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Jameie M, Amanollahi M, Ahli B, Farahmand G, Magrouni H, Sarraf P. Coexistence of myasthenia gravis and lichen planus: A case report and systematic review of related case reports from 1971 to 2024. Clin Case Rep 2024; 12:e9065. [PMID: 38883218 PMCID: PMC11177179 DOI: 10.1002/ccr3.9065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/03/2024] [Accepted: 05/31/2024] [Indexed: 06/18/2024] Open
Abstract
Key Clinical Message The co-occurrence of myasthenia gravis (MG) and lichen planus (LP) is a rare phenomenon, with only 13 cases reported in the English literature between 1971 and 2024. Patients with MG or LP, regardless of the thymoma status, require close monitoring for other autoimmune diseases. Abstract Myasthenia gravis (MG) is an uncommon autoimmune disease, resulting in fatigable muscle weakness in the ocular, bulbar, and respiratory muscles, as well as muscles of the extremities. Lichen planus (LP) is an autoimmune mucocutaneous disease, presenting with pruritic and violaceous plaques on the skin and mucosal surfaces. So far, MG and LP co-occurrence is only reported in anecdotal individuals. This study reports a patient with MG and LP and systematically reviews the English literature on this rare co-occurrence from 1971 to 2024, indicating only 13 cases with similar conditions. A 67-year-old man presented with ocular and progressive bulbar symptoms, a year after being diagnosed with generalized LP. Laboratory evaluations were normal except for the high anti-AchR-Ab titer and a positive ANA titer. Neurologic examinations revealed asymmetric bilateral ptosis, weakness and fatigability in proximal muscles, and a severe reduction in the gag reflex. He was diagnosed with late-onset, seropositive MG. The treatment included pyridostigmine (60 mg, three times daily), intravenous immunoglobulin (25 g daily for 5 days), and oral prednisolone. There was no evidence of thymoma in the chest x-ray and CT scan without contrast. However, a CT scan with contrast was not performed due to the patient's unstable condition. A common autoimmune mechanism may underlie the unclear pathophysiology of MG and LP co-occurrence, with or without thymoma. Patients with MG, LP, or thymoma require close monitoring and assessment for other possible autoimmune diseases.
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Affiliation(s)
- Melika Jameie
- Iranian Center of Neurological Research, Neuroscience Institute Tehran University of Medical Sciences Tehran Iran
| | - Mobina Amanollahi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Bahareh Ahli
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Ghasem Farahmand
- Neurology Department, Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Hana Magrouni
- Neurology Department, Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Payam Sarraf
- Iranian Center of Neurological Research, Neuroscience Institute Tehran University of Medical Sciences Tehran Iran
- Neurology Department, Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
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Wang J, Zhou H, Chen H, Feng H, Chang T, Sun C, Guo R, Ruan Z, Bi F, Li J, Wang J, Wang K, Ma G, Lei S, Wang C, Wang Z, Huang F, Zhang S, Wen Q, Wang Y, Sun Y, Li Y, Xie N, Liu H, Jiang Y, Lei L, Fan Z, Su S, Lu Y, Di L, Xu M, Wang M, Chen H, Wang S, Wen X, Zhu W, Duo J, Huang Y, Zheng D, Da Y. Environmental factors affecting the risk of generalization for ocular-onset myasthenia gravis: a nationwide cohort study. QJM 2024; 117:109-118. [PMID: 37802883 DOI: 10.1093/qjmed/hcad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/20/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The environmental effects on the prognosis of ocular myasthenia gravis (OMG) remain largely unexplored. AIM To investigate the association between specific environmental factors and the generalization of OMG. DESIGN The cohort study was conducted in China based on a nationwide multicenter database. METHODS Adult patients with OMG at onset, who were followed up for at least 2 years until May 2022, were included. We collected data on demographic and clinical factors, as well as environmental factors, including latitude, socioeconomic status (per capita disposable income [PDI] at provincial level and education) and smoking. The study outcome was the time to the development of generalized myasthenia gravis (GMG). Cox models were employed to examine the association between environmental exposures and generalization. Restricted cubic spline was used to model the association of latitude with generalization risk. RESULTS A total of 1396 participants were included. During a median follow-up of 5.15 (interquartile range [IQR] 3.37-9.03) years, 735 patients developed GMG within a median of 5.69 (IQR 1.10-15.66) years. Latitude of 20-50°N showed a U-shaped relation with generalization risk, with the lowest risk at around 30°N; both higher and lower latitudes were associated with the increased risk (P for non-linearity <0.001). Living in areas with lower PDI had 1.28-2.11 times higher risk of generalization. No significant association was observed with education or smoking. CONCLUSIONS Latitude and provincial-level PDI were associated with the generalization of OMG in China. Further studies are warranted to validate our findings and investigate their potential applications in clinical practice and health policy.
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Affiliation(s)
- Jingsi Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Huiyu Feng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ting Chang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Chao Sun
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Rongjing Guo
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhe Ruan
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Fangfang Bi
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jianwen Wang
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Kang Wang
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Gaoting Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shaoyuan Lei
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunxiu Wang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhihong Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feifei Huang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shu Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Wen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yaye Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanan Sun
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yun Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Nairong Xie
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haoran Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuting Jiang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lin Lei
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhirong Fan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shengyao Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Lu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li Di
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Min Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Min Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hai Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Suobin Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xinmei Wen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenjia Zhu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianying Duo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yue Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Deqiang Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yuwei Da
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Li J, Wang F, Zhang C, Li Z, Gao J, Liu H. Genetically predicted effects of physical activity and sedentary behavior on myasthenia gravis: evidence from mendelian randomization study. BMC Neurol 2023; 23:299. [PMID: 37568096 PMCID: PMC10416521 DOI: 10.1186/s12883-023-03343-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Myasthenia gravis (MG) is an autoimmune disorder affecting the neuromuscular junction. Despite the potential benefits of higher physical activity and lower sedentary behavior in MG patients, evidence from observational studies for the effect of physical activity on the risk of MG is limited and inconclusive. METHODS We employed linkage disequilibrium score (LDSC) regression, two-sample Mendelian randomization (MR), and its multivariable extension analyses (MVMR) to assess the relationship between leisure screen time (LST), moderate-to-vigorous intensity physical activity during leisure time (MVPA) and the risk of MG using genome-wide association studies (GWAS) summary datasets. MR analyses were performed using the inverse-variance-weighted (IVW), weighted-median, and MR-Egger regression. Sensitivity analyses were further performed using alternative instruments to test the robustness of our findings. RESULTS We found evidence of genetic overlap between LST (rg = 0.113, P = 0.023) and MG, as well as between MVPA (rg=-0.220, P = 0.0001) and MG, using LDSC method. The results of the MR suggested an association between genetic liability to LST and increased risk of MG (IVW OR = 1.609, 95% CI = 1.153 to 2.244; P = 0.005). This association was particularly notable for late-onset MG (IVW OR = 1.698, 95% CI = 1.145 to 2.518; P = 0.008), but not for early-onset MG. Consistent findings were obtained in the MVMR analysis using BMI as covariate (IVW OR = 1.593, 95% CI 1.167 to 2.173, P = 0.003). However, the MR analysis does not support a substantial causal effect of MVPA on the risk of MG. CONCLUSION Our findings support a causal effect of sedentary behavior as measured by LST on MG, indicating that lack of exercise may play a role in the development of MG. Longitudinal and interventional studies of this association are warranted.
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Affiliation(s)
- Jiao Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Fei Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Chen Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Department of Neurology, PLA Rocket Force Characteristic Medical Center, No. 16 Xinjiekouwai Street, Xicheng District, Beijing, 100088, China
| | - Zhen Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Juan Gao
- Department of Neurology, Central Hospital, Baoding No. 1, Baoding, 071000, China
| | - Haijie Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
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Huang EJC, Wu MH, Wang TJ, Huang TJ, Li YR, Lee CY. Myasthenia Gravis: Novel Findings and Perspectives on Traditional to Regenerative Therapeutic Interventions. Aging Dis 2023; 14:1070-1092. [PMID: 37163445 PMCID: PMC10389825 DOI: 10.14336/ad.2022.1215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/15/2022] [Indexed: 05/12/2023] Open
Abstract
The prevalence of myasthenia gravis (MG), an autoimmune disorder, is increasing among all subsets of the population leading to an elevated economic and social burden. The pathogenesis of MG is characterized by the synthesis of autoantibodies against the acetylcholine receptor (AChR), low-density lipoprotein receptor-related protein 4 (LRP4), or muscle-specific kinase at the neuromuscular junction, thereby leading to muscular weakness and fatigue. Based on clinical and laboratory examinations, the research is focused on distinguishing MG from other autoimmune, genetic diseases of neuromuscular transmission. Technological advancements in machine learning, a subset of artificial intelligence (AI) have been assistive in accurate diagnosis and management. Besides, addressing the clinical needs of MG patients is critical to improving quality of life (QoL) and satisfaction. Lifestyle changes including physical exercise and traditional Chinese medicine/herbs have also been shown to exert an ameliorative impact on MG progression. To achieve enhanced therapeutic efficacy, cholinesterase inhibitors, immunosuppressive drugs, and steroids in addition to plasma exchange therapy are widely recommended. Under surgical intervention, thymectomy is the only feasible alternative to removing thymoma to overcome thymoma-associated MG. Although these conventional and current therapeutic approaches are effective, the associated adverse events and surgical complexity limit their wide application. Moreover, Restivo et al. also, to increase survival and QoL, further recent developments revealed that antibody, gene, and regenerative therapies (such as stem cells and exosomes) are currently being investigated as a safer and more efficacious alternative. Considering these above-mentioned points, we have comprehensively reviewed the recent advances in pathological etiologies of MG including COVID-19, and its therapeutic management.
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Affiliation(s)
- Evelyn Jou-Chen Huang
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Meng-Huang Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Tsung-Jen Wang
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Tsung-Jen Huang
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Yan-Rong Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ching-Yu Lee
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- International PhD Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
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5
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Miyazaki Y, Sakushima K, Niino M, Takahashi E, Oiwa K, Naganuma R, Amino I, Akimoto S, Minami N, Yabe I, Kikuchi S. Smoking and younger age at onset in anti-acetylcholine receptor antibody-positive myasthenia gravis. Immunol Med 2022; 46:77-83. [PMID: 36346077 DOI: 10.1080/25785826.2022.2143077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Smoking is a known risk factor for the development and progression of several autoimmune diseases. Previous studies have pointed out the association of smoking with the development and worsening of symptoms in myasthenia gravis (MG), but further investigation is necessary to confirm this association. Smoking history was investigated in a cross-sectional study of 139 patients with anti-acetylcholine receptor antibody-positive MG, and the association of smoking history with the age at the onset of MG was analyzed. Patients who had been smoking at the onset of MG were significantly younger compared with those who had never smoked or had quit before the onset of MG. A linear regression analysis adjusting for sex and the presence/absence of thymoma showed a significant association between smoking at onset and younger age at onset (regression coefficient -9.05; 95% confidence interval, -17.6, -0.51; p = 0.039). Among patients with smoking exposure within 10 years prior to or at the onset of MG, women were significantly younger at the onset of MG compared with men. Our results suggest that smoking is an independent risk factor for the earlier development of anti-acetylcholine receptor antibody-positive MG and further support the putative link between smoking and MG.
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Affiliation(s)
- Yusei Miyazaki
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Ken Sakushima
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masaaki Niino
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Eri Takahashi
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Kei Oiwa
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Ryoji Naganuma
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Itaru Amino
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Sachiko Akimoto
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Naoya Minami
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Ichiro Yabe
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Seiji Kikuchi
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
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Miyazaki Y, Niino M, Sakushima K, Takahashi E, Naganuma R, Amino I, Akimoto S, Minami N, Yabe I, Kikuchi S. Association of Smoking and Generalized Manifestations of Myasthenia Gravis. Intern Med 2022; 61:1693-1698. [PMID: 34744112 PMCID: PMC9259322 DOI: 10.2169/internalmedicine.8460-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Smoking is a known risk factor for the development and progression of autoimmune diseases. Previous studies in ocular myasthenia gravis (MG) patients showed that smoking is associated with the severity of symptoms and progression to generalized MG. However, whether smoking affects MG symptoms in patients with a broader clinical spectrum of presentations is unknown. Therefore, in this study, the associations of smoking with the clinical characteristics of MG were analyzed in a cohort of patients including those with generalized, seronegative, and thymoma-associated MG. Methods The smoking history was investigated in a cross-sectional study of 187 patients with MG followed in a referral hospital for neurology. The association of smoking with MG-activities of daily living score at survey, the presence of generalized manifestations, and the age of onset was assessed using multiple regression models. Results Neither current nor prior smoking habit was associated with the MG-activities of daily living score at survey. However, smoking exposure after MG onset was significantly associated with the presence of generalized manifestations during the disease course (odds ratio, 3.57; 95% confidence interval, 1.04, 12.3). The smoking history before or at onset of MG was not associated with the age of onset. Conclusion Smoking exposure after the onset is associated with generalized manifestations of MG in our cohort of patients with a broad clinical spectrum of presentations.
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Affiliation(s)
- Yusei Miyazaki
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Japan
| | - Masaaki Niino
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Japan
| | - Ken Sakushima
- Department of Neurology, Hokkaido University Graduate School of Medicine, Japan
| | - Eri Takahashi
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Japan
| | - Ryoji Naganuma
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Japan
| | - Itaru Amino
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Japan
| | - Sachiko Akimoto
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Japan
| | - Naoya Minami
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Japan
| | - Ichiro Yabe
- Department of Neurology, Hokkaido University Graduate School of Medicine, Japan
| | - Seiji Kikuchi
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Japan
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7
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Petersson M, Feresiadou A, Jons D, Ilinca A, Lundin F, Johansson R, Budzianowska A, Roos AK, Kågström V, Gunnarsson M, Sundström P, Piehl F, Brauner S. Patient-Reported Symptom Severity in a Nationwide Myasthenia Gravis Cohort: Cross-sectional Analysis of the Swedish GEMG Study. Neurology 2021; 97:e1382-e1391. [PMID: 34376512 PMCID: PMC8520390 DOI: 10.1212/wnl.0000000000012604] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To describe myasthenia gravis activities of daily living (MG-ADL) in relation to clinical characteristics in a large Swedish nationwide cohort. METHODS In a cross-sectional prevalence cohort study, the Genes and Environment in Myasthenia Gravis study, performed from November 2018 through August 2019, patients with myasthenia gravis (MG) were invited to submit an extensive 106-item life environment questionnaire, including the MG-ADL score. Patients were classified into early-onset MG (EOMG, <50 years), late-onset MG (LOMG, ≥50 years), or thymoma-associated MG (TAMG). Comparisons of disease-specific characteristics were made between subgroups, sexes, and different MG-ADL scores. RESULTS A total of 1,077 patients were included, yielding a 74% response rate: 505 (47%) were classified as EOMG, 520 (48%) LOMG, and 45 (4%) TAMG. Mean age at inclusion was 64.3 years (SD 15.7) and mean disease duration was 14.6 years (SD 14.0). Complete MG-ADL scores (n = 1,035) ranged from 0p to 18p, where 26% reported a score of 0p. Higher MG-ADL scores were associated with female sex, obesity, and diagnostic delay (odds ratio [OR] 1.62, 1.72, and 1.69; p adj = 0.017, 0.013, and 0.008) and inversely correlated with high educational attainment (OR 0.59; p adj = 0.02), but not with age at inclusion, disease subtype, or disease duration. Almost half of the population (47%) reported MG-ADL ≥3p, corresponding to an unsatisfactory symptom state. DISCUSSION In this nationwide study, comprising more than 40% of the prevalent MG population in Sweden, almost half of the patients reported current disease symptoms associated with an unsatisfactory symptom state, indicating the need for improved treatment options.
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Affiliation(s)
- Malin Petersson
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Amalia Feresiadou
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Jons
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Andreea Ilinca
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Lundin
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Rune Johansson
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Anna Budzianowska
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Karin Roos
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Viktor Kågström
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Martin Gunnarsson
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Peter Sundström
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Piehl
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden
| | - Susanna Brauner
- From the Department of Clinical Neuroscience (M.P., F.P., S.B.), Karolinska Institutet, Stockholm; Department of Neuroscience, Neurology (A.F.), Uppsala University; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (D.J.), the Sahlgrenska Academy, University of Gothenburg; Department of Neurology (D.J.), Sahlgrenska University Hospital, Gothenburg; Department of Clinical Sciences Lund, Neurology (A.I.), Skåne University Hospital, Lund University, Malmö; Departments of Neurology (F.L.) and Biomedical and Clinical Sciences (F.L., A.B.), Division of Neurobiology, Linköping University; Department of Neurology and Rehabilitation (R.J.), Karlstad Central Hospital; Department of Internal Medicine in Jönköping (A.B.), Section of Neurology, Region Jönköping County; Department of Clinical Science, Neurosciences (A.-K.R.), Unit of Neurology, Umeå University, Östersund; Rehabilitation Clinic (V.K.), Sundsvall Hospital; Department of Neurology, Faculty of Medicine and Health (M.G.), Örebro University; Department of Clinical Science, Neurosciences (P.S.), Umeå University; and Department of Neurology (F.P., S.B.), Karolinska University Hospital, Stockholm, Sweden.
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8
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O'Connor L, Westerberg E, Punga AR. Pattern of Habitual Physical Exercise in Myasthenia Gravis Patients. J Neuromuscul Dis 2020; 6:85-91. [PMID: 30452423 DOI: 10.3233/jnd-180355] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Notwithstanding the amount of deliberate exercise, the daily patterns of active versus sedentary behavior have a major influence on health outcomes [1]. Patterns of habitual active and sedentary behavior in Myasthenia Gravis (MG) patients, as well as their possible relations to disease activity, are not known. OBJECTIVE To evaluate baseline patterns of physical and sedentary behavior in MG patients. METHODS Activity patterns of twenty-seven MG patients were assessed by a Dynaport MoveMonitor (McRoberts) accelerometer, worn for seven consecutive days. The amount of time spent in moderate and vigorous intensity activities, physical activity level (PAL), number of steps/day and sedentary time were assessed and correlations to disease severity were analyzed. The results were compared to general recommendations and published data of healthy individuals and to data of patients with the chronic disorders chronic obstructive pulmonary disease (COPD) and mitochondrial myopathy. RESULTS MG patients had sedentary behavior during 78±7% of the day. There was neither a correlation between disease severity and number of steps/day (R = -0.15; p = 0.56) nor between disease severity and PAL (R = 0.33; p = 0.26). Nevertheless, the MG patients met the recommendations of daily deliberate exercise (181±158 MET min/day). PAL was lower in MG patients (1.5±0.138) than in healthy individuals (1.67±0.145, p < 0.00001). CONCLUSION Although a majority of MG patients meet the recommendations of deliberate exercise, their baseline physical activity levels are dominated by sedentary behavior. In comparison with a healthy population, MG patients are less physically active, but the reason for this remains unclear with no correlations between disease severity and physical activity patterns.
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Affiliation(s)
- Laura O'Connor
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden
| | - Elisabet Westerberg
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden
| | - Anna Rostedt Punga
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden
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Apinyawasisuk S, Chongpison Y, Thitisaksakul C, Jariyakosol S. Factors Affecting Generalization of Ocular Myasthenia Gravis in Patients With Positive Acetylcholine Receptor Antibody. Am J Ophthalmol 2020; 209:10-17. [PMID: 31562855 DOI: 10.1016/j.ajo.2019.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the associated factors of conversion of ocular myasthenia gravis (OMG) to generalized myasthenia gravis (GMG) among patients with seropositive acetylcholine receptor antibody (AchR Ab). DESIGN Retrospective cohort study. METHODS Setting: Retrospective chart review. PATIENT Seventy-one OMG patients with seropositive AchR Ab presented during July 2009 and December 2016. The exclusion criteria were patients who (1) first presented with GMG, (2) were unable to identify the time of onset of OMG or GMG, (3) were unable to provide information about previous treatments before the onset of GMG, and (4) had incomplete or lost medical records. OBSERVATION PROCEDURE We collected demographic and clinical characteristics, including onset of OMG and GMG, presence of other autoimmune disorders, history of smoking, presence of thymic abnormalities, and medications received. MAIN OUTCOME MEASURES Conversion to GMG and time to conversion. RESULTS Thirty-six patients experienced conversion to GMG. Overall incidence of GMG was 14 (95% confidence interval [CI] 10.09-19.4) per 100 patient-years. Probability of conversion at 2 years was .37 (95% CI .27-.49). Overall median conversion time was 4.97 years. Cox proportional hazard model showed that risk factors were female sex (HR 2.52, 95% CI 1.04-6.10), history of smoking (HR 3.42, 95% CI 1.40-8.45), and thymic abnormalities (HR 1.82, 95% CI 0.91-3.67). Protective factors against conversion to GMG were receiving immunosuppressive agents (HR 0.42, 95% CI 0.19-0.97) and pyridostigmine (HR 0.37, 95% CI 0.14-0.93). CONCLUSIONS OMG patients with seropositive AchR Ab should be informed that taking pyridostigmine and/or immunosuppressive agents as well as smoking cessation might prevent conversion to GMG.
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Affiliation(s)
- Supanut Apinyawasisuk
- Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Yuda Chongpison
- Biostatistic Excellence Center, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Supharat Jariyakosol
- Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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10
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Identifying the culprits in neurological autoimmune diseases. J Transl Autoimmun 2019; 2:100015. [PMID: 32743503 PMCID: PMC7388404 DOI: 10.1016/j.jtauto.2019.100015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 12/16/2022] Open
Abstract
The target organ of neurological autoimmune diseases (NADs) is the central or peripheral nervous system. Multiple sclerosis (MS) is the most common NAD, whereas Guillain-Barré syndrome (GBS), myasthenia gravis (MG), and neuromyelitis optica (NMO) are less common NADs, but the incidence of these diseases has increased exponentially in the last few years. The identification of a specific culprit in NADs is challenging since a myriad of triggering factors interplay with each other to cause an autoimmune response. Among the factors that have been associated with NADs are genetic susceptibility, epigenetic mechanisms, and environmental factors such as infection, microbiota, vitamins, etc. This review focuses on the most studied culprits as well as the mechanisms used by these to trigger NADs. Neurological autoimmune diseases are caused by a complex interaction between genes, environmental factors, and epigenetic deregulation. Infectious agents can cause an autoimmune reaction to myelin epitopes through molecular mimicry and/or bystander activation. Gut microbiota dysbiosis contributes to neurological autoimmune diseases. Smoking increases the risk of NADs through inflammatory signaling pathways, oxidative stress, and Th17 differentiation. Deficiency in vitamin D favors NAD development through direct damage to the central and peripheral nervous system.
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11
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Westerberg E, Landtblom AM, Punga AR. Lifestyle factors and disease-specific differences in subgroups of Swedish Myasthenia Gravis. Acta Neurol Scand 2018; 138:557-565. [PMID: 30155967 DOI: 10.1111/ane.13017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/19/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate disease-specific differences between Myasthenia Gravis (MG) subgroups and compare patterns of lifestyle between MG patients and population controls. METHODS All MG patients (n = 70) in Jönköping County, Sweden, were invited to answer a disease-specific questionnaire, containing questions about disease-specific data, lifestyle, comorbidity, and mental fatigue. The patients were clinically evaluated. Four hundred age- and gender-matched population controls were invited to answer the nondisease-specific part of the questionnaire. Disease-specific issues were compared between MG subgroups. Lifestyle-related factors and concomitant conditions were compared to the population controls. RESULTS Forty MG patients and 188 population controls participated in the study. In the late-onset MG (LOMG; N = 18) subgroup, the male predominance was higher than previously reported. In the early-onset MG (EOMG; N = 17) subgroup, time to diagnosis was longer, fatigue was higher, and bulbar weakness was the dominant symptom (65%). Compared to their matched population controls, LOMG patients were more obese (OR = 13.7, P = 0.015), ate less fish (OR = 4.1, P = 0.012), tended to smoke more (OR = 4.1, P = 0.086), and tended to be employed as manual laborers more often (OR = 2.82, P = 0.083). Mental health problems and sickness benefits were more common among MG patients than in controls, and MG patients were less regularly doing focused physical activity. CONCLUSIONS It is important to consider disease-specific differences when tailoring the management of individual MG patients. There is a need for improved knowledge on how to apply primary and secondary prevention measures to lifestyle disorders in MG patients without risk of deterioration.
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Affiliation(s)
- Elisabet Westerberg
- Department of Neuroscience and Clinical Neurophysiology; Uppsala University; Uppsala Sweden
| | | | - Anna Rostedt Punga
- Department of Neuroscience and Clinical Neurophysiology; Uppsala University; Uppsala Sweden
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12
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Liu FC, Kuo CF, See LC, Tsai HI, Yu HP. Familial aggregation of myasthenia gravis in affected families: a population-based study. Clin Epidemiol 2017; 9:527-535. [PMID: 29138598 PMCID: PMC5679568 DOI: 10.2147/clep.s146617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction Myasthenia gravis (MG) is clinically heterogeneous and can be life-threatening if bulbar or respiratory muscles are involved. However, relative contributions of genetic, shared, and nonshared environmental factors to MG susceptibility remain unclear. The aim of this study was to examine the familial aggregation and heritability of MG and the relative risks (RRs) of other autoimmune diseases in the relatives of patients with MG. Methods A population-based family study using the Taiwan National Health Insurance (NHI) Database was conducted. Participants included all individuals (N=23,422,955) who were actively registered in the NHI Database in 2013, 15,066 of whom had at least one first-degree relative with MG. We identified 8,638 parent–child relationships, 3,279 with an affected offspring, 3,134 with affected siblings, and 26 with affected twins. Prevalence and RRs of MG and other autoimmune diseases in the relatives of patients as well as the relative contributions of heritability, shared, and nonshared environmental factors to MG susceptibility were measured. Results RRs (95% confidence intervals [CIs]) for MG were 17.85 (8.71–36.56) for patients’ siblings, 5.33 (2.79–10.18) for parents, 5.82 (3.03–11.16) for offspring, and 1.42 (0.20–10.10) for spouses without genetic similarities. RRs (95% CIs) in individuals with a first-degree relative with MG were 2.18 (1.53–3.12) for systemic lupus erythematosus, 1.73 (1.09–2.74) for primary Sjögren’s syndrome, 1.90 (1.66–2.18) for autoimmune thyroid disease, and 1.68 (1.22–2.30) for rheumatoid arthritis. Accountability for the phenotypic variance of MG was 82.1% for familial transmission and 17.9% for nonshared environmental factors. Conclusion Individual risks of MG and other autoimmune diseases are increased in the relatives of patients with MG. Familial transmission of MG was estimated to be 82.1%.
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Affiliation(s)
- Fu-Chao Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital.,College of Medicine, Chang Gung University
| | - Chang-Fu Kuo
- College of Medicine, Chang Gung University.,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital.,Department of Public Health, College of Medicine, Chang Gung University.,Office for Big Data Research, Chang Gung Memorial Hospital
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University.,Biostatistics Core Laboratory, Molecular Medicine Research Center
| | - Hsin-I Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital.,College of Medicine, Chang Gung University.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Huang-Ping Yu
- Department of Anesthesiology, Chang Gung Memorial Hospital.,College of Medicine, Chang Gung University
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13
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Abstract
Survivin is a protein functionally important for cell division, apoptosis, and possibly, for micro-RNA biogenesis. It is an established marker of malignant cell transformation. In non-malignant conditions, the unique properties of survivin make it indispensable for homeostasis of the immune system. Indeed, it is required for the innate and adaptive immune responses, controlling differentiation and maintenance of CD4+ and CD8+ memory T-cells, and in B cell maturation. Recently, survivin has emerged as an important player in the pathogenesis of autoimmune diseases. Under the conditions of unreserved inflammation, survivin enhances antigen presentation, maintains persistence of autoreactive cells, and supports production of autoantibodies. In this context, survivin takes its place as a diagnostic and prognostic marker in rheumatoid arthritis, psoriasis, systemic sclerosis and pulmonary arterial hypertension, neuropathology and multiple sclerosis, inflammatory bowel diseases and oral lichen planus. In this review, we summarise the knowledge about non-malignant properties of survivin and focus on its engagement in cellular and molecular pathology of autoimmune diseases. The review highlights utility of survivin measures for clinical applications. It provides rational for the survivin inhibiting strategies and presents results of recent reports on survivin inhibition in modern therapies of cancers and autoimmune diseases.
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Popperud TH, Boldingh MI, Brunborg C, Faiz KW, Heldal AT, Maniaol AH, Müller KI, Rasmussen M, Øymar K, Kerty E. Juvenile myasthenia gravis in Norway: A nationwide epidemiological study. Eur J Paediatr Neurol 2017; 21:312-317. [PMID: 27666466 DOI: 10.1016/j.ejpn.2016.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/17/2016] [Accepted: 09/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to assess the incidence rate and prevalence of autoimmune myasthenia gravis (MG) among children in Norway. METHODS This retrospective population-based study was performed in Norway from January 2012 to December 2013. Cases of juvenile MG (JMG) with onset < 18 years were identified through searches in coding systems of electronic patient records at the 15 main hospitals in Norway from 1989 to 2013. In addition, the acetylcholine receptor antibody database at Haukeland University Hospital and the clinical nationwide MG database at Oslo University Hospital were searched for cases of JMG. Diagnosis and age at onset were verified through medical records. Incidence and prevalence rates were calculated using the Norwegian population as reference. RESULTS In total 63 unique JMG cases were identified. This corresponds to an average annual incidence rate of 1.6 per million. Incidence rate was stable over the study period. Prevalence of JMG was 3.6-13.8 per million. Females constituted the majority of JMG cases (55 vs 8 males). The risk of JMG was higher among females both in the postpubertal and prepubertal group (p < 0.001 and p = 0.02, respectively). CONCLUSION This study confirms the rarity of JMG in Norway, especially among males, and shows a stable incidence rate over the last 25 years.
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Affiliation(s)
- T H Popperud
- Department of Neurology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - M I Boldingh
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - C Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - K W Faiz
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - A T Heldal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A H Maniaol
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - K I Müller
- Department of Neurology and National Neuromuscular Centre, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT - The Artic University of Norway, Tromsø, Norway
| | - M Rasmussen
- Department of Clinical Neuroscience for Children, Section for Child Neurology, Oslo University Hospital, Oslo, Norway; Unit for Hereditary and Inborn Neuromuscular Disorders, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - K Øymar
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - E Kerty
- Department of Neurology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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15
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Su Z, Wang B, Ni J, Hu Y, Weng Y, Zhang X. Comment on 'Myasthenia gravis: descriptive analysis of life-threatening events in a recent nationwide registry'. Eur J Neurol 2017; 24:e17. [PMID: 28211243 DOI: 10.1111/ene.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 01/04/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Z Su
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang
| | - B Wang
- Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai
| | - J Ni
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang
| | - Y Hu
- Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Y Weng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang
| | - X Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang
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Boldingh MI, Maniaol A, Brunborg C, Dekker L, Lipka A, Niks EH, Verschuuren J, Tallaksen C. Prevalence and clinical aspects of immigrants with myasthenia gravis in northern Europe. Muscle Nerve 2017; 55:819-827. [PMID: 27641227 DOI: 10.1002/mus.25408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/07/2016] [Accepted: 09/14/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Multiethnic studies can provide etiological clues toward the genetic and environmental influence of a disease. The aim of this study was to determine prevalence and clinical features of myasthenia gravis (MG) in immigrants compared with native patients in 2 population-based cohorts. METHODS This cross-sectional study included 843 MG patients (375 from Norway and 468 from the Netherlands). Ethnic background was defined by questionnaires. RESULTS Among the participating MG patients, 163 of 843 (19.3%) were first or second generation immigrants, mainly from Europe, Asia, and South America. No marked prevalence differences were found between immigrants and native ethnic groups. MG with muscle specific kinase antibodies and MG with thymoma were more frequent in Asian MG immigrants compared with other ethnic groups (8% vs. 0-4%; P < 0.001 and 21% vs. 6-10%; P < 0.001), respectively. CONCLUSIONS Our findings indicate that Asian immigrant MG patients carry genetic factors or environmental/lifestyle factors which contribute to their specific phenotype, even after migration. Muscle Nerve 55: 819-827, 2017.
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Affiliation(s)
- Marion Ingeborg Boldingh
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Angelina Maniaol
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway
| | - Cathrine Brunborg
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Luuk Dekker
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Alexander Lipka
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Erik Harmen Niks
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Jan Verschuuren
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Chantal Tallaksen
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Boldingh MI, Maniaol AH, Brunborg C, Weedon-Fekjær H, Verschuuren JJGM, Tallaksen CME. Increased risk for clinical onset of myasthenia gravis during the postpartum period. Neurology 2016; 87:2139-2145. [PMID: 27770065 DOI: 10.1212/wnl.0000000000003339] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/03/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To study the risk of clinical onset of myasthenia gravis (MG) in pregnancy and during the first 6 months postpartum because an association between pregnancy or the postpartum period and the onset of autoimmune MG is widely assumed but not proven. METHODS The design was a cross-sectional population-based cohort study of 2 MG cohorts (Norway and the Netherlands) with 1,038 healthy controls from Norway. Data were obtained on 246 women with MG (age at onset 15-45 years). Data on pregnancy, hormonal factors, and clinical symptoms were collected by a previously validated environmental MG questionnaire. Relative risk of MG onset before, during, and after pregnancy was calculated by multinomial logistic regression for Norwegian women reaching 45 years of age, adjusted for the observed distribution of person-years in the corresponding control group. RESULTS Of the included women with MG, 13 (11.5%) of the Dutch and 24 (18.0%) of the Norwegian patients had their first myasthenia symptoms during the pregnancy or postpartum period. The postpartum period was confirmed to be significantly associated with the onset of symptoms of MG in Norwegian women with MG (relative risk 5.5, 95% confidence interval 2.6-11.6). The risk was highest after the first childbirth. CONCLUSIONS Women have a high-risk period for the onset of clinical symptoms of MG in the postpartum period, in particular after the first childbirth. Future studies should aim at elucidating the role of the hormonal-immunological-genetic interaction in the pathogenesis of MG.
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Affiliation(s)
- Marion I Boldingh
- From the Department of Neurology (M.I.B., A.H.M., C.M.E.T.) and Oslo Centre for Biostatistics and Epidemiology (C.B., H.W.-F.), Research Support Services, Oslo University Hospital, Norway; Department of Neurology (J.J.G.M.V.), Leiden University Medical Centre, the Netherlands; and Institute of Clinical Medicine (M.I.B., C.M.E.T.), University of Oslo, Norway.
| | - Angelina H Maniaol
- From the Department of Neurology (M.I.B., A.H.M., C.M.E.T.) and Oslo Centre for Biostatistics and Epidemiology (C.B., H.W.-F.), Research Support Services, Oslo University Hospital, Norway; Department of Neurology (J.J.G.M.V.), Leiden University Medical Centre, the Netherlands; and Institute of Clinical Medicine (M.I.B., C.M.E.T.), University of Oslo, Norway
| | - Cathrine Brunborg
- From the Department of Neurology (M.I.B., A.H.M., C.M.E.T.) and Oslo Centre for Biostatistics and Epidemiology (C.B., H.W.-F.), Research Support Services, Oslo University Hospital, Norway; Department of Neurology (J.J.G.M.V.), Leiden University Medical Centre, the Netherlands; and Institute of Clinical Medicine (M.I.B., C.M.E.T.), University of Oslo, Norway
| | - Harald Weedon-Fekjær
- From the Department of Neurology (M.I.B., A.H.M., C.M.E.T.) and Oslo Centre for Biostatistics and Epidemiology (C.B., H.W.-F.), Research Support Services, Oslo University Hospital, Norway; Department of Neurology (J.J.G.M.V.), Leiden University Medical Centre, the Netherlands; and Institute of Clinical Medicine (M.I.B., C.M.E.T.), University of Oslo, Norway
| | - Jan J G M Verschuuren
- From the Department of Neurology (M.I.B., A.H.M., C.M.E.T.) and Oslo Centre for Biostatistics and Epidemiology (C.B., H.W.-F.), Research Support Services, Oslo University Hospital, Norway; Department of Neurology (J.J.G.M.V.), Leiden University Medical Centre, the Netherlands; and Institute of Clinical Medicine (M.I.B., C.M.E.T.), University of Oslo, Norway
| | - Chantal M E Tallaksen
- From the Department of Neurology (M.I.B., A.H.M., C.M.E.T.) and Oslo Centre for Biostatistics and Epidemiology (C.B., H.W.-F.), Research Support Services, Oslo University Hospital, Norway; Department of Neurology (J.J.G.M.V.), Leiden University Medical Centre, the Netherlands; and Institute of Clinical Medicine (M.I.B., C.M.E.T.), University of Oslo, Norway
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Perricone C, Versini M, Ben-Ami D, Gertel S, Watad A, Segel MJ, Ceccarelli F, Conti F, Cantarini L, Bogdanos DP, Antonelli A, Amital H, Valesini G, Shoenfeld Y. Smoke and autoimmunity: The fire behind the disease. Autoimmun Rev 2016; 15:354-74. [DOI: 10.1016/j.autrev.2016.01.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 12/31/2015] [Indexed: 12/14/2022]
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Abstract
BACKGROUND Myasthenia gravis is an autoimmune disease of the neuromuscular junction, commonly affecting the ocular muscles. Cigarette smoking has been shown to influence many autoimmune diseases, including multiple sclerosis and rheumatoid arthritis, but its effect on myasthenia gravis has not been well studied. We sought to determine whether cigarette smoking influenced disease-related symptoms in ocular myasthenia gravis (OMG). METHODS We performed a prospective, clinic-based cross-sectional study in a single academic neuro-ophthalmology practice. All patients diagnosed with OMG between November 2006 and April 2014 were included. A prospective telephone survey was administered to determine smoking status and myasthenia gravis-related symptom severity. The main outcome measure was the myasthenia gravis-specific activities of daily living (MG-ADL) score, a well-validated marker of symptoms and quality of life in myasthenia gravis. RESULTS Forty-four patients were included in the analysis. Comparison of MG-ADL ocular subscores between current smokers (3.4 ± 2.6), former smokers (1.8 ± 2.1), and never smokers (1.1 ± 1.5) revealed a statistically significant relationship (P = 0.031) where current smokers had the highest MG-ADL ocular subscores and never smokers the lowest. Comparison of MG-ADL total scores revealed the same relationship (current 5.6 ± 4.5, former 2.9 ± 3.1, never 1.4 ± 2.5, P = 0.003). There were borderline significant correlations of pack years with MG-ADL ocular subscore (r = 0.27, P = 0.074) and MG-ADL total score (r = 0.30, P = 0.051). CONCLUSIONS Our findings indicate an association between cigarette smoking and symptom severity in OMG. This association suggests that smoking cessation in OMG patients may lead to improved symptom-related quality of life.
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Boldingh MI, Dekker L, Maniaol AH, Brunborg C, Lipka AF, Niks EH, Verschuuren JJGM, Tallaksen CME. An up-date on health-related quality of life in myasthenia gravis -results from population based cohorts. Health Qual Life Outcomes 2015; 13:115. [PMID: 26232146 PMCID: PMC4522107 DOI: 10.1186/s12955-015-0298-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/03/2015] [Indexed: 12/03/2022] Open
Abstract
Abstract Current available therapies control Myasthenia gravis (MG) reasonably well, but Health Related Quality of life (HRQOL) remains lower than expected. The aim was provide insights in how HRQOL in MG stands across borders and time, compare the scores to general population controls and other chronic disorders and assess the impact of potential predictors for quality of life such as a) clinical characteristics b) antibodies c) thymoma and d) treatment in a population-based cohort. Methods We designed a population-based cross-sectional study including 858 patients, 373 from Norway and 485 from the Netherlands. The Short Form Health Survey 36 (SF-36) and a cross-cultural validated questionnaire were used. Data were in addition compared to the general population, other chronic diseases and previous studies. Results Mean physical composite score was 59.4 and mental composite score 69.0 with no differences between the countries. The mean HRQOL score was lower in patients with bulbar and generalized symptoms (p < 0.001) compared to sex and age adjusted healthy controls, but not in patients with ocular symptoms or patients in remission. Multivariate analysis revealed that female gender, generalized symptoms and use of secondary immunosuppressive drugs at the time of testing were risk factors for reduced HRQOL. Conclusions Remission and absence of generalized symptoms were favorable factors for HRQOL in MG patients. Historically, the HRQOL levels have not changed since 2001 and no new clinical predictors could be detected in this exhaustive population-based study. Further studies should explore the impact of non clinical factors like ethnic variations, socio-economic and hormonal factors on HRQOL. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0298-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M I Boldingh
- Department of Neurology, Oslo University Hospital, Ullevål and Rikshospitalet, Ullevål, Pb. 4950 Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - L Dekker
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| | - A H Maniaol
- Department of Neurology, Oslo University Hospital, Ullevål and Rikshospitalet, Ullevål, Pb. 4950 Nydalen, 0424, Oslo, Norway.
| | - C Brunborg
- Department of Neurology, Oslo University Hospital, Ullevål and Rikshospitalet, Ullevål, Pb. 4950 Nydalen, 0424, Oslo, Norway. .,Department of Epidemiology and Biostatistics, Oslo University Hospital, Ullevål, Oslo, Norway.
| | - A F Lipka
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| | - E H Niks
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| | - J J G M Verschuuren
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| | - C M E Tallaksen
- Department of Neurology, Oslo University Hospital, Ullevål and Rikshospitalet, Ullevål, Pb. 4950 Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Benamer HTS, Bredan A. The epidemiology of myasthenia gravis in Arab countries: a systematic review. Muscle Nerve 2014; 51:144-5. [PMID: 25088247 DOI: 10.1002/mus.24350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hani T S Benamer
- Neurology Department, New Cross Hospital, Wolverhampton, UK; Department of Neurology, Queen Elizabeth Neuroscience Centre, Birmingham, UK
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22
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Affiliation(s)
- A H V Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, UK.
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23
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Farrugia ME, Carmichael C, Cupka BJ, Warder J, Brennan KM, Burns TM. The modified rankin scale to assess disability in myasthenia gravis: Comparing with other tools. Muscle Nerve 2014; 50:501-7. [DOI: 10.1002/mus.24214] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Maria E. Farrugia
- Department of Neurology; Institute of Neurological Sciences, Southern General Hospital; 1345 Govan Road Glasgow G51 4TF UK
| | - Caroline Carmichael
- Department of Neurology; Institute of Neurological Sciences, Southern General Hospital; 1345 Govan Road Glasgow G51 4TF UK
| | - Bryan J. Cupka
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
| | - Judy Warder
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
| | - Kathryn M. Brennan
- Department of Neurology; Institute of Neurological Sciences, Southern General Hospital; 1345 Govan Road Glasgow G51 4TF UK
| | - Ted M. Burns
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
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Nordman JC, Muldoon P, Clark S, Damaj MI, Kabbani N. The α4 nicotinic receptor promotes CD4+ T-cell proliferation and a helper T-cell immune response. Mol Pharmacol 2013; 85:50-61. [PMID: 24107512 DOI: 10.1124/mol.113.088484] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Smoking is a common addiction and a leading cause of disease. Chronic nicotine exposure is known to activate nicotinic acetylcholine receptors (nAChRs) in immune cells. We demonstrate a novel role for α4 nAChRs in the effect of nicotine on T-cell proliferation and immunity. Using cell-based sorting and proteomic analysis we define an α4 nAChR expressing helper T-cell population (α4(+)CD3(+)CD4(+)) and show that this group of cells is responsive to sustained nicotine exposure. In the circulation, spleen, bone marrow, and thymus, we find that nicotine promotes an increase in CD3(+)CD4(+) cells via its activation of the α4 nAChR and regulation of G protein subunit o, G protein regulated-inducer of neurite outgrowth, and CDC42 signaling within T cells. In particular, nicotine is found to promote a helper T cell 2 adaptive immunologic response within T cells that is absent in α4(-/-) mice. We thus present a new mechanism of α4 nAChR signaling and immune regulation in T cells, possibly accounting for the effect of smoking on the immune system.
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Affiliation(s)
- Jacob C Nordman
- Department of Molecular Neuroscience, Krasnow Institute for Advanced Study, George Mason University, Fairfax, Virginia (J.C.N., S.C., N.K.); and Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, Virginia (P.M., M.I.D.)
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