Myasthenia Gravis and Associated Diseases
DOI:
https://doi.org/10.3889/oamjms.2018.110Keywords:
Myasthenia gravis, Autoimmune disease, Associated condition, Thymus, Tumor, ThymectomyAbstract
BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease caused by the action of specific antibodies to the postsynaptic membrane of the neuromuscular junction, leading to impaired neuromuscular transmission. Patients with MG have an increased incidence of other autoimmune diseases.
AIM: to determine the presence of other associated diseases in patients with MG.
METHOD: A group of 127 patients with MG followed in 10 years period, in which the presence of other associated diseases has been analysed.
RESULTS: The sex ratio is in favour of the female sex, the average age of the initial manifestation of the disease is less than 50 years, 65.4% of the patients with MG have another disease. 15.0% patients have associated another autoimmune disease. Thyroid disease is the most common associated with MG, rarely rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and other autoimmune diseases. Other diseases include hypertension, heart disease, diabetes, respiratory diseases, dyslipidemia. 10.2% of the patients are diagnosed with extrathymic tumours of various origins.
CONCLUSION: Associated diseases are common in patients with MG, drawing attention to the possible common basis for their coexistence, as well as their impact on the intensity and treatment of the disease.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Drachman DB. Myasthenia gravis. N Engl J Med. 1994; 330(25):1797–1810. https://doi.org/10.1056/NEJM199406233302507PMid:8190158
Gilhus NE. Myasthenia gravis. N Eng J Med. 2016; 375:2570-81. https://doi.org/10.1056/NEJMra1602678PMid:28029925
Juel CV. Massey MJ. Myasthenia gravis. Orphanet J Rare Dis. 2007; 2:44. https://doi.org/10.1186/1750-1172-2-44 PMid:17986328 PMCid:PMC2211463
Cavalcante P, Bernasconi P, Mantegazza R. Autoimmune mechanisms in myasthenia gravis. Curr Opin Neurol. 2012; 25:621–629. https://doi.org/10.1097/WCO.0b013e328357a829 PMid:22941261
Berrih-Aknin S. Myasthenia Gravis: paradox versus paradigm in autoimmunity. J Autoimmun. 2014;52:1-28. https://doi.org/10.1016/j.jaut.2014.05.001 PMid:24934596
Osserman KE. Ocular myasthenia gravis. Invest Ophtalmol. 1967; 6(3):277-287.
Abt PL, Patel HJ, Marsh A, Schwartz SI. Analysis of thymectomy for myasthenia gravis in older patients: A 20-year single institution experience. J Am Coll Surg. 2001; 192:459-464. https://doi.org/10.1016/S1072-7515(01)00795-5
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997; 40(9):1725. https://doi.org/10.1002/art.1780400928 PMid:9324032
Aletaha D, Neogi T, Silman AJ, et al. The 2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Rheumatoid Arthritis. Arthritis Rheum. 2010; 62(9):2569-81. https://doi.org/10.1002/art.27584 PMid:20872595
Anaya JM, Shoenfeld Y, Correa PA. Garcia Carasco M, Cervera R. Autoimmunity and autoimmune disease. Medellin: CIB, 2005.
Cooper GS, Stroehla BC. The epidemiology of autoimmune diseases. Autoimmun Rev. 2003; 2:119-125. https://doi.org/10.1016/S1568-9972(03)00006-5
Shoenfeld Y, Isenberg DA. The mosaic of autoimmunity. Immunol Today. 1989; 10:123-126. https://doi.org/10.1016/0167-5699(89)90245-4
Sardu C, Cocco E, Mereu A, et al. Population based study of 12 autoimmune diseases in Sardinia, Italy: prevalence and comorbidity. PLoS One. 2012; 7(3):e32487. https://doi.org/10.1371/journal.pone.0032487 PMid:22396771 PMCid:PMC3292563
Mao ZF, Yang LX, Mo XA, et al. Frequency of autoimmune diseases in myasthenia gravis: a systematic review. Int J Neurosci. 2011; 121(3):121-9. https://doi.org/10.3109/00207454.2010.539307 PMid:21142828
Nacu A, Andersen JB, Lisnic V, Owe JF, Gilhus NE. Complicating autoimmune diseases in myasthenia gravis: a review. Autoimmunity 2015; 48(6):362-368. https://doi.org/10.3109/08916934.2015.1030614 PMid:25915571 PMCid:PMC4616023
Christensen PB, Jensen TS, Tsiropoulos I, et al. Associated autoimmune diseases in myasthenia gravis. Acta Neurol Scand. 1995; 91:192-195. https://doi.org/10.1111/j.1600-0404.1995.tb00432.x PMid:7793234
Gilhus NE, Nacu A, Andersen JB, Owe JF. Myasthenia gravis and risks for comorbidity. Eur J Neurol. 2014; 0:1–7.
Cacho-Diaz B, Flores-Gavilán P, GarcÃa-Ramos G, Lorenzana-Mendoza NA. Myasthenia Gravis and Its Comorbidities. J Neurol Neurophysiol. 2015; 6:317. https://doi.org/10.4172/2155-9562.1000317
Kaplan I, Blakely BT, Pavlath GK, Travis M, Blau HM. Steroids induce acetylcholine receptors on cultured human muscle: implications for myasthenia gravis. Proceedings of the National Academy of Sciences of the United States of America. 1990; 87: 8100-8104. https://doi.org/10.1073/pnas.87.20.8100 PMid:2236023 PMCid:PMC54900
Tamer S, Güneş HNG, Gökçal E, Yoldaş TK. Coexistence of autoimmune diseases and autoantibodies in myasthenia gravis patients. Neurol India. 2016; 64:45-49. https://doi.org/10.4103/0028-3886.173638 PMid:26754991
Lin YP, Iqbal U, Nguyen PA,et al. The concomitant association of thyroid disorders and myasthenia gravis. Transl Neurosci. 2017; 8:27-30. https://doi.org/10.1515/tnsci-2017-0006 PMid:28729915 PMCid:PMC5443889
Marino M, Ricciardi R, Pinchera A, et al. Mild clinical expression of myasthenia gravis associated with autoimmune thyroid diseases. J Clin Endocrinol Metab.1997; 82:438-443. https://doi.org/10.1210/jc.82.2.438
Chen YL, Yeh JH, Chiu HC. Clinical features of myasthenia gravis patients with autoimmune thyroid disease in Taiwan. Acta Neurol Scand. 2013; 127:170-4. https://doi.org/10.1111/j.1600-0404.2012.01693.x PMid:22725712
Kanazawa M, Shimohata T, Tanaka K, Nishizawa M. Clinical features of patients with myasthenia gravis associated with autoimmune diseases. Eur J Neurol. 2007; 14:1403-4. https://doi.org/10.1111/j.1468-1331.2007.01978.x PMid:17941854
Thorlacius S, Aarli JA, Riise T, Matre R, Johnsen HJ. Associated disorders in myasthenia gravis: autoimmune diseases and their relation to thymectomy. Acta Neurol Scand. 1989; 80:290-295. https://doi.org/10.1111/j.1600-0404.1989.tb03881.x PMid:2816285
Jallouli M, Saadoun D, Eymard B, et al. The association of systemic lupus erythematosus and myasthenia gravis: A series of 17 cases, with a special focus on hydroxychloroquine use and a review of the literature. J Neurol. 2012; 259:1290-7. https://doi.org/10.1007/s00415-011-6335-z PMid:22160434
Sthoeger Z, Neiman A, Elbirt D, et al. High prevalence of systemic lupus erythematosus in 78 myasthenia gravis patients: A clinical and serologic study. Am J Med Sci. 2006; 331:4-9. https://doi.org/10.1097/00000441-200601000-00004 PMid:16415656
Hrycek A. Systemic lupus erythematosus and myasthenia gravis. Pol Arch Med Wewn. 2009; 119:582-5. PMid:19776704
Vaiopoulos G, Sfikakis PP, Kapsimali V, et al. The association of systemic lupus erythematosus and myasthenia gravis. Postgrad Med J. 1994; 70(828):741-5. https://doi.org/10.1136/pgmj.70.828.741 PMid:7831174 PMCid:PMC2397764
Park MJ, Kim YA, Lee SS, et al. Appearance of systemic lupus erythemathosus in patients with myasthenia gravis following thymectomy: two Case Reports. J Korean Med Sci. 2004; 134-6. https://doi.org/10.3346/jkms.2004.19.1.134 PMid:14966356 PMCid:PMC2822250
Monden Y, Uyama T, Nakahara K et al. Clinical characteristics and prognosis of myasthenia gravis with other autoimmune diseases. Ann Thorac Surg. 1986; 41:189-192. https://doi.org/10.1016/S0003-4975(10)62667-7
Téllez-Zenteno JF, Cardenas G, Esta-ol B, Garcia-Ramos G, Weder-Cisneros N. Associated conditions in myasthenia gravis: response to thymectomy. Eur J Neurol. 2004; 11:767–773. https://doi.org/10.1111/j.1468-1331.2004.00968.x PMid:15525299
Poulas K, Koutsouraki E, Kordas G, Kokla A, Tzartos SJ. Anti-MuSK- and anti-AChR-positive myasthenia gravis induced by d-penicillamine. J Neuroimmunol. 2012; 250:94-98. https://doi.org/10.1016/j.jneuroim.2012.05.011 PMid:22683336
Owe JF, Daltveit AK, Gilhus NE. Causes of death among patients with myasthenia gravis in Norway between 1951 and 2001. J Neurol Neurosurg Psychiatry. 2006; 77:203–207. https://doi.org/10.1136/jnnp.2005.072355 PMid:16421123 PMCid:PMC2077560
Shukla G, Gupta S, Goyal V, et al. Abnormal sympathetic hyper-reactivity in patients with myasthenia gravis: A prospective study. Clin Neurol Neurosurg. 2013; 115:179-186. https://doi.org/10.1016/j.clineuro.2012.05.013 PMid:22676958
Shivamurthy P, Parker MW. Cardiac manifestations of myasthenia gravis: A systematic review. IJC Metab Endocr. 2014; 5:3-6. https://doi.org/10.1016/j.ijcme.2014.08.003
Limaye K, Vallurupalli S, Lee RW. Myasthenia of the Heart. Am J Med. 2016; 129(6):10-21. https://doi.org/10.1016/j.amjmed.2016.01.020 PMid:26841298
Wakata N, Nemoto H, Konno S, et al. Myasthenia Gravis and Diabetes Mellitus. Intern Med. 2007; 46(9):557-9. https://doi.org/10.2169/internalmedicine.46.6237 PMid:17473488
Gittoes NJL, Kendall MJ, Ferner RE. Drugs and diabetes mellitus. In: Pickup J, William G, Eds. Textbook of Diabetes. 2nd ed. Bickwell Science, Massachusetts. 1997: 69.1-69.10.
Grob D, Brunner N, Namba T, Pagala M. Lifetime course of myasthenia gravis. Muscle Nerve. 2008; 37:141–149. https://doi.org/10.1002/mus.20950 PMid:18059039
Kim WH, Kim JH, Kim EK, et al. Myasthenia Gravis Presenting as Isolated Respiratory Failure: A Case Report. Korean J Intern Med. 2010; 25(1):101-104. https://doi.org/10.3904/kjim.2010.25.1.101 PMid:20195411 PMCid:PMC2829406
Gale J, Danesh-Mayer HV. Statins can induce myasthenia gravis. J Clin Neurosci. 2014; 21:195-197. https://doi.org/10.1016/j.jocn.2013.11.009 PMid:24433954
Papatestas AE, Osserman KE, Kark AE. The relationship between thymus and oncogenesis. A study of incidence of non-thymic malignancy in myasthenia gravis. Br J Cancer. 1971; 25:635-645. https://doi.org/10.1038/bjc.1971.79
PMid:5144531 PMCid:PMC2008859
Evoli A, Batocchi AP, Tonali P, MarcianoM. Risk of cancer in patients with myasthenia gravis. AnnNY Acad Sci. 1998; 841:742–745. https://doi.org/10.1111/j.1749-6632.1998.tb11011.x
Monden Y, Uyama T, Kimura S, Taniki T. Extrathymic malignancy in patients with myasthenia gravis. Eur J Cancer. 1991; 27:745–747. https://doi.org/10.1016/0277-5379(91)90179-H
Pan CC, Chen PC, Wang LS, Chi KH, Chiang H. Thymoma is associated with an increased risk of second malignancy. Cancer. 2001; 92:2406–2411. https://doi.org/10.1002/1097-0142(20011101)92:9<2406::AID-CNCR1589>3.0.CO;2-7
Levin N, Abramsky O, Lossos A, et al. Extrathymic malignancies in patients with myasthenia gravis. J Neurol Sci. 2005; 237(1-2):39-43. https://doi.org/10.1016/j.jns.2005.05.009
PMid:15990114
Wakata N, Sugimoto H, Nomoto N, et al. Extrathymic tumors in patients with myasthenia gravis: a 35 year retrospective study. Neurologist 2006; 12:53–55. https://doi.org/10.1097/01.nrl.0000195828.36108.c3 PMid:16547448
Basta I, Pekmezovic T, Peric S, et al. Extrathymic malignancies in a defined cohort of patients with myasthenia gravis. J Neurol Sci. 2014; 346(1):80-84. https://doi.org/10.1016/j.jns.2014.07.060 PMid:25129207
Citterio A, Beghi E, Millul A, et al. Risk factors for tumor occurrence in patients with myasthenia gravis. J Neurol 2009; 256:1221–7. https://doi.org/10.1007/s00415-009-5091-9 PMid:19330280
Downloads
Published
How to Cite
Issue
Section
License
http://creativecommons.org/licenses/by-nc/4.0