ABSTRACT
Myasthenia gravis (MG) is a rare and treatable antibody-mediated autoimmune disease. Pseudo internuclear ophthalmoplegia (-INO) or pyramidal tract damage is rarely observed in MG, and there were no known cases of MG with both pseudo-INO and pyramidal tract damage. Here, we report a case of a 61-year-old female suffering from MG accompanied by pseudo-INO and pyramidal tract damage with a rapid progressive course. Her blood and cerebrospinal fluid (CSF) tests were normal, except for the presence of the anti-acetylcholine receptor antibody. CT and contrast enhancement of the chest showed a thymic involution. MRI and contrast enhancement images of the brain and whole spine were normal. Both the clinical response to the administration of neostigmine and the repetitive nerve stimulation test were positive. The motor evoked potentials at lower limb recordings were normal. According to her signs, symptoms, decrementing response on repetitive stimulation test, elevated anti-acetylcholine receptor antibody and positive response to neostigmine, the patient was diagnosed as having MG. After treatment with pyridostigmine, intravenous immunoglobulin, prednisone acetate tablets and methotrexate, all her symptoms disappeared, including pseudo-INO and pyramidal tract damage. To our best knowledge, this is the first report of a case of MG with both pseudo-INO and pyramidal tract damage. Based on our case and a review of the literature, we propose that pyramidal tract damage and pseudo-INO can be two signs of MG, and that MG can cause damage to other systems besides neuromuscular junctions.
ABSTRACT
OBJECTIVE: To study the efficacy and safety of Chinese drugs for expelling evil-wind, removing dampness, promoting blood circulation and invigorating yin in treating active rheumatoid arthritis (RA). METHODS: Sixty-seven patients with active RA were randomized into 3 groups, the Group A, B and C. They were made coequal in terms of age, sex and condition of disease and treated respectively with basic treatment (non-steroid anti-inflammation drug combined with immune inhibitor) only, basic treatment + small dose prednisone, and basic treatment + Chinese herbal medicine, all for 8 weeks. The efficacy and adverse effects of treatment were analyzed by scoring. RESULTS: The total effective rate was 20.0% (4/20) in Group A, 810% (17/21) in Group B and 85.7% (18/21) in Group C, the latter two were superior to the former one (P <0.01). Before treatment, comparison of disease activity score (DAS) among the three groups showed no significant difference (P > 0.05). After treatment, improvements of Ritchie arthritis index (RAI), number of swollen joint, erythrocyte sedimentation rate (ESR), general health (GH), and DAS were shown in Group B and C (P <0.05), while in Group A, improvement was only shown in GH (P <0.05). The difference of DAS between pre- and post-treatment was 0.25 +/- 0.77 in Group A, 0.87 +/- 0.60 in Group B and 0.92 +/- 0.59 in Group C, showing statistical significance between Group A vs B and A vs C (P = 0.0000). The total accumulative score of adverse reaction was 3.76 +/- 2.72 in Group C, 9.10 +/- 6.01 in Group A and 14.38 +/- 9.36 in Group B, also showing statistical significance among groups (P < 0.05). CONCLUSION: The combination of Chinese and Western medicine for active RA is effective and safe.
