Myasthenia Gravis With Acetylcholine Receptor Antibodies in the Very Old: Treatment Challenges and Diagnostic Pitfalls - PubMed

9 hours ago

Myasthenia Gravis (MG) with acetylcholine receptor (AChR) antibodies presents unique challenges in the very old, with increasing incidence and prevalence.
Diagnostic delays are common in very late onset MG, often due to comorbidities leading to misdiagnosis.
AChR antibodies have high diagnostic specificity (~100%) and sensitivity (~80%) in elderly patients.
Very late onset MG is often mild but can debut with life-threatening respiratory insufficiency in 20% of cases.
Treatment includes pyridostigmine, first-line immunosuppressive therapy, and newer treatments like rituximab, complement inhibitors, and FcRn blockers.
MG in the very old is a fluctuating disease requiring frequent adjustments in drug therapy.
Active treatment should aim for pharmacological remission or minimal manifestations, including symptomatic drugs, immunosuppressants, physical activity, and general support.

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