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ObjectivesTo clarify the social disadvantages associated with myasthenia gravis (MG) and examine associations with its disease and treatment.DesignCross-sectional study.Setting and participantsWe evaluated 917 consecutive cases of established MG seen at 13 neurological centres in Japan over a short duration.Outcome measuresAll patients completed a questionnaire on social disadvantages resulting from MG and its treatment and a 15-item MG-specific quality of life scale at study entry. Clinical severity at the worst condition was graded according to the MG Foundation of America classification, and that at the current condition was determined according to the quantitative MG score and MG composite. Maximum dose and duration of dose ≥20 mg/day of oral prednisolone during the disease course were obtained from the patients' medical records. Achievement of the treatment target (minimal manifestation status with prednisolone at ≤5 mg/day) was determined at 1, 2 and 4 years after starting treatment and at study entry.ResultsWe found that 27.2% of the patients had experienced unemployment, 4.1% had been unwillingly transferred and 35.9% had experienced a decrease in income, 47.1% of whom reported that the decrease was ≥50% of their previous total income. In addition, 49.0% of the patients reported feeling reduced social positivity. Factors promoting social disadvantages were severity of illness, dose and duration of prednisolone, long-term treatment, and a depressive state and change in appearance after treatment with oral steroids. Early achievement of the treatment target was a major inhibiting factor.ConclusionsPatients with MG often experience unemployment, unwilling job transfers and a decrease in income. In addition, many patients report feeling reduced social positivity. To inhibit the social disadvantages associated with MG and its treatment, greater focus needs to be placed on helping patients with MG resume a normal lifestyle as soon as possible by achieving the treatment target.

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IntroductionIn this study we sought to clarify the effects of early fast‐acting treatment (EFT) strategies on the time course for achieving the treatment target in generalized myasthenia gravis (MG).MethodsThis retrospective study of 923 consecutive MG patients analyzed 688 generalized MG patients who had received immunotherapy during the disease course. The time to first achieve minimal manifestations (MM) or better while receiving prednisolone at ≤5 mg/day for ≥6 months (MM‐or‐better‐5mg) up to 120 months after starting immunotherapy was compared between EFT and non‐EFT patients.ResultsAchievement of MM‐or‐better‐5mg was more frequent and earlier in the EFT group (P = 0.0004, Wilcoxon test; P = 0.0001, log‐rank test). Multivariate Cox regression analysis calculated a hazard ratio of 1.98 (P < 0.0001) for utilization of EFT. Dosing regimens of oral steroids in EFT produced no differences in the time course.ConclusionsEFT strategies are advantageous for early achievement of MM‐or‐better‐5mg. Muscle Nerve 55: 794–801, 2017