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

Abstract

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.

A Triangle: Rheumatoid Arthritis, Myasthenia Gravis and Anti-Tnf. Good News or Bad News? Long -Term Follow-Up: Case Report and Review of Literature

“…There are potential side effects of longterm immunosuppressant agents in MG. It has been supported by a limited number of studies that TNF-alpha inhibitors can be preferred instead of these immunosuppressant drugs in MG (11). However, it has been reported in several cases that TNF-alpha blockers used in various autoimmune chronic inflammatory diseases can trigger another autoimmune disease, such as MG (12,13) (Table 1).…”

Increased Prevalence of Myasthenia Gravis in a Cohort of Patients with Inflammatory Bowel Disease

“…MG prevalence was 0.66% in our cohort of IBD patients. This prevalence is eight times higher than in a cohort of rheumatoid arthritis patients [44] and maybe within the same range of patients with SLE: 0.15-1.3% [45]. A national MG registry study in Sweden documented a 2.3 times increased risk of CD in MG patients (CI=1.3-4.0) and 2.1 times increased risk for UC (CI=1.3-3.5) [3].…”