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A study of comorbidities in myasthenia gravis

  • Usha K. MisraEmail author
  • Jayantee Kalita
  • Varun K. Singh
  • Surendra Kumar
Original article
  • 30 Downloads

Abstract

Management of myasthenia gravis (MG) in the presence of comorbidities may be difficult. We report the effect of comorbidities in the outcome of MG. The patients with MG during 1991–2016 were included and evaluated including their demographic variables, clinical findings, Myasthenia Gravis Foundation of America (MGFA) score. The patients were categorized into early onset (≤ 40 years) and late onset (> 40 years) MG. The comorbidities (autoimmune and miscellaneous) and iatrogenic complications were compared between early and late onset, and in good and poor outcome groups. Out of 81 patients with MG, 48 patients had early and 33 late onset. In 71 (88%) patients, comorbidities were present and were autoimmune in 8 (10%) and miscellaneous in all the patients (88%). Iatrogenic complications were present in 54 (67%) patients. Thymectomy was done in 19 patients; 16 had thymoma and 3 thymic hyperplasia. Myasthenic crisis occurred in 28 patients; 5 (18%) had autoimmune and all had miscellaneous comorbidities. The patients with poor outcome had ≥ 2 comorbidities, myasthenic crisis, leukocytosis, elevated serum bilirubin and creatinine, and increased number of hospital admissions (P < 0.05). Myasthenia gravis is associated with comorbidities in majority of patients especially in late onset group, and more than two comorbidities are related to poor outcome.

Keywords

Myasthenia gravis Comorbidity Outcome Autoimmune Iatrogenic Drug induced Myasthenic crisis 

Abbreviations

MG

Myasthenia gravis

MGFA

Myasthenia Gravis Foundation of America

MuSK

Muscle specific kinase

LRP4

Lipoprotein-related protein 4

Notes

Acknowledgements

We thank Mr. Shakti Kumar for secretarial help.

Author contributions

UKM: Writing and drafting of manuscript. JK: Writing and drafting of manuscript. VKS: Data collection and analysis of data. SK: Data collection, analysis of data and statistical analysis.

Funding

None.

Compliance with ethical standards

Ethical approval

This study was approved by Institutional Ethics Committee, SGPGIMS, Lucknow INDIA. All the patients or care givers gave their written informed consent for research, which was conducted in accordance with the Helsinki Declaration.

Conflict of interest

The authors declare that the have no conflict of interest.

References

  1. 1.
    Gilhus NE, Verschuuren JJ (2015) Myasthenia gravis: subgroup classification and therapeutic strategies. Lancet Neurol 14:1023–1036CrossRefGoogle Scholar
  2. 2.
    Nacu A, Andersen JB, Lisnic V, Owe JF, Gilhus NE (2015) Complicating autoimmune diseases in myasthenia gravis: a review. Autoimmunity 48:362–368CrossRefGoogle Scholar
  3. 3.
    Tamer S, Gokce Gunes HN, Gokcal E, Yoldas TK (2016) Co-existence of autoimmune disease and autoantibodies in patients with myasthenia gravis. Neurol India 64:45–49CrossRefGoogle Scholar
  4. 4.
    Thorlacius S, Aarli JA, Riise T, Matre R, Johnsen HJ (1989) Associated disorders in myasthenia gravis: autoimmune diseases and their relation to thymectomy. Acta Neurol Scand 80:290–295CrossRefGoogle Scholar
  5. 5.
    Christensen PB, Jensen TS, Tsiropoulos I et al Sørensen T, Kjaer M, Højer-Pedersen E, Rasmussen MJ, Lehfeldt E (1995) Associated autoimmune diseases in myasthenia gravis. A population-based study. Acta Neurol Scand 91:192–195CrossRefGoogle Scholar
  6. 6.
    Mao ZF, Yang LX, Mo XA, Qin C, Lai YR, He NY, Li T, Hackett ML (2011) Frequency of autoimmune diseases in myasthenia gravis: a systematic review. Int J Neurosci 121:121–129CrossRefGoogle Scholar
  7. 7.
    Ramanujam R, Piehl F, Pirskanen R, Gregersen PK, Hammarstrom L (2011) Concomitant autoimmunity in myasthenia gravis—lack of association with IgA deficiency. J Neuroimmunol 236:118–122CrossRefGoogle Scholar
  8. 8.
    Gihus NE, Nacu A, Anderson JB, Owe JF (2011) Myasthenia gravis and risk of comorbidity. Eur J Neurol 22:17–23CrossRefGoogle Scholar
  9. 9.
    Téllez-Zenteno JF, Cardenas G, Estañol B, Garcia-Ramos G, Weder-Cisneros N (2004) Associated conditions in myasthenia gravis: response to thymectomy. Eur J Neurol 11:767–773CrossRefGoogle Scholar
  10. 10.
    Guglin M, Campellone JV, Heintz K, Parrillo JE (2003) Cardiac disease in myasthenia gravis: a literature review. J Clin Neuromuscul Dis 4:199–203CrossRefGoogle Scholar
  11. 11.
    Johannessen K, Mygland A, Gilhus NE, Aarli J, Vik- Mo H (1992) Left ventricular function in myasthenia gravis. Am J Cardiol 69:129–132CrossRefGoogle Scholar
  12. 12.
    Meriggioli MN, Sanders DB (2009) Autoimmune myasthenia gravis: emerging clinical and biological heterogeneity. Lancet Neurol 8:475–490CrossRefGoogle Scholar
  13. 13.
    Jaretzki A 3rd, Barohn RJ, Ernstoff RM, Kaminski HJ, Keesey JC, Penn AS, Sanders DB (2000) Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology 55:16–23CrossRefGoogle Scholar
  14. 14.
    James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML et al (2014) Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC-8). JAMA 311:507–520CrossRefGoogle Scholar
  15. 15.
    American Diabetes Association (2016) Erratum. Classification and diagnosis of diabetes. Section 2. In Standards of Medical Care in Diabetes-2016. Diabetes Care 39(Suppl. 1):S13–S22. Diabetes Care. 39:1653 2016Google Scholar
  16. 16.
    Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, Grunberger G, Guerin CK et al (2017) American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for the management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract 23:479–497CrossRefGoogle Scholar
  17. 17.
    Clinical history and meeting the GOLD criteria for COPD (From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2014Google Scholar
  18. 18.
    Sardu C, Cocco E, Mereu A, Massa R, Cuccu A, Marrosu MG, Contu P (2012) Population based study of 12 autoimmune diseases in Sardinia, Italy: prevalence and comorbidity. PLoS One 7:e32487CrossRefGoogle Scholar
  19. 19.
    Fang F, Sveinsson O, Thormar G, Granqvist M, Askling J, Lundberg IE, Ye W, Hammarström L et al (2015) The autoimmune spectrum of myasthenia gravis: a Swedish population-based study. J Intern Med 277:594–604CrossRefGoogle Scholar
  20. 20.
    Jallouli M, Saadoun D, Eymard B, Leroux G, Haroche J, Le Thi Huong D, De Gennes C, Chapelon C et al (2012) 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 259:1290–1297CrossRefGoogle Scholar
  21. 21.
    Kaminski HJ, Li Z, Richmonds C, Ruff RL, Kusner L (2003) Susceptibility of ocular tissues to autoimmune diseases. Ann N Y Acad Sci 998:362–374CrossRefGoogle Scholar
  22. 22.
    Chen YL, Yeh JH, Chiu HC (2013) Clinical features of myasthenia gravis patients with autoimmune thyroid disease in Taiwan. Acta Neurol Scand 127:170–174CrossRefGoogle Scholar
  23. 23.
    Kalita J, Kohat AK, Misra UK (2014) Predictors of outcome of myasthenic crisis. Neurol Sci 35:1109–1114CrossRefGoogle Scholar
  24. 24.
    Fink ME (1993) Treatment of the critically ill patient with myasthenia gravis. In: Ropper AH (ed) Neurological and neurosurgical intensive care, 3rd edn. Raven Press, New York, pp 351–362Google Scholar
  25. 25.
    Andersen JA, Owe JF, Engeland A, Gilhus NE (2014) Total drug treatment and comorbidity in myasthenia gravis; a population- base cohort study. Eur J Neurol 21:948–995CrossRefGoogle Scholar
  26. 26.
    Pouwels S, Javald M, Boer AD, de Vries F (2011) Risk of fracture in patients with myasthenia gravis: the general practice research database. Bone 48:270CrossRefGoogle Scholar

Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  1. 1.Department of NeurologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia

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