Rituximab desensitization in two patients with muscle‐specific kinase myasthenia gravis

Abstract

Including antimitochondrial antibodies (AMA) testing in undifferentiated cases of peripheral sensory disorders may improve diagnosis and prognosis in the subset of patients with undiagnosed PBC. AMA positivity can precede the development of hepatic dysfunction in patients with PBC, sometimes by many years, and is exquisitely sensitive and specific for PBC. 7 Antinuclear antibodies (ANA) are often also positive in PBC. However, ANA are less sensitive than AMA for detecting PBC, and a negative ANA result should not preclude AMA testing. 1 The treatment window, therapeutic options, and prognosis of PBC-associated sensory neuronopathy are unknown. Including AMA testing in the assessment of sensory neuronopathies, even if initial liver function testing is normal, can diagnose patients with PBC-associated neurological dysfunction and allow researchers to address these unanswered questions. Early AMA testing will also facilitate prompt treatment with UDCA, which may improve outcomes in early-stage PBC. 1 In summary, we recommend that clinicians exclude PBC with AMA testing when investigating cases of CIDP or neuropathy, even in the absence of hepatic dysfunction. We anticipate that including this widely available, noninvasive test will improve PBC outcomes through earlier diagnosis. Ultimately, this will help us understand the true prevalence and underlying pathophysiology of PBC-associated sensory nerve disorders.