Fatigue, physical activity and associated factors in 779 patients with myasthenia gravis

Andersen, Linda Kahr; Aadahl, Mette; Vissing, John

doi:10.1016/j.nmd.2021.05.007

Cited by 16 publications

(10 citation statements)

References 59 publications

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“…MG patients were less active than controls and did not meet the WHO recommendations for physical activity. An association between moderate or high levels of physical activity and low levels of fatigue was found in a cross‐sectional study of 779 Danish MG patients [92]. Similarly, lower fatigue scores were found in physically active Dutch patients [96].…”

Section: Resultsmentioning

confidence: 95%

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Generalized myasthenia gravis with acetylcholine receptor antibodies: A guidance for treatment

Gilhus,

Andersen,

Andersen

et al. 2024

Euro J of Neurology

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BackgroundGeneralized myasthenia gravis (MG) with antibodies against the acetylcholine receptor is a chronic disease causing muscle weakness. Access to novel treatments warrants authoritative treatment recommendations. The Nordic countries have similar, comprehensive health systems, mandatory health registers, and extensive MG research.MethodsMG experts and patient representatives from the five Nordic countries formed a working group to prepare treatment guidance for MG based on a systematic literature search and consensus meetings.ResultsPyridostigmine represents the first‐line symptomatic treatment, while ambenonium and beta adrenergic agonists are second‐line options. Early thymectomy should be undertaken if a thymoma, and in non‐thymoma patients up to the age of 50–65 years if not obtaining remission on symptomatic treatment. Most patients need immunosuppressive drug treatment. Combining corticosteroids at the lowest possible dose with azathioprine is recommended, rituximab being an alternative first‐line option. Mycophenolate, methotrexate, and tacrolimus represent second‐line immunosuppression. Plasma exchange and intravenous immunoglobulin are used for myasthenic crises and acute exacerbations. Novel complement inhibitors and FcRn blockers are effective and fast‐acting treatments with promising safety profiles. Their use depends on local availability, refunding policies, and cost–benefit analyses. Adapted physical training is recommended. Planning of pregnancies with optimal treatment, information, and awareness of neonatal MG is necessary. Social support and adaptation of work and daily life activities are recommended.ConclusionsSuccessful treatment of MG rests on timely combination of different interventions. Due to spontaneous disease fluctuations, comorbidities, and changes in life conditions, regular long‐term specialized follow‐up is needed. Most patients do reasonably well but there is room for further improvement. Novel treatments are promising, though subject to restricted access due to costs.

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Section: Resultsmentioning

confidence: 95%

“…Studies have examined habitual physical activity in patients by questionnaires [92], accelerometer [93,94], or in combination [95]. MG patients were less active than controls and did not meet the WHO recommendations for physical activity.…”

Section: Physical Activity and Trainingmentioning

confidence: 99%

Generalized myasthenia gravis with acetylcholine receptor antibodies: A guidance for treatment

Gilhus,

Andersen,

Andersen

et al. 2024

Euro J of Neurology

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“…The decline in walking performance was gradual in MG patients, and the average distance covered in the 60s decreased significantly in MG patients 9 . Another study stated that the average value of walking speed in MG patients reached 1.54 and 1.51 m/s 26 .…”

Section: Discussionmentioning

confidence: 96%

“…Several statements say that subjective fatigue affects walking ability, but objective fatigue impacts individual weakness, meaning it impacts the quality of walking capability, not ability 28 . Previous studies assessed the relationship between fatigue and walking endurance in MG patients using the 6-minute walking test, which found a decrease in walking speed between the first and sixth min 26 . Other studies have shown that central and peripheral fatigue do not affect the speed of muscle contraction during submaximal force.…”

Section: Discussionmentioning

confidence: 99%

Correlation of fatigue on walking ability in myasthenia gravis patients: a cross-sectional study

Kartika,

Subadi,

Pawana

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction: Myasthenia gravis (MG) is a neuromuscular junction autoimmune disease characterised of intermittent muscle weakness that increases with activity and recovers with rest. Objective: Analysing the correlation of fatigue on walking ability in MG patients. Methods: This study used a cross-sectional design with consecutive sampling. Participants MG patients took in this trial. Data collection encompasses fatigue and walking ability, with fatigue being assessed using the fatigue severity scale (FSS) and walking ability being assessed using the 10-metre walking test. The 10-metre walking test assessment contains three components: comfortable walking speed (CWS), maximum walking speed (MWS), and natural cadence. The statistical analysis used in this study includes the Pearson correlation and Spearman rank tests with P<0.05. Results: The number of participants was 23 MG patients, and most of the participant was female (69.6%). The participant’s fatigue value was 5.46±1.13, including MGFA 1=5.32±1.15, MGFA 2A=5.5±1.11, and MGFA 2B=5.61±1.30. Meanwhile, the participant’s walking abilities included CWS of 1.10±0.11 m/s, MWS of 1.31±0.15 m/s, and natural cadence of 110.91±7.74 steps/min. No significant correlation of fatigue on walking ability including FSS vs. CWS (r=−0.141; P=0.520), FSS vs MWS (r=−0.169; P=0.442), and FSS vs. natural cadence (r=−0.050; P=0.822). Conclusion: There was no significant correlation between fatigue and walking ability in MG patients who had MGFA 1, MGFA 2A, and MGFA 2B.

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“…Eye problems and fatigue were also among the most discussed symptoms, reflecting a pattern of symptoms seen in real-world observational studies 7 . Fatigue is common in MG, particularly among women and those with more severe disease 30 , 37 , 38 , and is an important indicator of worsening quality of life 30 , 39 . While one domain of fatigue relates to the muscular disorder that impacts patients’ functional performance (peripheral fatigue), another is independent of muscle weakness, relating to a lack of energy and feelings of tiredness that interfere with patients’ mental and/or physical activities (central fatigue) 30 , 39 .…”

Section: Discussionmentioning

confidence: 99%

Patient perceptions of disease burden and treatment of myasthenia gravis based on sentiment analysis of digital conversations

Anderson,

Pesa,

Choudhry

et al. 2024

Sci Rep

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Myasthenia gravis (MG) is a rare, autoimmune, antibody-mediated, neuromuscular disease. This study analyzed digital conversations about MG to explore unprovoked perspectives. Advanced search, data extraction, and artificial intelligence-powered algorithms were used to harvest, mine, and structure public domain digital conversations about MG from US Internet Protocol addresses (August 2021 to August 2022). Thematic analyses examined topics, mindsets, and sentiments/key drivers via natural language processing and text analytics. Findings were described by sex/gender and treatment experience with steroids or intravenous immunoglobulin (IVIg). The 13,234 conversations were extracted from message boards (51%), social media networks (22%), topical sites (21%), and blogs (6%). Sex/gender was confirmed as female in 5703 and male in 2781 conversations, and treatment experience was with steroids in 3255 and IVIg in 2106 conversations. Topics focused on diagnosis (29%), living with MG (28%), symptoms (24%), and treatment (19%). Within 3176 conversations about symptoms, eye problems (21%), facial muscle problems (18%), and fatigue (18%) were most commonly described. Negative sentiments about MG were expressed in 59% of conversations, with only 2% considered positive. Negative conversations were dominated by themes of impact on life (29%), misdiagnosis problems (27%), treatment issues (24%), and symptom severity (20%). Impact on life was a key driver of negativity in conversations by both men (27%) and women (34%), and treatment issues was a dominant theme in conversations by steroid-treated (29%) and IVIg-treated (31%) patients. Of 1382 conversations discussing treatment barriers, 36% focused on side effects, 33% on lack of efficacy, 21% on misdiagnosis, and 10% on cost/insurance. Side effects formed the main barrier in conversations by both steroid-treated and IVIg-treated patients. Capturing the patient voice via digital conversations reveals a high degree of concern related to burden of disease, misdiagnosis, and common MG treatments among those with MG, pointing to a need for treatment options that can improve quality of life.

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Fatigue, physical activity and associated factors in 779 patients with myasthenia gravis

Cited by 16 publications

References 59 publications

Generalized myasthenia gravis with acetylcholine receptor antibodies: A guidance for treatment

Generalized myasthenia gravis with acetylcholine receptor antibodies: A guidance for treatment

Correlation of fatigue on walking ability in myasthenia gravis patients: a cross-sectional study

Patient perceptions of disease burden and treatment of myasthenia gravis based on sentiment analysis of digital conversations

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