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Myasthenia Gravis for a Nursing Program

Myasthenia gravis (MG) is a known autoimmune disease of the neuromuscular junction. It results in fluctuating muscle weakness and general fatigue or state of tiredness of the voluntary muscles (Joensen, 2014). This essay presents a review of two articles on Myasthenia Gravis, Myasthenia gravis incidence in a general North Atlantic isolated population  by Joensen (2014) and  Diurnal and day-to-day variation of isometric muscle strength in myasthenia gravis by Vinge, Jakobsen, Pedersen and Andersen (2016). The goal is to gain knowledge and improve understanding on myasthenia gravis.

MG is one of the autoimmune diseases. Both articles by Joensen (2014) and Vinge et al., (2016), state that MG is characterized by general fatigue of the voluntary muscles and fluctuating muscle weakness as a result of impaired neuromuscular transmission. Consequently, MG patients are projected to experience a gradual decrease of muscle strength throughout the day due to physical activities (Vinge et al., 2016). However, Vinge and colleagues (2016), through an isometric muscle strength analysis of the knee, shoulder, and ankle concluded that muscle strength decreases gradually both diurnally or day-to-day in both MG patients and controls. Besides, there are no significant differences in terms of decreasing muscle strength with physical activity in both MG patients and controls. Isometric muscle performance and variation of muscle strength does not depend in the time of the day (Vinge et al., 2016).It implies that variation in muscle weakness is not automatically greater among the MG patients compared with controls. Future research studies should aim to study and compare decreasing muscle strength given various demographic parameters such as sex, age, ethnicity, socioeconomic status, and race.

In most cases (85% of cases), MG is associated with a build-up of serum antibodies which inhibit the acetylcholine receptors of the muscle at the post-synaptic neuromuscular junction. In some few patients, however, MG is associated with production of antibodies that inhibit muscle-specific receptors, tyrosine kinase (Joensen, 2014). Prescription of the anticholinesterase is beneficial for treating MG symptoms in almost all MG patients (Joensen, 2014). A population wide screening program accompanied by population education is necessary to boost diagnosis as gain more reliable incidence and prevalence of disease in a given county. This way opens the door for early diagnosis and improved treatment outcomes for the general population.

The incidence of MG in North America and Europe places the incidence of MG at 6.5 per million person year, for pooled incidences.  The incidence of MG in Norway, Spain, Italy, and London, UK is between 20 and 30 per million person-years compared with 24.9 in Taiwan and 21.0 in Australia based on the recent studies. Based on a survey that spanned from 1954 to 1963, the incidence of MG in North Atlantic was 4.1 per million person-years. By comparing the time before and after 1976, the incidences of MG in North America and Europe have doubled (Joensen, 2014).  The incidence of the disease should also be performed in other parts of the world that are somehow being neglected by researcher such Africa, South American and Asia. A global perspective of a given area allows international organizations and agencies such as the World Health Organization (WHO) to identify parts of the world that requires special focus and better distribution of limited resources to control, treat or manage disorders such as MG.

The incidence of onset of MG in the Faroe Islands, between 1986 and 2013 was 9.4 per million person-years. The incidences of MG in Faroe Islands seem to be generally lower compared to incidence of the disease in Europe, North America, Italy, London, UK; and Spain (Joensen, 2014). MG patients may present with a generalized MG, pure ocular disease, bulbar, proximal limb muscles, and/or restricted to bulbo-facial muscles. Sex ratio incidence was 2:1 (females/males) (Joensen, 2014). Fatigue and muscle weakness are considered as the MG cardinal symptoms (Vinge et al., 2016). The condition seems to affect key voluntary muscles in the body. Besides, MG seems greater among females than in males, but further studies are required in order to support this argument.

            MG is an autoimmune disease characterized by fatigue and general muscle weakness. However, decreasing muscle strength with physical activity is not significantly greater among MG patients compared with controls. In addition, fatigue and muscle strength is not determined by the time of the day. In most cases, it is caused by the production of antibodies against the acetyl choline receptors. The disease incidence seems to affect females far greater than in males.