The features of myasthenia gravis with autoantibodies to MuSK
- D Lavrnic1,
- M Losen3,
- A Vujic1,
- M De Baets3,
- L J Hajdukovic4,
- V Stojanovic1,
- R Trikic1,
- P Djukic2,
- S Apostolski1
- 1The Institute of Neurology, Clinical Centre of Serbia, Belgrade, Serbia and Montenegro
- 2Institute of Cardiovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia and Montenegro
- 3Department of Cellular Neuroscience, Universiteit Maastricht, The Netherlands
- 4Institute for the Application of Nuclear Energy, Belgrade, Serbia and Montenegro
- Correspondence to: Dr D Lavrnic Institute of Neurology, Clinical Centre of Serbia, 11000 Belgrade, 6 Dr Subotica Street, Serbia and Montenegro;
- Received 22 August 2004
- Accepted 16 December 2004
- Revised 8 November 2004
Objectives: To determine if myasthenia gravis (MG) with antibodies to MuSK is a distinct subgroup of seronegative MG.
Methods: We assayed antibodies to muscle specific tyrosine kinase (MuSK) in 55 MG patients who had no antibodies to acetylcholine receptors and looked for the specific phenotype, comparing clinical features of anti-MuSK positive and anti-MuSK negative MG patients.
Results: MG with anti-MuSK antibodies was characterised by a striking prevalence of female patients (15 women, two men). Age at onset ranged from 22 to 52 years, with 70.6% of patients presenting at <40 years of age. The majority of patients (82.4%) had prevalent involvement of facial and bulbar muscles. One third of them did not respond well to anticholinesterase drugs. Steroid immunosuppression was effective in eight patients (44.4%). Nine patients underwent thymectomy; six of these had no thymus pathology, while three had a hyperplastic thymus. At the end of the observation period, six (35.3%) patients were in remission, five (29.4%) improved, four (23.6%) did not change, and two (11.7%) had died.
Conclusions: MG patients with antibodies to MuSK have characteristic clinical features that are different from features of the remaining seronegative MG patients. This emphasises the predictive value of anti-MuSK antibody analysis in seronegative MG patients.
- AChR, acetylcholine receptors
- MDS, mean disability score
- MDSQ, mean disability score quotient
- MG, myasthenia gravis
- MuSK, muscle specific tyrosine kinase
- SNMG, seronegative myasthenia gravis
Competing interests: none declared