Having MG significantly hinders patients’ ability to work, study finds

Worse disease severity tied to greater impact on daily living activities

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by Andrea Lobo |

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People with myasthenia gravis (MG) — particularly those with more severe symptoms — are significantly hindered both in their ability to work and to engage in activities of daily living, a survey study reported.

The impact of these impairments ranged from 13% to 40% across work time missed, as well as reductions in work productivity. Further, patients experienced an overall impact in work and in activities of daily living, highlighting the negative toll the disease poses on quality of life for those with MG.

“More effective treatment strategies would enable patients to lead more productive lives and could impact decisions relating to work and career,” the researchers wrote.

The study, “The impact of myasthenia gravis severity on work and daily activities,” was published in the journal Muscle & Nerve.

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Survey sought to better understand MG impact on daily life, ability to work

MG is an autoimmune condition caused by autoantibodies that attack proteins involved in nerve-muscle communication. This autoimmune attack causes patients to develop symptoms of muscle weakness and fatigue.

The disease has long been known to pose a significant burden on patients, impacting their ability to perform activities of daily living and work, and reducing their health-related quality of life, as compared with the general population.

“However, the details and nature of this burden are not well understood or quantified,” the researchers wrote.

To know more, the team conducted a multinational survey study that was completed by physicians and MG patients from the U.S. and five European countries in 2020. Those five nations were France, Germany, Italy, Spain, and the United Kingdom.

Collected data included physician-reported patient records, along with patient-reported information on MG’s impact on work and activities of daily living, which was assessed by the Work Productivity and Activity Impairment (WPAI) questionnaire.

In total, the researchers analyzed data from 330 patients who completed the WPAI questionnaire. Among them, slightly more than half (52.7%) were men, and the mean age was 55.1 years.

Nearly half of the patients (48.5%) were classified as being class II on the MG Foundation of America (MGFA) scale, as reported by their physicians. MGFA is a standard measure of MG disease activity; it ranges from class I to class V, with a higher class indicating more severe disease.

More than a quarter of patients (29.4%) were class III/IV, while just less than one-fourth (22.1%) were reported as class I.

Among currently employed patients, the mean percentage of work time missed, noted as absenteeism, was 13.3%. Further, there was a 26.7% mean reduction in work productivity, known as presenteeism.

Overall, patients experienced a 30% reduction in their ability to work, and their ability to perform activities of daily living not related to work decreased by 39.2%.

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The extent of the impact increased significantly with disease severity. Being classified as MGFA class III/IV was a predictor of reduced work productivity and overall impairment in work and activities of daily living. Moreover, the burden of other coexistent disorders and the time since MG diagnosis had a particular impact on missed work time.

Also, specific symptoms could predict the impact across all four WPAI domains. Specifically, difficulty swallowing/choking on food and weakness in the hands and legs were associated with work absenteeism, while slurred speech and weakness in the neck and hands were the strongest predictors of overall work impact and reduced productivity.

Symptoms specifically associated with impairments in activities of daily living included weakness in the hands and legs and shortness of breath. Weakness in eye muscles and/or upper eyelid droopiness or double vision predicted impairment in all four domains.

These results characterize the burden of disease for patients with MG, particularly those with severe symptoms, and highlight the impact that poor disease control can have on a patient’s lived experience and their ability to participate fully in regular employment and daily activities.

According to the researchers, the study not only investigated but demonstrated “the nuanced ways in which work activity is impaired among patients who are in employment.”

“The clinical burden of MG appears to reduce a person’s ability to attend work regularly and to perform work-related tasks to the same standard that they may have done if they did not have MG,” the team wrote.

Overall, the findings show the significant impact MG has on patients.

“These results characterize the burden of disease for patients with MG, particularly those with severe symptoms, and highlight the impact that poor disease control can have on a patient’s lived experience and their ability to participate fully in regular employment and daily activities,” the researchers wrote.

The findings also “highlight a need for more effective treatments for patients with MG, with the aim of improving symptoms of patients in class III/IV and achieving greater stability,” the team added.