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Myasthenia gravis (Associations (SLE, Pernicious anaemia, RA, Addison'…

- - - - Steroids
        Indication: acute crisis/relapse
        Example: prednisolone
        SEs: initial deterioration in symptoms (can cause resp failure)
        NB. observe in hospital
      - Immunosuppressants
        Indication: long-term maintenance therapy
        E.g. azathioprine (steroid-sparing), methotrexate, rituximab
      - Cholinesterase inhibitors
        Indication: 1L maintenance
        Example: pyridostigmine
        MOA: peripheral ACh-esterase inhibitor
        SE: salivation, sweats, lacrimation,
        abdominal pain, vomiting, diarrhoea
        OD: cholinergic crisis - muscle weakness
        (bulbar, respiratory)
      - Plasma exchange, IV Ig
        Indication: myasthemic crises with severe
        bulbar and respiratory compromise
    - - Thymectomy
        Indication: prevent spread of thymoma;
        therapeutic benefit in MG (may remit)
      - Eyelid surgery
        Intractable ptosis