Within the previous case sample, ME was found in 21/25 (84%) dogs, compared with our 68/94 (72%). The age range of our current sample of myasthenic dogs was similar to that in previous studies.7, 10 However, in previous retrospective studies female dogs outnumbered male dogs,10, 15, 19 in JAM3 contrast to the even distribution of both sexes present in this cohort. to treat 90/94 (96%) dogs, which in 63/94 (67%) was the sole treatment; other drugs included immune modulators. Clinical remission (lack of clinical signs 4?weeks after treatment cessation) was observed in 29 (31% [95% confidence interval (CI): 22.4\40.8%]) dogs, clinical response (lack of clinical signs on treatment) in 14 (15% [95% CI: 9.0\23.6%]) dogs, clinical improvement (on treatment) in 24 (26% [95% CI: 17.8\35.2%]) dogs, and no clinical improvement in 27 (29% [95% CI: 20.5\38.6%]) dogs. Immunological remission was observed in 27/46 (59%) dogs, with clinical remission in all 27. Younger age (axis for clarity. Dogs that were euthanized or died are represented by ; those lost to follow\up are represented by white dots Fifty\seven (61%) of the 94 dogs had both generalized MG and ME, 26/94 (28%) dogs had solely generalized MG, and 11/94 (12%) dogs had focal MG with ME only. Comorbid neoplasms included thymoma in 10/94 (11%) dogs (1 of which also had 2 pulmonary masses), and other or unknown neoplasia in 5/94 (5%) Biochanin A (4-Methylgenistein) dogs, including 2 with a current or historical mast cell tumor, and 1 case each of cranial mediastinal mass (unspecified), adrenal mass, and pulmonary mass (unspecified). Comorbid neurologic disease or neurologic manifestations were observed in 11/94 (12%) dogs, and included seizures (5), idiopathic epilepsy (1), spinal cord disease (2), and laryngeal paralysis (3). Comorbid endocrine disease was observed in 8/94 (9%) dogs, and included hypothyroidism (6), diabetes mellitus (1), and hyperadrenocorticism (1). Method of diagnosis of endocrine diseases was not specified in the data collected for each individual case. Systemic disease was observed in 8/94 (9%) dogs, including suspected allergic skin disease (2), of which 1 dog also had a history of pyloric stenosis; urinary tract infection (UTI) and a nonspecific arrhythmia (1); and 1 each with a history of collapsing trachea, chronic diarrhea, inflammatory bowel disease, neosporosis, and campylobacteriosis. Comorbid immune\mediated diseases were observed in 4/94 (4%) dogs, including 2 with current or historical masticatory myositis, 1 with pemphigus foliaceus, and 1 with a history of both immune\mediated polyarthritis, and precursor\targeted immune\mediated anemia (the same dog also had a history of neosporosis). Finally, 4/94 (4%) dogs had comorbid orthopedic diseases, including hip dysplasia (2) and cruciate ligament disease (2) (Table?3 and Figure?3). Open in a separate window FIGURE 3 Distribution of presenting clinical signs and comorbidities with clinical group of myasthenia gravis. The clinical scoring groups are organized by colored bars, shaded areas below the bars representing the Biochanin A (4-Methylgenistein) cases within that group with the corresponding presenting clinical signs (upper rows) or comorbidities (lower rows). dz, disease Most dogs were treated with AD (90/94, 96%); of those, 60/94 (64%) dogs were treated with AD alone. Fifteen (15/94; 16%) dogs in total were treated with prednisone, most often in combination with AD (11/94, 12%). The corticosteroid doses administered to dogs in this study were predominantly anti\inflammatory (0.5\1.0?mg/kg/day; 12/15, 80%). One dog (1/15, 7%) was administered an intermediate dose between anti\inflammatory and immunosuppressive (1.5?mg/kg/day), 1 (7%) received an immunosuppressive dose (2?mg/kg/day), and 1 (7%) received an unknown dose. Other treatments included a combination of AD with other ID (cyclosporine, azathioprine, or mycophenolate; 12/94, 13%); AD, prednisone, and ID (cyclosporine, azathioprine, or Biochanin A (4-Methylgenistein) mycophenolate; 1/94, 1%); AD and prednisone with thymectomy in the case of thymoma (3/94, 3%); AD with thymectomy in the case of thymoma (2/94, 2%); ID alone (2/94, 2%); and 1 each of thymectomy alone, mycophenolate with 2 human intravenous immunoglobulin infusions, and chemotherapy drugs alone (carboplatin and toceranib in a dog with pulmonary and cranial mediastinal neoplasia). Baseline AChR Ab concentrations for each of the clinical groups are depicted in Figure?4. Forty\six of 94 (49%) dogs had follow\up AChR Ab assays, which yielded subsequent normal values (representing immunological remission) in 27/46 (59%) dogs. AChR assays were repeated in 36 dogs showing lower, but not yet normal, AChR Ab concentrations, of which 29/36 (81%) subsequently decreased to normal. Individual changes from baseline to follow\up AChR.
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