Elsevier

Journal of Clinical Neuroscience

Volume 79, September 2020, Pages 84-89
Journal of Clinical Neuroscience

Clinical study
Fatigue, self-efficacy and psychiatric symptoms influence the quality of life in patients with myasthenia gravis in Tianjin, China

https://doi.org/10.1016/j.jocn.2020.06.023Get rights and content

Highlights

  • •

    Myasthenia gravis always have subjective syndromes, such as fatigue, self-efficacy, depression, and anxiety.

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    However, no previous study has adequately explored the relationship between the subjective symptoms and quality of life of MG patients. We found subjective symptoms might contribute to the reduced quality of life .

  • •

    We have reasons to believe that psychosocial support improve the results of conventional MG treatment and consequently HRQoL. In the course of treatment, the evaluation of HRQoL should be included in the routine assessment of patients with MG.

Abstract

Background

Muscle weakness related to myasthenia gravis (MG) limits the daily functioning of patients. MG patients often experience subjective symptoms including psychiatric disorders, fatigue, and reduction in self-efficacy. All of which ultimately influence their life. The relationship between the subjective symptoms and health-related quality of life (HRQoL) has never been systematically explored among MG patients.

Objective

This study aimed to evaluate the HRQoL of patients with MG in China, and to assess the impact of potential predictors of HRQoL.

Methods

This was a cross-sectional observational study in patients with confirmed diagnosis of MG. Patients with MG were assessed using the 36-Item Short-Form Health Survey (SF-36) questionnaire, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Fatigue Severity Scale (FSS), and Self-Efficacy for Managing Chronic Disease 6 items scale (SES6G). Disease severity was evaluated by two specialists at the same time.

Results

Patients had significantly lower mean SF-36 scores for the categories role physical and general health (GH). The mean physical and mental composite scores were 57.76 ± 21.28 and 60.03 ± 23.75. Sex and unemployment influenced the QoL. Financial burden was negatively associated with total SF-36 scores. Compared to the control group, patients with generalized symptoms (MGFA II and III) had lower SF-36 scores, but the patients with pure ocular symptoms (MGFA I) had not significant difference, except GH. The SF-36 scores were highly correlated with the severity of the disease, the states of mood, fatigue, and self-efficacy.

Conclusions

The decrease in the HRQoL of patients with MG was related not only to the gender, severity of disease, and unemployment but also to the subjective experience including depressive and anxiety disorders, fatigue, and self-efficacy. In the course of treatment, the evaluation of HRQoL should be included in the routine assessment of patients with MG. Psychosocial treatment, social support, and health education should be advocated.

Introduction

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction characterized by fluctuating muscle weakness. Anti-acetylcholine receptor (AChR) antibodies, muscle-specifific kinase (MuSK) antibodies, and lipoprotein-related protein 4 antibodies typically serve as pathogenic autoantibodies [1]. Skeletal muscle fatigue affects the extraocular, facial, axial, limb, bulbar, and respiratory muscles preferentially. Additionally, MG-related muscle weakness and abnormal fatigability limit the daily functioning and activities of patients with MG, ultimately impairing their health-related quality of life (HRQoL). Long-lasting therapies do not always provide a complete remission of the disease, but could cause severe side effects [2]. Although we always pay extensive attention to the evaluation of objective treatment efficacy, we ignore the mental state and subjective symptoms, such as fatigue, self-efficacy, depression, and anxiety. Psychiatric symptoms have been reported for having an influence on HRQoL [3], but very few studies have reported on the association of fatigue and self-efficacy with HRQoL among MG patients.

Fatigue is a subjective symptom that involves a persistent and overwhelming feeling of general exhaustion, tiredness, and a loss of physical and/or cognitive energy. Fatigue is highly prevalent in MG and plays a negative role. It is influenced by depressive symptoms and disease severity [4]. Self-efficacy is the perceived capability to perform specific actions required to achieve concrete goals [5].Self-efficacy was found to be a prerequisite for successful effective self-management [6] through the Chronic Disease Self-Management Program (CDSMP) that was extensively studied in the 1990s [7]. Researchers have extracted core domains, which could be generalized among patients with different chronic diseases, and created a reliable, valid, and economic six-item scale measuring self-efficacy for managing chronic diseases [8]. Several self-management programs successfully targeted self-efficacy, resulting in improved health outcomes [9], [10]. MG is a chronic disease characterized by fluctuating muscles fatigue. Thus, the goal of this study was to identify the HRQoL and the relationship with fatigue, self-efficacy, and psychiatric symptoms among patients with MG in China.

Section snippets

Participants and methods

Patients with MG were followed at the department of Neurology in the Tianjin Medical University General Hospital or in the Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital between July 2016 and April 2018. Among all patients, MG was diagnosed on clinical grounds and confirmed by electromyography test, positive neostigmine test, and detection of AChR and MuSK antibodies in serum.

The exclusion criteria were as follows: (1) age less than 15 years; (2) coexisting diseases that

Results

Sixty nine eligible MG patients participated and completed the questionnaires. The demographic details of the patients are presented in Table 1. The average age at disease onset was 50.8 ± 14.8 years, and 59.4% of the patients were classified as late onset MG (≥50 years). There was a characteristic male predominance in the MG cohort (62.3% vs. 37.7%). Most patients presented with ptosis as the initial manifestation of MG. Of the patients, 62.3% had moderate and high educational levels. Only

Discussion

QoL is an important issue to be considered while deciding on treatment strategies, and the Japanese Clinical Guidelines mention its priority [11]. A comparison of SF-36 mean scores in patients with MG versus the healthy population revealed differences in almost all eight SF-36 components [12], [13]. Paul et al. found lower scores in seven of the eight domains of the SF-36 in MG patients (n = 27) [12]. Padua et al. investigated 46 MG patients; their HRQoL was lowered in all scales of the SF-36

Conclusion

Summarizing, this study found that the HRQoL decreased in patients with MG in China, both in PCS and MCS. The findings indicated that besides sex, the financial burden, and severity of the disease, the subjective experience of MG patients including the states of mood, fatigue, and the self-efficacy might contribute to the reduced HRQoL. We have reasons to believe that psychosocial support as a regular therapeutic intervention for patients; social support including enough medical insurance

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgement

We thank Zhang Linjie for literature search. Many thanks also go to Editage for Language editor.

Ethical approval

All procedures performed in this study were approved by the Regional Ethical Review Board in Tianjin, China, and were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Fan Xin], [Xing Chunye] and [Wang jing]. The first draft of the manuscript was written by [Fan xin] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding

This study was funded by the National Natural Science Foundation of China (grant numbers 81771363).

The data that support the findings of this study are openly available in https://orcid.org/0000–0001-7637–4218.

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    • Cited by (0)

    1

    These authors contributed to the work equally and should be regarded as co-first authors.

    2

    ORCID ID: 0000-0001-7637-4218.

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