Myasthenia gravis is a lifelong autoimmune condition. There isn’t a cure, but long-term treatment can help you live with few to no symptoms. Learn more about what remission is and how your doctor can help you get there.
What Is Remission in Myasthenia Gravis?
It generally means you don’t have any myasthenia gravis symptoms for a while, and your doctor can’t tell you have the disease when they test your muscles. But there are medical definitions for remission. You can read more about them by searching online for "Myasthenia Gravis Foundation of America Post-intervention Status (MGFA-PIS)."
When talking about remission and myasthenia gravis, your doctor may use terms such as:
Complete stable remission. Your doctor finds no evidence of disease activity or muscle weakness during a checkup, and you haven’t been on medical treatment for at least one year. This kind of remission is rare, but it’s possible.
Pharmacological remission. You don’t have myasthenia gravis symptoms, but you still need medication or some form of treatment to control your disease. Most people who get to remission fit into this category.
Minimal manifestations. Your disease is well-controlled, but you still have some muscle weakness and fatigue that comes and goes. But your symptoms aren’t so bad they stop you from daily activities. MM isn’t technically considered remission, but it’s a lot more common.
How Do You Get to Remission With Myasthenia Gravis?
When it comes to myasthenia gravis, there isn’t a single treatment that’s effective for everyone. You’ll need to work closely with your doctor to find the best fit for where you are in your disease course.
To fine-tune your myasthenia gravis treatment plan, your doctor will consider:
- The severity of your disease
- Where you have muscle weakness
- If other treatments haven’t worked
- Your age and other health conditions
- Your personal preference for treatment
- Possible side effects from short- or long-term treatment
- If you test positive for certain myasthenia gravis-related antibodies
Depending on your symptoms and health details, you may need one or more of the following:
Acetylcholinesterase inhibitors. These are muscle-strengthening drugs. Pyridostigmine is the most common one used to manage myasthenia gravis symptoms. It can ease weakness fast and may be all you need if your disease is mild. But anticholinesterase drugs don’t target the part of your immune system that triggers your symptoms in the first place. So it may not be enough to manage generalized myasthenia gravis.
Corticosteroids. Your doctor will likely give you steroids to quickly suppress your immune system when your disease is active. Drugs like prednisone can ease symptoms in a matter of days or weeks, but they aren’t used as a long-term treatment. That’s because they can cause health problems such as weight gain, bone thinning, diabetes, and other unwanted side effects.
Immunosuppressants. These drugs change how your immune system works but in a different way than steroids. You can safely take immunotherapy for years, but treatment can take about 6 to 12 months to work.
Examples of common immunotherapies for myasthenia gravis include:
- Azathioprine
- Cyclosporine
- Mycophenolate
- Tacrolimus
Monoclonal antibodies. These are drugs like eculizumab or rituximab. They mimic natural parts of the immune system. You get these treatments through a vein in your arm. Your doctor may suggest these drugs if you don’t respond to other therapies and test positive for anti-acetylcholine receptor (AChR) or anti-muscle specific kinase (MuSK) autoantibodies. But they’re not widely used.
Other intravenous therapies. Plasmapheresis (plasma exchange) filters harmful antibodies from your blood. With intravenous immunoglobulin (IVIg), you get an infusion of healthy antibodies from a donor. These treatments work fast (usually within 1 week), but the benefits don’t last long.
You may need plasma exchange or IVIg if you:
- Have life-threatening symptoms from an exacerbation or myasthenic crisis.
- Are going to have a thymectomy or other surgery.
- Need to control serious symptoms before your immunotherapies kick in.
Thymectomy. Your doctor will suggest taking out your thymus gland if you have a tumor on it (thymoma). But this surgery may help you get to remission or ease your symptoms and need for medication even if you don’t have a thymoma.
Talk to your doctor about a thymectomy if:
- You’re younger than 60.
- You have moderate to serious symptoms.
- You have weakness that affects more than your eyes.
- You’re early in your disease course.
- You have mild weakness, but it affects your breathing or swallowing.
Can Lifestyle Changes Help You Get to Remission?
Along with medical treatment, there are other steps you can take to boost your strength. If you’re not sure where to get started, ask the doctor for a referral to an occupational therapist. They can help you figure out which lifestyle factors may help you the most.
Here are some things they might suggest:
- Eat, work, or do chores when your energy is highest.
- Take breaks and rest before you feel tired.
- Learn your physical and emotional triggers.
- Find ways to manage stress.
- Follow a nutritious eating plan.
- Stay as active as possible (when your symptoms are stable).
- Talk to a mental health professional.
Consider reaching out to people who know what you’re going through. While myasthenia gravis affects everyone differently, people who live with the same disease you have can offer real-world tips your doctor might not think of. Search for in-person or online myasthenia gravis support groups through the Myasthenia Gravis Foundation of America, or ask your medical team if they know of a meetup in your area.
Keep the Conversation Going
You may need to follow up with your doctor every few months, especially if you haven’t found a treatment to control your symptoms. But it’s important to check in with your medical team regularly even if you feel good. They can update you on the latest myasthenia gravis treatments and which ones might be right for you.
Make sure you ask about vaccines at your next appointment. Most are safe for people with myasthenia gravis, and they can lessen the chances you’ll get very sick from certain infections, such as flu or COVID-19.
Keep in mind that there’s no cure for myasthenia gravis, so you can still have an exacerbation or crisis after you get to remission. Your symptoms may worsen during pregnancy or when you:
- Take certain drugs.
- Taper off treatment.
- Have surgery.
- Get a bacterial or viral infection.
Show Sources
Photo Credit: Tetra Images/Getty Images
SOURCES:
Richard J. Nowak, MD, associate professor of neurology; director, Program in Clinical & Translational Neuromuscular Research, Yale School of Medicine; director, Yale Myasthenia Gravis Clinic.
NYU Langone: “Recovery & Support for Myasthenia Gravis.”
Myasthenia Gravis Foundation of America: “myasthenia gravisFA Post-intervention Status (myasthenia gravisFA-PIS),” “Thymectomy,” “Find myasthenia gravis Support Groups.”
Frontiers on Neurology: “A Practical Approach to Managing Patients With Myasthenia Gravis – Opinions and a Review of the Literature,” “Rituximab treatment in myasthenia gravis."
Johns Hopkins Medicine: “Myasthenia Gravis.”
UpToDate: “Overview of the treatment of myasthenia gravis.”
Neurologic Clinics: “Treatment of Myasthenia Gravis.”
Mayo Clinic: “Myasthenia gravis.”
Saudi Journal of Medicine & Medical Sciences: “Thymectomy in Myasthenia Gravis: A Narrative Review.”
