Association Between Systemic Lupus Erythematosus and Myasthenia Gravis: Coincidence or Sequelae?

Abstract

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease and myasthenia gravis (MG) is an organ-specific autoimmune disease, both may exhibit positive anti-nuclear antibodies and a female preponderance. They may have similar features and can coexist in a patient or precede one another. This review article is based on electronic searches using PubMed as the primary database. Most of the articles used for this review were published in the last ten years with the exception of seven articles which were from 1995-2009. No guidelines have been followed. A total of 55 research articles were found related to the topic of this review article, and further scanning was done to eliminate some articles that did not meet the criteria. The coexistence of autoimmune diseases has been reported in many cases. The prevalence of a second autoimmune disease is higher among patients with a primary diagnosis of autoimmune disease than the general population. The prevalence of SLE in MG patients or vice-versa is greater than the general population. The association has been hypothesized to many mechanisms: thymectomy resulting in loss of central tolerance and generation of autoantibodies, regulatory T cell dysfunction, the dysregulated function of Fas receptor (CD95), anti-malarial drugs directly affecting the neuromuscular junction, the role of chemokine CXCL13 and GM-CSF in the pathogenesis. The association is rare, and the presence of one should be closely followed for further progression into other diseases. More research work needs to be done for a clear conclusion.

Systemic lupus erythematosus after delivery and myasthenia gravis with COL6A1 gene mutation: A case report

“…Typically, SLE and MG can coexist or precede one another, although rare associations involving many mechanisms have been proposed in the literature, including the immunostimulatory effect of sex hormones, 5 reduced number of T cells and functional defects, resulting in the generation of autoantibodies, 6 direct effect of anti-malarial drugs on the neuromuscular junction, 7 and the possible involvement of a gene mutation.…”

Postpartum Myasthenic Crisis in a Patient with SLE: A Case Report and Literature Review

“… 3 Similarly, the prevalence of SLE is higher in MG patients in the general population and is estimated to be up to 8%. 1 , 7 , 8 In most patients (62%), MG preceded SLE diagnosis. 1 …”

“…Myasthenia gravis (MG), an organ specific autoimmune disease, is characterized by the presence of specific autoantibodies against the presynaptic membrane receptors like Nicotinic acetylcholine receptor (nAChR), muscle-specific tyrosine kinase (MuSK) or lipoprotein receptor-related protein 4 (LRP4). 1 In 13–22 % of the cases MG is associated with other autoimmune diseases including Rheumatoid arthritis, SLE, Hashimoto thyroiditis, Graves’ disease, and pernicious anaemia. This association is more common in female and patients with early onset disease.…”

“… 3 SLE and MG share common features including higher prevalence among young women, positive antinuclear antibodies, and relapsing and remitting course. 1 , 4 , 5 Although both MG and SLE are relatively common autoimmune disorders, their coexistence is rarely reported. Here we have reported our experience of a SLE patient with postpartum myasthenia crisis.…”

Myasthenia Gravis: An Unanticipated Cause of Failure to Wean in a Postpartum Patient with Preexisting Systemic Lupus Erythematosus

“…Both SLE and MG present with organ-specific autoimmune antibodies and exhibit a female preponderance. 1 , 2 Systemic lupus erythematosus (SLE) and MG have known to either coexist or precede one another, the incidence of MG preceding SLE being common and thus reported more often. 3 – 6 We report a case of preexisting SLE which later developed MG, to present as an unanticipated reason for failure to wean.…”