Download PDF
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.
› Further Information
Also available at
   Permissions and Reprints

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/)

Thieme Revinter Publicações Ltda.
Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil

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
 

  • References

  • 1 Sardu C, Cocco E, Mereu A, Massa R, Cuccu A, Marrosu MG, Contu P. Population based study of 12 autoimmune diseases in Sardinia, Italy: prevalence and comorbidity. PLoS One 2012; 7 (03) e32487
    CrossrefPubMedSearch in Google Scholar
  • 2 Gilhus NE. Myasthenia Gravis. N Engl J Med 2016; 375 (26) 2570-2581
    CrossrefPubMedSearch in Google Scholar
  • 3 Fang F, Sveinsson O, Thormar G, Granqvist M, Askling J, Lundberg IE. et al. The autoimmune spectrum of myasthenia gravis: a Swedish population-based study. J Intern Med 2015; 277 (05) 594-604
    CrossrefPubMedSearch in Google Scholar
  • 4 Galbraith RF, Summerskill WH, Murray J. Systemic lupus erythematosus, cirrhosis and ulcerative colitis after thymectomy for myasthenia gravis. N Engl J Med 1964; 270: 229-231
    CrossrefPubMedSearch in Google Scholar
  • 5 Lossos A, River Y, Eliakim A, Steiner I. Neurologic aspects of inflammatory bowel disease. Neurology 1995; 45 (3 Pt 1): 416-421
    CrossrefPubMedSearch in Google Scholar
  • 6 Gondim FdA, Oliveira GRd, Teles BC, Souza MH, Braga LL, Messias EL. A case-control study of the prevalence of neurological diseases in inflammatory bowel disease (IBD). Arq. Neuro-Psiquiatr. 2015; 73 (02) 119-124  × 20140223
    CrossrefSearch in Google Scholar
  • 7 Gondim FdA, Oliveira GRd, Araújo DF, Souza MH, Braga LL, Thomas FP. Two patients with co-morbid myasthenia gravis in a Brazilian cohort of inflammatory bowel disease. Neuromuscul Disord 2014; 24 (11) 999-1002
    CrossrefPubMedSearch in Google Scholar
  • 8 Gondim FdA, Araújo DF, Oliveira IS, Vale OC. Small fiber dysfunction in patients with Wilson's disease. Arq. Neuro-Psiquiatr. 2014; 72 (08) 592-595  × 20140090
    CrossrefSearch in Google Scholar
  • 9 Angelucci E, Cesarini M, Vernia P. Successful resolution of pneumonia developed in a patient affected by Crohn's disease, rheumatoid arthritis, myasthenia gravis and recurrent uveitis during concomitant treatment with tumour necrosis factor alpha inhibitors and conventional immunosuppressive drugs. Rheumatol Int 2010; 30 (07) 977-978
    CrossrefPubMedSearch in Google Scholar
  • 10 Finnie IA, Shields R, Sutton R, Donnelly R, Morris AI. Crohn's disease and myasthenia gravis: a possible role for thymectomy. Gut 1994; 35 (02) 278-279
    CrossrefPubMedSearch in Google Scholar
  • 11 Manfredi R, Fasulo G, Fulgaro C, Sabbatani S. Associated thyreoiditis, myasthenia gravis, thymectomy, Chron's disease, and erythema nodosum: pathogenetic and clinical correlations, immune system involvement, and systemic infectious complications. Rheumatol Int 2008; 28 (11) 1173-1175
    CrossrefPubMedSearch in Google Scholar
  • 12 Martin RW, Shah A. Myasthenia gravis coexistent with Crohn's disease. J Clin Gastroenterol 1991; 13 (01) 112-113
    PubMedSearch in Google Scholar
  • 13 Murphree J, Mulherin DW, Morton C, Adams D. High-dose vitamin C therapy for symptomatic deficiency in a patient with myasthenia gravis and Crohn's disease. Nutr Clin Pract 2022; 37 (05) 1242-1245
    CrossrefPubMedSearch in Google Scholar
  • 14 Kumar S, Sultania M, Vatsal S, Sharma MC. Primary Ectopic Mediastinal Goiter in a Patient With Crohn's Disease Presenting as Myasthenia Gravis. Ann Thorac Surg 2015; 100 (06) 2333-2336
    CrossrefPubMedSearch in Google Scholar
  • 15 Garg R, Hasija N. Thymectomy in a patient with myasthenia gravis and Crohn's disease – Anaesthetic Challenges. J Anesth Clin Care 2015; 2 (01) 1-3 10.24966/ACC-8879/100007
    Search in Google Scholar
  • 16 Cojocaru IM, Cojocaru M, Tănăsescu R, Burcin C, Atanasiu AN, Mitu AC. et al. Some clinico-immunological aspects in patients with ocular myasthenia gravis associated with inflammatory bowel disease. Rom J Intern Med 2008; 46 (02) 165-168
    PubMedSearch in Google Scholar
  • 17 Takechi K, Mihara M, Saito Y, Yamada T, Moriwaki H, Muto Y. et al. A case of inflammatory bowel disease accompanied by myasthenia gravis. Dig Endosc 1993; 5 (01) 102-106
    CrossrefSearch in Google Scholar
  • 18 Foroozan R, Sambursky R. Ocular myasthenia gravis and inflammatory bowel disease: a case report and literature review. Br J Ophthalmol 2003; 87 (09) 1186-1187
    CrossrefPubMedSearch in Google Scholar
  • 19 Gower-Rousseau C, Reumaux D, Bellard M, Delecourt L, Ribet M, Colombel JF. Remission of myasthenia gravis after proctocolectomy in a patient with ulcerative colitis. Am J Gastroenterol 1993; 88 (07) 1136-1138
    PubMedSearch in Google Scholar
  • 20 Hertervig E, Nilsson A. [Myasthenia gravis in patients with ulcerative colitis–an overlooked autoimmune association?]. Lakartidningen 1992; 89 (36) 2860-2862
    PubMedSearch in Google Scholar
  • 21 Koc F, Yerdelen DY. Rare association of myasthenia gravis and ulcerative colitis. Neurosciences (Riyadh) 2009; 14 (04) 382-383
    PubMedSearch in Google Scholar
  • 22 McCann P, Pramanik A. Dysphagia and unexpected myasthenia gravis associated with primary biliary cirrhosis, ulcerative colitis and vitiligo. J Am Geriatr Soc 2004; 52 (08) 1407-1408
    CrossrefPubMedSearch in Google Scholar
  • 23 Miller TN. Myasthenia gravis, ulcerative colitis and lichen planus. Proc R Soc Med 1971; 64 (08) 807-808
    PubMedSearch in Google Scholar
  • 24 Setti-Carraro P, Ritchie JK, Wilkinson KH, Nicholls RJ, Hawley PR. The first 10 years' experience of restorative proctocolectomy for ulcerative colitis. Gut 1994; 35 (08) 1070-1075
    CrossrefPubMedSearch in Google Scholar
  • 25 Tan RS. Ulcerative colitis, myasthenia gravis, atypical lichen planus, alopecia areata, vitiligo. Proc R Soc Med 1974; 67 (03) 195-196
    PubMedSearch in Google Scholar
  • 26 Sanghi P, Bremner F. An unusual presentation of thymoma: dysgeusia, ulcerative colitis, keratoconjunctivitis sicca, autoimmune retinopathy and myasthenia gravis. BMJ Case Rep 2022; 15 (01) e246861
    CrossrefPubMedSearch in Google Scholar
  • 27 Yagi N, Watanabe T, Ikeda Y, Fukushima N. Successful bridge to recovery in a patient with fulminant giant cell myocarditis that developed from multiple autoimmune disorders including myasthenia gravis: a case report. Eur Heart J Case Rep 2022; 6 (02) ytac046
    CrossrefPubMedSearch in Google Scholar
  • 28 Guinet-Charpentier C, Bilbault C, Kennel A, Perrier P, Peyrin-Biroulet L, Morali A. Unusual association of myasthenia gravis and ulcerative colitis in a 14-year-old boy. Arch Pediatr 2015; 22 (01) 81-83
    CrossrefPubMedSearch in Google Scholar
  • 29 Evoli A, Caliandro P, Iorio R, Alboini PE, Damato V, LaTorre G. et al. Poly-autoimmunity in patients with myasthenia gravis: A single-center experience. Autoimmunity 2015; 48 (06) 412-417
    CrossrefPubMedSearch in Google Scholar
  • 30 Harris L, Graham S, MacLachlan S, Exuzides A, Jacob S. A retrospective longitudinal cohort study of the clinical burden in myasthenia gravis. BMC Neurol 2022; 22 (01) 172
    CrossrefPubMedSearch in Google Scholar
  • 31 Ruiter AM, Strijbos E, Meel RHPd, Lipka AF, Raadsheer WF, Tannemaat MR, Verschuuren JJGM. Accuracy of patient-reported data for an online patient registry of autoimmune myasthenia gravis and Lambert-Eaton myasthenic syndrome. Neuromuscul Disord 2021; 31 (07) 622-632
    CrossrefPubMedSearch in Google Scholar
  • 32 Ramanujam R, Piehl F, Pirskanen R, Gregersen PK, Hammarström L. Concomitant autoimmunity in myasthenia gravis--lack of association with IgA deficiency. J Neuroimmunol 2011; 236 (1-2): 118-122
    CrossrefPubMedSearch in Google Scholar
  • 33 Blum S, Lee D, Gillis D, McEniery DF, Reddel S, McCombe P. Clinical features and impact of myasthenia gravis disease in Australian patients. J Clin Neurosci 2015; 22 (07) 1164-1169
    CrossrefPubMedSearch in Google Scholar
  • 34 Allen JA, Scala S, Jones HR. Ocular myasthenia gravis in a senior population: diagnosis, therapy, and prognosis. Muscle Nerve 2010; 41 (03) 379-384
    CrossrefPubMedSearch in Google Scholar
  • 35 Bixio R, Bertelle D, Pistillo F, Pedrollo E, Carletto A, Rossini M, Viapiana O. Rheumatoid arthritis and myasthenia gravis: a case-based review of the therapeutic options. Clin Rheumatol 2022; 41 (04) 1247-1254
    CrossrefPubMedSearch in Google Scholar
  • 36 Raut S, Reddy I, Sahi FM, Masood A, Malik BH. Association Between Systemic Lupus Erythematosus and Myasthenia Gravis: Coincidence or Sequelae?. Cureus 2020; 12 (06) e8422 Published Jun 3 .
    CrossrefPubMedSearch in Google Scholar
  • 37 Evoli A, Meacci E. An update on thymectomy in myasthenia gravis. Expert Rev Neurother 2019; 19 (09) 823-833
    CrossrefPubMedSearch in Google Scholar
  • 38 Günther C, Rothhammer V, Karow M, Neurath M, Winner B. The Gut-Brain Axis in Inflammatory Bowel Disease-Current and Future Perspectives. Int J Mol Sci 2021; 22 (16) 8870
    CrossrefPubMedSearch in Google Scholar
  • 39 Massironi S, Fanetti I, Viganò C, Pirola L, Fichera M, Cristoferi L. et al. Systematic review-pancreatic involvement in inflammatory bowel disease. Aliment Pharmacol Ther 2022; 55 (12) 1478-1491
    CrossrefPubMedSearch in Google Scholar
  • 40 Polilli E, Frattari A, Esposito JE, Angelini G, Di Risio A, Mazzotta E. et al. SOX-1 antibodies in a patient with Crohn's disease: a case report. BMC Neurol 2022; 22 (01) 404
    CrossrefPubMedSearch in Google Scholar