EXPLORE UNCONTROLLED DISEASE OVER THE YEARS

  • MICHELLE
  • BILL

MICHELLE

44-year-old married mother of 3 children; works as a nurse

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

2017

2018

2019

2020

Clinical assessments / findings
Presenting symptoms upon referral to neurology

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 IlIa)
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

AChR-Ab+=acetylcholine receptor antibody-positive; BID=two times a day; FVC=Forced Vital Capacity; MG-ADL=Myasthenia Gravis Activities of Daily Living; MGFA=Myasthenia Gravis Foundation of America; MIP=Maximal Inspiratory Pressure; MMT3=Manual Muscle Testing Grade 3; QD=once a day; TID=three times a day.

WOULD YOU LIKE TO KEEP THE PATIENT CASE STUDIES ON HAND?

 

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WHAT’S YOUR MONITORING 
APPROACH?

Keep these questions in mind during your next conversation with a patient with gMG:

  • How are you currently assessing your gMG patients?
    Are you using the MG-ADL questionnaire or other assessment measures?
  • Do your patients keep track of their condition between visits?
    How do you advise they keep track?
  • Are your patients sharing the full burden of their disease?
    Do you discuss changes in their personal and/or professional lives?
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