Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China.
Front Immunol. 2023 Sep 14;14:1223322. doi: 10.3389/fimmu.2023.1223322. eCollection 2023.
Multiple reports on the co-existence of autoimmune diseases and myasthenia gravis (MG) have raised considerable concern. Therefore, we reviewed autoimmune diseases in MG to explore their clinical presentations and determine whether the presence of autoimmune diseases affects the disease severity and treatment strategies for MG. We reviewed all the major immune-mediated coexisting autoimmune conditions associated with MG. PubMed, Embase and Web of Science were searched for relevant studies from their inception to January 2023. There is a higher frequency of concomitant autoimmune diseases in patients with MG than in the general population with a marked risk in women. Most autoimmune comorbidities are linked to AChR-MG; however, there are few reports of MuSK-MG. Thyroid disorders, systemic lupus erythematosus, and vitiligo are the most common system autoimmune diseases associated with MG. In addition, MG can coexist with neurological autoimmune diseases, such as neuromyelitis optica (NMO), inflammatory myopathy (IM), multiple sclerosis (MS), and autoimmune encephalitis (AE), with NMO being the most common. Autoimmune diseases appear to develop more often in early-onset MG (EOMG). MS coexists more commonly with EOMG, while IM coexists with LOMG. In addition, MG complicated by autoimmune diseases tends to have mild clinical manifestations, and the coexistence of autoimmune diseases does not influence the clinical course of MG. The clinical course of neurological autoimmune diseases is typically severe. Autoimmune diseases occur most often after MG or as a combined abnormality; therefore, timely thymectomy followed by immunotherapy could be effective. In addition, thymoma-associated AChR MG is associated with an increased risk of AE and IM, whereas NMO and MS are associated with thymic hyperplasia. The co-occurrence of MG and autoimmune diseases could be attributed to similar immunological mechanisms with different targets and common genetic factor predisposition. This review provides evidence of the association between MG and several comorbid autoimmune diseases.
多篇关于自身免疫性疾病和重症肌无力（MG）共存的报告引起了相当大的关注。因此，我们复习了 MG 中的自身免疫性疾病，以探讨其临床表现，并确定自身免疫性疾病的存在是否会影响 MG 的疾病严重程度和治疗策略。我们复习了与 MG 相关的所有主要免疫介导的共存自身免疫性疾病。从研究开始到 2023 年 1 月，我们在 PubMed、Embase 和 Web of Science 上搜索了相关研究。MG 患者伴发自身免疫性疾病的频率高于普通人群，女性风险显著增加。大多数自身免疫性合并症与 AChR-MG 相关；然而，MuSK-MG 报道较少。甲状腺疾病、系统性红斑狼疮和白癜风是与 MG 相关的最常见的系统性自身免疫性疾病。此外，MG 可与神经自身免疫性疾病共存，如视神经脊髓炎（NMO）、炎性肌病（IM）、多发性硬化（MS）和自身免疫性脑炎（AE），其中 NMO 最常见。自身免疫性疾病似乎在早发性 MG（EOMG）中更常发生。MS 更常与 EOMG 共存，而 IM 则与 LOMG 共存。此外，合并自身免疫性疾病的 MG 往往表现出较轻的临床表现，且自身免疫性疾病的共存并不影响 MG 的临床病程。神经自身免疫性疾病的临床病程通常较为严重。自身免疫性疾病通常发生在 MG 之后或作为联合异常；因此，及时进行胸腺切除术和免疫治疗可能有效。此外，胸腺瘤相关的 AChR-MG 与 AE 和 IM 风险增加相关，而 NMO 和 MS 与胸腺增生相关。MG 和自身免疫性疾病的共存可能归因于具有不同靶点和共同遗传因素易感性的相似免疫机制。本综述提供了 MG 与几种共存自身免疫性疾病相关的证据。
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