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Chinese Journal of Diagnostics(Electronic Edition) ›› 2021, Vol. 09 ›› Issue (01): 30-34. doi: 10.3877/cma.j.issn.2095-655X.2021.01.008

Special Issue:

• Diagnostic Thinking of Cases • Previous Articles     Next Articles

Analysis of case characteristics of four kinds of antibody-positive patient with myasthenia gravis complicated with rheumatoid arthritis

Zhijuan Sun1, Jingfeng Liu2, Jingyang Zhang1, Hongjun Hao3,()   

  1. 1. Department of Rheumatology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou 061001, China
    2. Department of Neurology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou 061001, China
    3. Department of Neuroimmune, Peking University First Hospital, Beijing 100034, China
  • Received:2020-08-12 Online:2021-02-10 Published:2021-02-10
  • Contact: Hongjun Hao

Abstract:

Objective

To explore the diagnostic features of four antibody-positive patient with myasthenia gravis (MG) combined with rheumatoid arthritis(RA).

Methods

The clinical data of a MG patient with four antibody-positive combined with RA in the Rheumatology Department of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine were retrospectively analyzed, and related literatures were reviewed.

Results

The patient was diagnosed with MG and RA with ptosis, fatigue, dysphagia, symmetrical polyarticular swelling and pain four years and six months ago. He was given pyridostigmine bromide, prednisone acetate, methotrexate, leflunomide and hydroxychloroquine, and the above symptoms improved. Due to the discontinuation of pyridostigmine bromide and prednisone acetate reduction, the disease recurred. After perfecting the MG-related antibodies examinations, it was found that the acetylcholine receptor (AChR) antibody, the muscle-specific tyrosine kinase (MuSK) antibody, the ryanodine receptor (RyR) antibody, and the acetylcholinesterase (AChE) antibody were positive at the same time. Adjusting the treatment plans to prednisone acetate, cyclosporine and pyridostigmine bromide, the condition was gradually eased.

Conclusion

Four kinds of antibodies can be detected in patients with MG and RA, suggesting that different antibody-mediated pathogenic mechanisms may exist in autoimmune overlap.

Key words: Myasthenia gravis, Arthritis, rheumatoid, Receptors, cholinergic, Receptor protein-tyrosine kinases, Ryanodine receptor calcium release channel

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