIRA PwRRMS were older (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). At y5 PIRA PwRRMS had lower EQ-5D-3L (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.001), higher MSIS-29-PHYS (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), delta values showed lower EQ-5D-3L (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001) and EQ-VAS (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.010), higher MSIS-29-PHYS (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.004) and MSIS-29-PSYCH (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.036). Linear-mixed-effects-models showed that, compared to PIRA, non-PIRA PwRRMS had an improvement in QoL: EQ-5D-3L: \u03b2 = 0.039,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001; EQ-VAS: \u03b2 = 2.401,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001; MSIS-29-PHYS: \u03b2 = \u22120.107,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001; MSIS-29-PSYCH, \u03b2 = \u22120.115,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001, during the 5-year study period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Deteriorating QoL in the early course of relapsing-remitting multiple sclerosis (RRMS) is strongly associated with PIRA. Our results suggest that QoL PROMs should be monitored and recognized as an important aspect of progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585251318516","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T06:01:33Z","timestamp":1739858493000},"page":"548-557","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Quality of life is decreased in persons with relapsing-remitting multiple sclerosis experiencing progression independent of relapse activity"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8349-1403","authenticated-orcid":false,"given":"Sarah","family":"Lindberg","sequence":"first","affiliation":[{"name":"Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6206-3339","authenticated-orcid":false,"given":"Sofia","family":"Sandgren","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Neurology, Region V\u00e4stra G\u00f6taland, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Axelsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Neurology, Region V\u00e4stra G\u00f6taland, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5078-9690","authenticated-orcid":false,"given":"Igal","family":"Rosenstein","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Neurology, Region V\u00e4stra G\u00f6taland, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7891-8466","authenticated-orcid":false,"given":"Jan","family":"Lycke","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Neurology, Region V\u00e4stra G\u00f6taland, Sahlgrenska 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