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Lifestyle factors and gender-related differences in clinical subgroups of Myasthenia Gravis in southern Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
(English)In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377Article in journal (Refereed) Submitted
Abstract [en]

Background: Based on the need for further regional and global epidemiological knowledge on Myasthenia Gravis (MG) and MG subgroups, we conducted a questionnaire-based epidemiological survey in a medium-sized health care region in southern Sweden. The primary aims were to investigate disease-specific items and lifestyle related factors between MG subgroups and matched population controls.

Methods: All MG patients (n=70) in Jönköping County were invited to participate in a survey, using a standardized disease-specific questionnaire, previously developed by an expert group. This questionnaire contains three parts, including demographic and disease-specific data, lifestyle and health-related aspects as well as co-morbidity and mental fatigue. The patients were clinically evaluated. Four hundred age- and gender matched randomly selected population controls excluding MG were invited to answer the non-disease-specific part of the questionnaire. Statistical tests included student t-test (for parametric data) or Mann–Whitney U test (for nonparametric data) and Chi-square test and Fisher’s exact test for evaluations between MG subgroups. In the case-control analysis conditional logistic regression was used to estimate the adjusted Odds Ratios.

Results: Forty of the 70 identified MG patients and 188 of the 400 age-and gender matched population controls participated in the study (response rate 57.1%). In the late onset MG (LOMG; N=18) subgroup, the male predominance was higher than previously reported. In the early onset MG (EOMG; N=17) group, time to diagnosis was longer and bulbar weakness was the dominant symptom (65%). EOMG patients had higher fatigue compared to LOMG. Compared to their matched population controls, LOMG patients were obese more often, ate ess fish, smoked more, had a lower educational level and were employed as manual laborers more often. Mental health problems and sickness benefits were more common among MG patients than in controls and MG patients were less regularly doing focused physical activity.

Conclusions: These findings highlight lifestyle and gender related differences between the EOMG and LOMG subgroups and between MG patients and population controls. Importantly, these lifestyle issues such as cardiovascular risk factors and physical inactivity, as well as mental health problems should be addressed intensively in the clinical follow-up of MG patients.

Keywords [en]
Myasthenia Gravis, late onset MG, early onset MG, lifestyle, fatigue
National Category
Neurology
Research subject
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-344665OAI: oai:DiVA.org:uu-344665DiVA, id: diva2:1188588
Funder
Swedish Research Council, VR-523-2014-2048Futurum - Academy for Health and Care, Jönköping County Council, Sweden, 488501Available from: 2018-03-08 Created: 2018-03-08 Last updated: 2018-03-08
In thesis
1. Environmental Factors of Importance in Myasthenia Gravis: Emphasis on Physical Activity
Open this publication in new window or tab >>Environmental Factors of Importance in Myasthenia Gravis: Emphasis on Physical Activity
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Myasthenia Gravis (MG) is an autoimmune disease caused by antibodies directed against proteins at the neuromuscular junction (NMJ). The disturbed neuromuscular transmission induces fatigable weakness in skeletal muscles. The severity of MG ranges from purely ocular symptoms to extensive weakness with, at worst, respiratory failure and need of intensive care. Due to different pathogenic antibodies, as well as varying phenotypes there is a classification into MG subgroups.

As lifestyle disorders are common conditions they occur also in MG patients. It is unknown whether there are any lifestyle factors associated with MG or MG subgroups. However, medication side effects and disability due to disease could contribute to higher risks for lifestyle related diseases. General treatment guidelines are not suitable to MG patients, since various medications are known to affect the disease negatively and as the tolerance and effects of physical activity in MG is unknown.

In this thesis the occurrence of lifestyle related environmental factors in MG patients were investigated. MG epidemiology, subgroup differences and the presence of lifestyle related risks in MG patients were evaluated in Jönköping county in Southern Sweden. The findings were compared to a similar evaluation in a region of Estonia. We found that MG patients in the late-onset disease subgroup had a more disadvantageous pattern of life-style related risk factors, with a higher rate of obesity, smoking and physical inactivity and a lower rate of fish consumption in comparison to matched population controls. Furthermore, we found that despite comparable clinical muscle fatigue status, Estonian MG patients subjectively scored fatigue and disease severity higher than Swedish MG patients. More Estonian patients were physically inactive. The tolerance and effects of physical exercise was further evaluated in two intervention studies, where MG patients with stable disease performed a 12-week-training-program according to general exercise recommendations to healthy adults. We found that physical exercise was well tolerated by the MG patients and that they had a beneficial skeletal muscle response to physical exercise.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 75
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1439
Keywords
Myasthenia Gravis, MG subgroups, Environmental factors, Lifestyle, Physical activity, Exercise
National Category
Neurology
Research subject
Clinical Neurophysiology
Identifiers
urn:nbn:se:uu:diva-344667 (URN)978-91-513-0262-1 (ISBN)
Public defence
2018-04-27, Gunnesalen, Psykiatrins hus, Akademiska sjukhuset, ingång 10, Uppsala, 09:00 (English)
Opponent
Supervisors
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenSwedish Research Council
Note

Ytterligare forskningsfinansiärer: Neuroförbundet, Palle Ferbs minnesfond samt Erik, Karin och Gösta Selanders stiftelse

Available from: 2018-04-05 Created: 2018-03-08 Last updated: 2018-04-24

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Westerberg, ElisabetLandtblom, Anne-MarieRostedt Punga, Anna

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