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EVALUATING IF YOUR PATIENT’S gMG IS UNDER CONTROL
The following hypothetical case studies show how consistent MG-ADL score monitoring and patient symptom logging may help identify characteristics of uncontrolled generalized myasthenia gravis (gMG).
EXPLORE UNCONTROLLED DISEASE OVER THE YEARS IN AChR+ & MuSK+ PATIENTS
MICHELLE
BILL
MARIA
MICHELLE
44-year-old married mother of 3 children; works as a nurse
CALCULATING THE PERSONAL IMPACT OF UNCONTROLLED gMG
Patients with uncontrolled gMG experience unpredictable symptoms that impact daily life and lead to a loss of time. See the true impact of uncontrolled gMG.
10
DAYS IMPACTED EACH MONTH
Factors that contributed to Michelle’s lost time:
Progressive weakness upon exertion causing her to quit volunteering at the animal shelter
Ongoing exacerbations leading to taking time off work and inability to spend time with husband and 3 children
Myasthenic crisis: ED visit and hospitalization
1-2 missed workdays each month due to regular doctor visits
Poor sleep, fatigue, depression leading to missed social activities
Summary of medical history
MGFA Class IIIa at diagnosis (AChR-Ab+)
Multiple changes to drug therapy to manage gMG; currently managed with pyridostigmine (120 mg TID) and cyclosporine (5 mg/kg/day)
Other medical history: history of leukopenia and recurrent respiratory infections; comorbid for depression and anxiety managed with sertraline (50 mg QD)
Three factors to consider in this case
Consistently high MG-ADL scores
Debilitating symptoms that continually impact professional life and physical health
Ongoing exacerbations
BILL
56-year-old widowed father of 3 adult children; works in construction
CALCULATING THE PERSONAL IMPACT OF UNCONTROLLED gMG
Patients with uncontrolled gMG experience unpredictable symptoms that impact daily life and lead to a loss of time. See the true impact of uncontrolled gMG.
6
DAYS IMPACTED EACH MONTH
Factors that contributed to Bill's lost time:
Had to leave work early on several occasions due to extremity weakness
Difficulty getting on and off construction equipment
Difficulty doing construction work due to ongoing symptoms
Weakness in extremities
Routine visits to PCP and neurology leading to 1-2 days missed per month
Summary of medical history
gMG MGFA Class IIa (AChR-Ab+, diagnosed 5 years prior); managed with prednisone (5 mg QD) + mycophenolate mofetil (1500 mg BID)
Hypertension; managed with benazepril + amlodipine
Type 2 diabetes mellitus (DMII); managed with metformin + repaglinide
Three factors to consider in this case
Frequent therapy changes and escalation indicating patient’s gMG is poorly controlled
Debilitating symptoms that continually impact professional life and physical health
Ongoing challenges with comorbidity management
MARIA
38-year-old female of Mediterranean descent; works as a teacher
CALCULATING THE PERSONAL IMPACT OF UNCONTROLLED gMG
Patients with uncontrolled gMG experience unpredictable symptoms that impact daily life and lead to a loss of time. See the true impact of uncontrolled gMG.
13
DAYS IMPACTED EACH MONTH
Factors that contributed to Maria's lost time:
Ongoing moderate-to-severe disease led to a change to part-time role at work and missing time
Significant neck and respiratory weakness with intermittent GI symptoms
Significant trouble with chewing and slurred speech with moderate weakness in arms and legs
Severe restrictive pathology and difficulty swallowing leading to ED visit
Multiple hospitalizations over the past 2 years, with 3 admissions to the ICU
Summary of medical history
MGFA Class IIb at diagnosis in 2017 (MuSK-Ab+)
Multiple changes to drug therapy to manage refractory gMG
Comorbidities: GERD, managed with lanzoprazole; hypertension managed with metroprolol; dyslipidemia managed with atorvastatin
Three factors to consider in this case
Distinct clinical presentation and treatments for poorly controlled MuSK-Ab+ gMG
Debilitating symptoms that continually impact professional life and physical heath
Progressive limb weakness, fatigable bilateral ptosis, dysphagia, and exertional dyspnea
Recently quit volunteering at an animal shelter due to progressive weakness upon exertion
Diagnosis
gMG (MGFA Class IIIa) MG-ADL: 12
Laboratory / radiological findings
Findings
AChR-Ab+
Therapeutic management / changes
Initial management
Pyridostigmine (60 mg TID) and prednisone (10 mg QD)
Referred for surgical resection of the thymus gland via open thymectomy
Clinical assessments / findings
Neurology visit 1 month later
Mild improvements to symptoms, but patient still presents with limb weakness (MMT3 bilateral), dysphagia, and exertional dyspnea.
MG-ADL: 11
Therapeutic management / changes
Treatment change
Pyridostigmine titrated to maximum dose (120 mg TID); prednisone titrated to 30 mg QD
Thymectomy conducted
Clinical assessments / findings
PCP routine visit
General fatigue at work (floor nurse) required
Patient to transition to a stationary occupation
Patient reported feeling down and less social, related to increased weight (+3.6 kg since diagnosis)
MG-ADL: not recorded
Laboratory / radiological findings
DEXA scan conducted due to risk of osteoporosis under chronic high-dose prednisone therapy
(T-score: -2.4)
Therapeutic management / changes
Treatment change
Initiated azathioprine (50 mg QD, then titrated to BID) based on continuing symptoms; prednisone titrated down and discontinued due to risk of AEs (osteoporosis and weight gain present)
Clinical assessments / findings
Exacerbation
Patient presented to the ED due to worsening dysphagia, dyspnea, and cough, and was admitted to the hospital
Febrile (38.4 °C/101.1 °F)
MG-ADL: not recorded
Laboratory / radiological findings
Workup for suspected chest infection
Chest CT and microbial testing confirmed community-acquired pneumonia
Therapeutic management / changes
Treatment
IVIg + prednisone (60 mg IV QD) for management of impending myasthenic crisis (2 g/kg over 3 days); background therapy was maintained
Amoxicillin (1 g TID) + azithromycin (500 mg first day, then 250 mg daily) for community-acquired pneumonia
Clinical assessments / findings
Neurology visit
Patient noted she had recurrent lower respiratory tract infections that were treated empirically over 24 months; patient discussed recent anxiety and depressive thoughts. Patient also noted missing 1-2 days of work every month
MG-ADL: 9 MGFA Class IIIa
Laboratory / radiological findings
Findings
Leukopenia
Therapeutic management / changes
Treatment change
Transition from azathioprine to cyclosporine (2.5 mg/kg/ day titrated to 5 mg/kg/day) using an IVIg bridge, due to leukopenia and recurrent infections suspected to be related to azathioprine
Clinical assessments / findings
Psychiatry visit
Patient self-presented to a psychiatry clinic at the recommendation of her husband
Reported poor sleep, fatigue, depressive symptoms, and worry over managing her symptoms in the context of her busy life (managing 3 young teenagers, job change, and social activities). She also is strongly considering changing to a part-time job, which causes additional worry about loss of income
Therapeutic management / changes
Sertraline (50 mg QD) was indicated for depression and anxiety
Clinical assessments / findings
ED visit
Presented to the ED due to acute worsening dyspnea and productive cough
MG-ADL: not recorded
Laboratory / radiological findings
Findings
FVC: 59%
MIP: -32 mmHg
Therapeutic management / changes
Treatment
IVIg (1 g/kg over 2 days) for a myasthenic exacerbation + prednisone (60 mg IV QD) until resolution
Follow-up visit
Respiratory symptoms resolved; generalized extremity weakness still present
Continued stable cyclosporine regimen (5 mg/kg/day)
Added metformin for DMII and benazepril + amlodipine for hypertension
Clinical assessments / findings
Neurology referral following PCP visit
Went from sometimes, to always having to use arms when rising from a chair, over the last several months
Shortness of breath with exertion
MG-ADL: 11
Therapeutic management / changes
Treatment change
Mycophenolate mofetil (1500 mg QD) in 2016 as MG symptoms persisted and due to concern about prednisone-related AEs (DMII and hypertension)
Prednisone reduced to 5 mg QD
Clinical assessments / findings
Routine visits to PCP and neurology
Routine visits to PCP were generally unremarkable, although the patient routinely reported dyspnea and generalized fatigue when pressed for symptoms. Diplopia was infrequent, and the patient expressed little interest in frequent neurology visits for MG-related symptoms.
Laboratory / radiological findings
Findings (2017)
HbA1c: 9.0% Blood pressure: 135/80 mmHg
Therapeutic management / changes
Treatment change
Prednisone discontinued in 2017 due to difficulty managing DMII and hypertension; mycophenolate mofetil continued
Clinical assessments / findings
Neurology visit
Referred to neurology from PCP after complaint of recent dyspnea on exertion and progressive fatigue
QMG 11
Patient noted difficulty in doing construction work related to weakness in extremities
Patient reported recent weight gain (currently 33.2 kg) and foot pain while working
MG-ADL: not recorded
Laboratory / radiological findings
Mild pancytopenia
Blood glucose (fasting): 178 mg/dL HbA1c: 8.1%
Therapeutic management / changes
Treatment change
Follow-up visit to PCP added repaglinide (1 mg TID) to manage DMII
Negative inspiratory force improved from -24 to -46 after PLEX
Therapeutic management / changes
Treatment change
Admitted for 5 sessions of PLEX
After her second session, she was able to walk around in the hallways without BiPAP and discharged
Clinical assessments / findings
Patient experienced respiratory worsening and needed her BiPAP 3-4 hours during the day
MG-ADL: 15
Therapeutic management / changes
Treatment change
Readmitted for another 5 sessions of PLEX
Clinical assessments / findings
Patient has a history of extended sick leaves from work due to symptoms and multiple hospitalizations over the past 2 years, with 3 admissions to the ICU
MG-ADL: ranged from 8 to 18
Therapeutic management / changes
Cycles of IVIG and then PLEX rescue therapies have provided only transient relief
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=diffusing capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=diffusing capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=diffusing capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=diffusing capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=diffusing capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=diffusing capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=diffusing capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide; GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous; IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide;GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous;IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide;GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous;IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide;GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous;IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide;GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous;IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide;GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous;IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide;GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous;IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
Ab=antibody; AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; BiPAP=bilevel positive airway pressure device; BMI=body mass index; DMII=type 2 diabetes mellitus; FEV=forced expiratory volume; FVC=forced vital capacity; DLCO=di!using capacity of the lungs for carbon monoxide;GERD= gastroesophogeal acid reflux disease; GCS=glucocorticoids; GI=gastrointestinal; gMG=generalized myasthenia gravis; IV=intravenous;IVIG=intravenous immune globulin; MG-ADL=myasthenia gravis activities of daily living; MGFA=Myasthenia Gravis Foundation of America; MIP=maximum inspiratory pressure; MMT3=Manual Muscle Testing Grade 3; MuSK=muscle-specific tyrosine kinase; PLEX=plasma exchange; PO=oral administration; QAD=every other day dosing; QD=once-daily dosing; SFMEG=single fiber electromyography; TID=three times a day.
WOULD YOU LIKE TO KEEP THE PATIENT CASE STUDIES ON HAND?
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