The association of systemic lupus erythematosus and myasthenia gravis: a series of 17 cases, with a special focus on hydroxychloroquine use and a review of the literature

被引：64

作者：

Jallouli, M. ^{[1
]}

Saadoun, D. ^{[1
]}

Eymard, B. ^{[2
]}

Leroux, G. ^{[1
]}

Haroche, J. ^{[1
]}

Huong, D. Le Thi ^{[1
]}

De Gennes, C. ^{[1
]}

Chapelon, C. ^{[1
]}

Benveniste, O. ^{[3
]}

Wechsler, B. ^{[1
]}

Cacoub, P. ^{[1
]}

Amoura, Z. ^{[1
]}

Piette, J. C. ^{[1
]}

Costedoat-Chalumeau, N. ^{[1
]}

机构：

[1] Univ Paris 06, Serv Med Interne, Ctr Reference Natl Lupus Syst & Syndrome Antiphos, CHU Pitie Salpetriere,AP HP, F-75651 Paris 13, France

[2] Univ Paris 06, Serv Neurol, AP HP, F-75651 Paris 13, France

[3] Univ Paris 06, Serv Med Interne 1, CHU Pitie Salpetriere, AP HP, F-75651 Paris 13, France

来源：

JOURNAL OF NEUROLOGY | 2012年 / 259卷 / 07期

关键词：

Systemic lupus erythematosus; Myasthenia gravis; Hydroxychloroquine; Antiphospholipid; Thymectomy; RECEPTOR ANTIBODIES; AUTOIMMUNE-DISEASES; BLOOD-LYMPHOCYTES; SJOGRENS-SYNDROME; CHEMOKINE CXCL13; FAS EXPRESSION; PRONE MICE; T-CELLS; THYMECTOMY; PATIENT;

D O I：

10.1007/s00415-011-6335-z

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

The coexistence of systemic lupus erythematosus (SLE) and myasthenia gravis (MG) is rarely reported, and most of the published studies are case reports. Hydroxychloroquine, an antimalarial agent, is an essential treatment in patients with SLE but special caution is recommended when used in MG patients. We retrospectively analyzed the clinical features, laboratory findings, and outcome of 17 patients with both diseases with a special focus regarding hydroxychloroquine use and with a review of the literature. All patients were women. The mean age at MG onset and SLE diagnosis was 34.5 [14-64] and 37.8 [18-72] years, respectively. The presenting symptoms of MG were limb weakness (94%), ocular (88%) and bulbar involvement (53%). Autoantibodies against the acetylcholine receptor were positive in 94% of cases. The main manifestations of SLE included arthritis (88%), cytopenias (53%) and skin rash (41%). Treatment of SLE required hydroxychloroquine (94%), steroids (47%) and immunosuppressive drugs (18%). Among eight patients (47%) who developed MG after initiation of hydroxychloroquine, the question of induction of MG by hydroxychloroquine was raised in one patient. On the other hand, an exacerbation of myasthenic symptoms was only seen in one of the eight patients who received hydroxychloroquine after the diagnosis of MG. Including our cases, we reviewed a total of 70 patients with SLE and MG. Compared with a large series of 1,000 unselected SLE patients, those with associated MG were older, had lower incidence of cutaneous, renal, and neurological manifestations, and higher frequency of anticardiolipin antibodies and lupus anticoagulant. In conclusion, the clinical pattern of patients with SLE and MG seems to be characterized by a less severe course of SLE and higher frequency of antiphospholipid antibodies. Hydroxychloroquine treatment appears to be safe in this setting.

引用

页码：1290 / 1297

页数：8

共 71 条

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