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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(04): s00451807717
DOI: 10.1055/s-0045-1807717
Original Article

The prevalence of myasthenia gravis is increased in inflammatory bowel disease

Antônio Miguel Furtado Leitão 
1   Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Morfologia, Fortaleza CE, Brazil.
,
Florian P. Thomas 
2   Hackensack University Medical Center, Hackensack Meridian School of Medicine, Department of Neurology, Hackensack NJ, United States.
,
Marcellus Henrique Loiola Ponte de Souza 
3   Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Serviço de Gastroenterologia, Fortaleza CE, Brazil.
,
Lúcia Libanez Bessa Campelo Braga 
3   Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Serviço de Gastroenterologia, Fortaleza CE, Brazil.
,
Francisco de Assis Aquino Gondim 
4   Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Serviço de Neurologia, Fortaleza CE, Brazil.
› Author Affiliations
Funding The authors declare that the present study was funded Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), and Universidade Federal do Ceará.
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Abstract

Background

Comorbid autoimmune disorders affect approximately 0.2% of the population. A second autoimmune disease occurs in up to 15% of myasthenia gravis (MG) patients.

Objective

To evaluate the association between MG and inflammatory bowel disease (IBD).

Methods

We conducted a cross-sectional study involving a Brazilian cohort of IBD patients and a literature review.

Results

In 2022, we found 1 MG patient with ulcerative colitis and 3 with Crohn's disease out of 606 IBD patients (0.66% prevalence). The patient with UC and MG died in April 2024. The mean IBD onset age was 33.5 ± 2.7; patients were 45.8 ± 7.3-years-old at evaluation. Further, 2 patients were acetylcholine receptor antibody positive, 1 was anti-muscle specific kinase positive, and 1 seronegative. Also, 3 had abnormal repetitive nerve stimulation, all had normal nerve conduction studies, abnormal skin wrinkling test, and mild small fiber neuropathy. None had thymoma and/or underwent thymectomy. According to the MG Foundation's classification, one was class V, one IVb, and two IIa. The MG diagnosis was masked by immunotherapy in all. The prevalence ratio of MG in IBD patients versus the proportion of MG among all patients in our center was 8.56 (p < 0.0001, CI = 3.1–23.5). Considering the lowest and highest prevalence of this condition reported in the literature, the ratio is 44.0 (p < 0.0001, CI: 16.3–118.4) and 26.4 (p < 0.0001, CI: 9.8–70.6), respectively.

Conclusion

The prevalence of MG is higher in IBD, may include muscle specific kinase positive disease (first report in the literature) and frequently overlaps with other autoimmune conditions and small fiber neuropathy.

Keywords

Crohn Disease - Inflammatory Bowel Diseases - Myasthenia Gravis - Colitis, Ulcerative

Authors' Contributions

AMFL: conceptualization, data curation, formal analysis, investigation, methodology, supervision, validation, writing – original draft, and writing – review & editing; FT: conceptualization, formal analysis, methodology, validation, writing – original draft, and writing – review & editing; MHLPS, LLBCB: formal analysis, investigation, methodology, writing – original draft, and writing – review & editing; FAAG: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, writing – original draft, and writing – review & editing.


Editor-in-Chief: Hélio A. G. Teive.


Associate Editor: Paulo José Lorenzoni.




Publication History

Received: 27 March 2024

Accepted: 06 February 2025

Article published online:
13 May 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Antônio Miguel Furtado Leitão, Florian P. Thomas, Marcellus Henrique Loiola Ponte de Souza, Lúcia Libanez Bessa Campelo Braga, Francisco de Assis Aquino Gondim. The prevalence of myasthenia gravis is increased in inflammatory bowel disease. Arq Neuropsiquiatr 2025; 83: s00451807717.
DOI: 10.1055/s-0045-1807717