Iron rim lesions linked to worse outcomes in MS, study finds

A new study has found that people with multiple sclerosis (MS) who have iron rim lesions (IRLs) on MRI scans are more likely to experience greater disability and brain damage.

The research, published in Neuroradiology, is a meta-analysis combining data from 13 studies involving over 900 people with MS. More than half of the participants had IRLs – a specific type of brain lesion that appears as a ring of iron-rich immune cells surrounding damaged nerve tissue.

Researchers found that individuals with IRLs had higher scores on the Expanded Disability Status Scale (EDSS), meaning more physical disability. They also had greater brain atrophy and more lesions in the white matter – the part of the brain responsible for communication between different areas.

Although relapse rates were slightly higher in people with IRLs, this difference wasn’t statistically significant. However, the researchers said the findings support the idea that IRLs play an important role in both relapse activity and long-term neurodegeneration in MS.

The study’s authors suggest that including IRL assessments in routine MRI scans could help doctors track disease progression more accurately and tailor treatment decisions. While people with or without IRLs responded similarly to disease-modifying therapies (DMTs), there were indications that those with IRLs might benefit more from intensive, high-dose DMTs – though more research is needed to confirm this.

Overall, the study highlights the potential of IRLs as a biomarker that could help personalise MS care and better predict disease outcomes.