A case of myasthenia gravis accompanied by erythema elevatum diutinum and rheumatoid arthritis

Wakata, Nobuo; Nakazato, Atushi; Sugimoto, Hideki; Iguchi, Hiroaki; Saito, Ryuzo

doi:10.1007/s004150170192

Cited by 10 publications

(5 citation statements)

References 12 publications

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“…Myasthenia gravis is an autoimmune disease of the nicotinic acethylcholine receptors of the neuromuscular junction 3 . It is occasionally accompanied by other autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, alopecia areata, lichen planus, vitiligo and erythema elevatum diutinum 4 . This case shows an association of myasthenia gravis with c‐PAN.…”

Section: Reportmentioning

confidence: 84%

Myasthenia gravis with cutaneous polyarteritis nodosa

et al. 2006

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Cutaneous polyarteritis nodosa presents with typical cutaneous lesions of polyarteritis nodosa without visceral involvement at the time of diagnosis. We report a 32-year-old woman with a 12-year history of myasthenia gravis under immunosuppressive treatment, who presented with tender, erythematous nodules 20 mm in diameter on her shins. A diagnosis of cutaneous polyarteritis nodosa was made, based on the clinical and histopathological findings. Myasthenia gravis, an antibody-mediated disease, is occasionally accompanied by other autoimmune diseases, but we found no previous report in the literature associating it with polyarteritis nodosa.

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Section: Reportmentioning

confidence: 84%

Myasthenia gravis with cutaneous polyarteritis nodosa

et al. 2006

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“…EED has also been reported in associated with systemic lupus erythematosus, lupus panniculitis, and Sjogren syndrome [9][10][11]. A single case of myasthenia gravis associated with EED has also been reported [12]. Several reported cases of EED have been associated with asymptomatic IgA monoclonal gammopathy [2,13].…”

Section: Discussionmentioning

confidence: 96%

Atypical Presentation of Erythema Elevatum Diutinum in a Patient With Hashimoto's Disease

Jacob¹,

Tschen²

2021

Cureus

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Erythema elevatum diutinum (EED) is a cutaneous vasculitis that is characterized by histopathologic findings of neutrophilic infiltration, vessel fibrosis, and leukocytoclasia. It most often presents as papules, plaques, and nodules on the extensor surfaces of the extremities. Herein, we present a case of a 44-year-old woman with Hashimoto's disease with an atypical presentation of EED on the palmar surface of the thumb, in addition to the classic appearance on the elbow. Diseases associated with EED, including autoimmune conditions, are discussed.

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“…RTX (1000 mg, then 500 mg every 6 months) led to the remission of both MG and RA Angelucci et al, 2010 [ 19 ] 68 F Seropositivity not specified, PR Seropositivity not specified Remission GC, AZA, ADA No impact on MG was reported. Exacerbation of MG after antirheumatic drugs withdrawal for pneumonia Comorbidity: Crohn’s disease, Uveitis Horai et al, 2014 [ 22 ] 73 M Manifestation not specified, seropositivity not specified, MM-2 ACPA + new-onset MTX, GC No impact on MG was reported Kerkeni et al, 2008 [ 23 ] 50 F Generalized, anti-AchR + , new-onset Seronegative active GC, MTX, AZA, IVIG, PEEX, RTX New-onset of MG and active RA, therapy with AZA, IVIG, and PEEX ineffective; RTX (375 mg/m 2 weekly over 4 weeks) led to remission of both MG and RA Pelachas et al, 2020 [ 24 ] 42 F Ocular, seronegative, new-onset RF + , remission MTX, ADA MG onset after 18 months of ADA and 24 months of MTX Fee et al, 2009 [ 25 ] 66 M Generalized, anti-AchR + , new-onset RF—no additional information ETN MG onset after 6 yrs of ETN, resolution after suspension Wakata et al, 2001 [ 26 ] 56 F Generalized, thymectomy, anti-AchR + , MM-0 RF + , new-onset Diphenyl sulfone auranofin loxo...…”

Section: Methodsmentioning

confidence: 99%

“…We retrieved 9 case reports of patients with concomitant RA and MG [19][20][21][22][23][24][25][26][27] and described three more cases. The clinical and therapeutic characteristics are summarized in Table 2.…”

Section: Literature Reviewmentioning

confidence: 99%

Rheumatoid arthritis and myasthenia gravis: a case-based review of the therapeutic options

et al. 2022

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Introduction Myasthenia gravis is an autoimmune disease affecting the neuromuscular junction, often associated with other autoimmune diseases, including rheumatoid arthritis. Patients with rheumatoid arthritis present an increased prevalence of myasthenia gravis compared to the general population. While these two diseases share some therapeutic options, such as glucocorticoids, methotrexate, and rituximab, there are no guidelines for treating concomitant disease. We aim to review the available evidence and to discuss the efficacy and safety of the therapeutic options in patients with rheumatoid arthritis associated with myasthenia gravis. Method We described three patients with rheumatoid arthritis associated with myasthenia gravis and we performed a systematic review of the associated literature. Results A 48-year-old man and two women (48 and 55 years old) with concomitant diagnoses of active rheumatoid arthritis and well-controlled myasthenia gravis are described. They were treated with methotrexate, leflunomide, upadacitinib, and adalimumab. None of them experienced changes in their myasthenic symptoms. We found 9 additional cases from our literature review. Methotrexate, rituximab, upadacitinib, diphenyl sulfone, auranofin, and loxoprofen sodium did not show an impact on the seven patients with previously well-controlled myasthenia. Glucocorticoids, methotrexate, and rituximab proved effective in active myasthenia gravis and arthritis. Conflicting data emerged for Tumor-necrosis factor inhibitors. Conclusions Although the available evidence remains scarce, we consider glucocorticoids, methotrexate, and rituximab as safe and effective options. The role of tumor-necrosis factor inhibitors remains uncertain. Eventually, Janus Kinase inhibitors are a novel interesting option for these patients. Key Points• To date, the only evidence on the treatment of patients with rheumatoid arthritis and concomitant myasthenia gravis derives from case reports.• Based on the review of the available case reports and on the cases we described, we consider glucocorticoids, methotrexate, and rituximab as safe and effective options, while the role of Tumor-necrosis factor inhibitors remains uncertain.• Based on the cases we described, Janus Kinase inhibitors are a novel interesting option for patients with concomitant rheumatoid arthritis and myasthenia gravis.

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A case of myasthenia gravis accompanied by erythema elevatum diutinum and rheumatoid arthritis

Cited by 10 publications

References 12 publications

Myasthenia gravis with cutaneous polyarteritis nodosa

Myasthenia gravis with cutaneous polyarteritis nodosa

Atypical Presentation of Erythema Elevatum Diutinum in a Patient With Hashimoto's Disease

Rheumatoid arthritis and myasthenia gravis: a case-based review of the therapeutic options

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