Autoimmune disorder myasthenia gravis

It is important to use these drag with caution in patients with a history of gastrointestinal disorders, renal disease, or liver impairment. The neuromuscular blocking action of die lincosamides poses a danger to patients widi myasthenia gravis (an autoimmune disease manifested by extreme weakness and exhaustion of die muscles). 

Measuring muscle-evoked responses to repetitive motor nerve electrical stimulation permits detection of presyn-aptic neuromuscular junction dysfunction. In botulism and the Lambert-Eaton syndrome, repetitive stimulation elicits a smaller than normal skeletal muscle response at the beginning of the stimulus train, due to impaired initial release of acetylcholine-containing vesicles from presyn-aptic terminals of motor neurons followed by a normal or accentuated incremental muscle response during repeated stimulation. This incremental response to repetitive stimulation in presynaptic neuromuscular disorders can be distinguished from the decremental response that characterizes autoimmune myasthenia gravis, which affects the postsynaptic component of neuromuscular junctions. 

Myasthenia gravis is an autoimmune disease resulting from production of autoantibodies against AChR at the motor end plate, causing defects in neuromuscular transmission. Depending on the muscles affected a patient may develop dysphagia or respiratory failure [1]. The appearance of pathological forms of erythrocytes such as stomatocytes, echinocytes etc., in peripheral blood causes microcirculation disorders [2]. 

Autoimmune responses seem to be the underlying basis for a number of diseases, including rheumatoid arthritis, diabetes mellitus, myasthenia gravis, systemic lupus erythematosus, scleroderma, polymyositis/der-matomyositis, and several other disorders.25,27,44 As indicated previously, it is not exactly clear what factors cause autoimmune responses, as well as why certain individuals are more prone to autoimmune-related diseases. Nonetheless, drugs that suppress the immune system can limit damage to various other tissues, and these drugs may produce dramatic improvements in patients with diseases that are caused by an autoimmune response. 

The possibility of autoimmune disorders during interferon alfa treatment has been addressed by many authors. The spectrum of interferon alfa-induced immune diseases includes organ-specific and systemic autoimmune diseases, such as thyroiditis, diabetes, hematological disorders, systemic lupus erythematosus, rheumatoid arthritis, dermatological disease, and myasthenia gravis (156). Several have been discussed in appropriate sections elsewhere in this monograph. The exact role of interferon alfa is usually difficult to ascertain, because the underlying disease, that is chronic hepatitis C, can also be associated with immune-mediated disease. 

Myasthenia gravis is a progressive disorder characterized by muscle weakness eye muscles are often the first affected. Research has shown it to be an autoimmune disease in which the victim forms antibodies to his or her nicotinic acetylcholine receptors at motor endplates. It is characterized by fatigability and weakness of the skeletal muscles, especially those of the eyes. Approximately 90% of the patients have droopy eyelids and double vision. Treatments include corticosteroids and thymectomy to reduce the actions of the immune system and anti-ChE agents such as pyridostigmine to improve the effectiveness of the receptors that remain. 

The least well characterized autoimmune polyglandular syndrome is the type 3 syndrome. This syndrome is defined by the presence of autoimmune thyroid disease with another autoimmune disease, such as diabetes mellitus type l, autoimmune gastritis, or myasthenia gravis, but in the absence of Addison disease. APGS type 3 primarily involves females (the female to male ratio is 7 1) who have HLA-DR3-associated autoimmune disease and is probably the most common of the autoimmune polyglandular syndrome disorders. Since different and multiple clinical combinations can be found, the classification of this type of autoimmune polyglandular syndrome is probably more complicated than originally anticipated. 

Myasthenia gravis is an autoimmune disorder, which is diagnosed in about 1 in 20 000 people every year in the United Kingdom, mainly affecting women between 20 and 40 and men over 50. In myasthenia gravis, normal communication between nerve and... 

Table 2 summarize.s the main clinical and EMG characteristics of some well-known disorders of neuromuscular transmission. Myasthenia gravi.s i.s an autoimmune disorder with postsynaptic impairment of neuromu.scuiar transmission due to complement deposition at the ACh receptor... 

Like ptosis and eyelid disorders, abnormal ocular movements in thyroid-associated eye diseases may be consequential to abnormalities at different levels of the nervous system. Apart from myasthenia gravis described under eyefid disorders, the association of exophthalmos with ophthalmoplegia in hypothyroidism has been described. Elevated titers of thyroid antibodies suggest a possible role of autoimmunity (Brownlie et ai, 1975), but concurrent mechanical factors related to exophthalmos cannot be entirely excluded. Hence, the neurological level of involvement remains uncertain. 

Some diseases, including dermatosclerosis, dermatomyositis, systemic lupus ery-thematosis, psoriasis, and myasthenia gravis, etc. may be the result of a disorder of immune responses. The Ganoderma lucidum spore extract showed inhibiting effects on DHT, decreased the primary antibody response in mice and also, in a dose related manner, suppression of murine splenocytes or human tonsil mononuclear cell proliferation in vitro. It inhibited a mixed lymphocyte reaction and decreased the IL-2 level. These results indicate that the inhibitory actions on both the cellular and humoral immunity might explain the use of this drug for the treatment of autoimmune disorders [52]. 

Although the clinical manifestations of Goodpasture s syndrome are usually limited to the lungs and kidneys, cerebral vasculitis occasionally associated with seizures has been described (66-68). Other autoimmune disorders that have been associated with anti-GBMAs include myasthenia gravis (69), primary bihary cirrhosis (70), polyartaltis nodosa (71), cardiac disease (72), and epidermolysis buUosa acquisita (72). 

Association with other autoimmune disorders and autoantibodies in frequencies analogous to the one seen in other autoimmune disorders (i.e. Myasthenia gravis, Lampert-Eaton myasthenic syndrome MG, LEMS). 

The classic clinical and histological phenotype of s-lBM, with prominent endomysial inflammation, has been seen in other family members of the same generation [12]. This association, which we have called "familial inflammatory IBM," is analogous to the familiar occurrence of other autoimmune disorders, such as myasthenia gravis, rheumatoid... 

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