A tri-modal distribution of age-of-onset in female patients with myasthenia gravis is associated with the gender-related clinical differences

Ali Asmail, Anat Kesler, Hadar Kolb, Vivian E. Drory, Arnon Karni

Research output: Contribution to journalArticlepeer-review

Abstract

Background: A tri-modal distribution of age-at-onset emerged among females patients with myasthenia gravis (MG) in our database. This finding may be indicative of different gender-based disease mechanisms. Methods: We retrospectively reviewed the files of 127 MG patients for the clinical, serology and thymus pathology according to their age at disease onset: ≤40 years (early-onset, EOMG), 40–70 years (intermediate-onset, IOMG) and >70 years (late-onset, LOMG). Results: EOMG was more common among females, and IOMG was more common among males. Ocular MG was more common among the male MG patients with an IOMG. Patients with EOMG had lower rates of positive anti-acetylcholine receptor (anti-AChR). IOMG females, but not IOMG males, had lower rates of positive anti-AChR. IOMG and EOMG females had high rates of thymic hyperplasia, while EOMG males had high rates of thymoma. Comorbidity with autoimmune diseases was common among females with IOMG and LOMG. Conclusions: The prevalence of IOMG was the reason for the trend reversal of MG prevalence between genders. The clinical features of patients with IOMG differed between genders in the rates of positive anti-AChR, follicular hyperplasia of the thymus and comorbidity with autoimmune diseases. This may suggest a different gender-based mechanism of immune intolerance towards AChR and other antigens.

Original languageEnglish
Pages (from-to)313-319
Number of pages7
JournalInternational Journal of Neuroscience
Volume129
Issue number4
DOIs
StatePublished - 3 Apr 2019

Keywords

  • Myasthenia gravis
  • age of onset
  • gender

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