Diagnostic challenge: Myasthenia gravis in the emergency department

Residual serum fibrinogen as a universal biomarker for all serotypes of Myasthenia gravis

Myasthenia Gravis (MG) is an autoimmune disease associated with severe neuromuscular weakness. Diagnostic confirmation of MG is typically delayed and secured in about 85% and 50% of patients with generalized and ocular MG, respectively with serum antibodies. We have identified a sensitive and specific diagnostic biomarker for various MG serotypes with quantitative proteomics. Serum proteomes of 18 individuals (MG patients, healthy controls (HC), Rheumatoid Arthritis (RA) were quantified in a pilot study and occurrence of high residual fibrinogen was validated by immunoblotting and further investigated by targeted mass spectrometry on the sera of 79 individuals (31 MG of various serotypes, 30 HC, 18 RA). Initial proteomic analysis identified high residual fibrinogen in MG patient sera which was then validated by antibody-based testing. Subsequently, a blinded study of independent samples showed 100% differentiation of MG patients from controls. A final serological quantification of 14 surrogate peptides derived from α-, β-, and γ-subunits of fibrinogen in 79 individuals revealed fibrinogen to be highly specific and 100% sensitive for MG (p < 0.00001), with a remarkable average higher abundance of > 1000-fold over control groups. Our unanticipated discovery of high levels of residual serum fibrinogen in all MG patients can secure rapid bedside diagnosis of MG.

Myasthenia gravis

Myasthenia gravis (MG) is a chronic neuromuscular disorder characterized by fluctuating skeletal muscle weakness and fatigue. This rare autoimmune condition can present a diagnostic challenge for the advanced practice nurse (APN). Because of its low incidence in clinical practice and frequently unrecognized symptoms, a delay of 1 to 2 years prior to diagnosis is not uncommon. Recognition of the clinical features is a key component of prompt diagnosis. To avoid delay in treatment, APNs should be aware of variations in MG symptoms and the tools used to confirm a suspected diagnosis. Because patients benefit from the care of neuromuscular specialists, APNs are not expected to be experts within MG treatment. But knowledge of general treatment principles affords the APN an opportunity to collaborate with the neuromuscular specialist to provide care for patients with MG. Using an individual example, this article reviews the experience of an older adult with MG from clinical presentation through treatment.

Myasthenia gravis: helping patients have better outcomes

Myasthenia gravis (MG) is the most common primary disorder of neuromuscular transmission. MG can be treated as a chronic disease with medication, surgery, plasmapheresis, and I.V. immunoglobulin.