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133  Adherence to the ABN guidelines for the diagnosis and management of myasthenia gravis
  1. Joseph Welch1,
  2. Saiju Jacob2
  1. 1University of Birmingham
  2. 2Queen Elizabeth Hospital, Birmingham


Background Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction causing fatigable muscle weakness.

Aim To assess adherence to the ABN guidelines for the diagnosis and management of MG at University Hospital Birmingham (UHB) and compare to the previous 2010–2014 audit.

Methods Clinic and discharge letters of patients diagnosed with MG from 2015–2019 including data were retrospectively analysed.

Results 66 patients diagnosed with MG from 2015–2019 were identified; 13/66 (20%) ocular, 53/66 (80%) generalised. Anti-AChR positive: 59/66 (89%). Tested for anti-MuSK antibodies: 6/66 (9.1%), in whom 3/6 (50%) were already anti-AChR positive. 30/66 (45%) patients had neurophysiology, 26 (87%) of whom were already anti-AChR positive. 1 patient with negative serology and neurophysiology did not receive MR brain. Mediastinal imaging: 59/66 (89%). 53/66 (80%) patients required glucocorticoids. 27/66 (41%) patients required IVIG and/or plasma exchange. 1 patient required rituximab. TPMT levels checked prior to commencing azathioprine: 23/23 (100%) vs. 71.4% in 2010–2014. Bone protection if on glucocorticoids: 51/53 (96%) vs. 90% in 2010–2014.

Conclusions Diagnosis and management of MG at UHB is generally in line with the ABN guidelines. TPMT testing and bone protection has improved since the 2010–2014 audit. Anti-MuSK and neurophysiology are often being used unnecessarily.

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