Determinants of quality of life in Brazilian patients with myasthenia gravis

Mourão, Aline Mansueto; Gomez, Rodrigo Santiago; Barbosa, Luiz Sergio Mageste; Freitas, Denise da Silva; Comini-Frota, Elizabeth Regina; Kummer, Arthur; Lemos, Stella Maris Aguiar; Teixeira, Antonio Lucio

doi:10.6061/clinics/2016(07)03

Aline Mansueto Mourão

Universidade Federal de Minas Gerais (UFMG), Hospital Universitário, Unidade de Neurologia, Clinica Neuromuscular

Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte/MG, Brazil

Rodrigo Santiago Gomez

Universidade Federal de Minas Gerais (UFMG), Hospital Universitário, Unidade de Neurologia, Clinica Neuromuscular

Luiz Sergio Mageste Barbosa

Universidade Federal de Minas Gerais (UFMG), Hospital Universitário, Unidade de Neurologia, Clinica Neuromuscular

Denise da Silva Freitas

Universidade Federal de Minas Gerais (UFMG), Hospital Universitário, Unidade de Neurologia, Clinica Neuromuscular

Elizabeth Regina Comini-Frota

Universidade Federal de Minas Gerais (UFMG), Hospital Universitário, Unidade de Neurologia, Clinica Neuromuscular

Arthur Kummer

Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte/MG, Brazil

Stella Maris Aguiar Lemos

Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte/MG, Brazil

Antonio Lucio Teixeira ^*E-mail: altexr@gmail.com

Universidade Federal de Minas Gerais (UFMG), Hospital Universitário, Unidade de Neurologia, Clinica Neuromuscular

Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte/MG, Brazil

Mourão AM, Gomez RS, Barbosa LS, Freitas DS, Comini-Frota ER were involved in subject recruitment, data collection and interpretation of the results. Kummer A, Lemos SM and Teixeira AL designed the research, supervised data collection and assisted in statistical analyses. Mourão AM, Kummer A and Teixeira AL drafted the original manuscript, which was read and amended when necessary. The final manuscript was approved by all authors.

E-mail: altexr@gmail.com

No potential conflict of interest was reported.

Characteristics	Patients (69)
Characteristics	N or Mean ± SD	% or Median (range)
Sex
Male	14	20.3
Female	55	79.7
Age (years)	44.5±10	45 (22-68)
Educational level (years of schooling)	8.6±2.5	8 (4-13)
Disease duration	14.5±10.5	12 (1-39)
Main symptom
Ocular	23	33.3
Bulbar	21	30.4
Generalized	25	36.2
MGFA Classification
I	13	18.8
IIA	14	20.3
IIB	2	2.9
IIIA	12	17.4
IIIB	7	10.1
IVA	4	5.8
IVB	3	4.3
V	14	20.3
MGC	7.5±5	6 (0-23)
HAD Anxiety subscale score	7.7±3.2	7 (2-16)
HAD Depression subscale score	4.6±4.4	3 (0-17)
Thymectomized	42	60.9
Pyridostigmine	58	84.1
Prednisone	44	63.8
Azathioprine	30	43,5
Other immunosuppressant	9	13

Questions:		Mean (SD)	Median (range)	Corrected item-total correlation	Cronbach 's alpha coefficient if the item is removed (αC)
1. I’m frustrated by my myasthenia gravis.	1. Eu estou frustrado por causa da Miastenia Gravis.	1.3 (1.5)	1 (0-4)	0.81	0.74
2. I have trouble using my eyes because of my myasthenia gravis.	2. Eu tenho dificuldade para usar meus olhos por causa da Miastenia Gravis.	1.4 (0.9)	2 (0-3)	0.78	0.75
3. I have trouble eating because of my myasthenia gravis.	3. Eu tenho dificuldade para comer por causa da Miastenia Gravis.	1.6 (0.9)	2 (0-4)	0.81	0.75
4. I have limited my social activity because of my myasthenia gravis.	4. Eu limitei a minha atividade social por causa da Miastenia Gravis.	1.6 (1.2)	1 (0-3)	0.89	0.74
5. My myasthenia gravis limits my ability to enjoy hobbies and activities.	5. A Miastenia Gravis limita minha capacidade de ter divertimento e atividades de lazer.	1.9 (0.9)	2 (0-4)	0.92	0.75
6. I have trouble meeting the needs of my family because of my myasthenia gravis.	6. Eu tenho dificuldade para atender as necessidades da minha família por causa da Miastenia Gravis.	1.9 (1)	2 (0-4)	0.85	0.75
7. I have to make plans around my myasthenia gravis.	7. Eu tenho que fazer os meus planos em torno da Miastenia Gravis.	2 (1)	2 (0-4)	0.80	0.75
8. My occupational skills and job status have been negatively affected by my myasthenia gravis.	8. Minhas habilidades profissionais e minha posição no trabalho (cargo) foram afetadas negativamente por causa da Miastenia Gravis.	2.1 (1.1)	2 (0-4)	0.84	0.75
9. I have difficulty speaking due to my myasthenia gravis.	9. Eu tenho dificuldade para falar por causa da Miastenia Gravis.	1.8 (1.1)	2 (0-4)	0.73	0.75
10. I have trouble driving due to my myasthenia gravis.	10. Eu tenho problemas para dirigir por causa da Miastenia Gravis.	1.3 (1.3)	1.5 (0-3)	0.08	0.77
11. I am depressed about my myasthenia gravis.	11. Eu estou deprimido por causa da Miastenia Gravis.	1 (1)	1 (0-3)	0.77	0.75
12. I have trouble walking due to my myasthenia gravis.	12. Eu tenho dificuldade para andar por causa da Miastenia Gravis.	1.9 (0.9)	2 (0-3)	0.77	0.75
13. I have trouble getting around public places because of my myasthenia gravis.	13. Eu tenho dificuldade de passear em lugares públicos por causa Miastenia Gravis.	2 (1.2)	2 (0-4)	0.91	0.74
14. I feel overwhelmed by my myasthenia gravis.	14. Sinto-me sobrecarregado por causa da Miastenia Gravis.	1.6 (1)	1 (0-4)	0.90	0.75
15. I have trouble performing my personal grooming needs because of myasthenia gravis.	15. Eu tenho dificuldade para realizar meus cuidados pessoais (higiene) por causa da Miastenia Gravis.	1.1 (0.7)	1 (0-3)	0.79	0.75
TOTAL:		23.8 (12.2)	21 (4-48)	1	0.95^* SD: standard deviation of the mean.

Continuous variables	Rho	p-value
SF-36	-0.63**	<0.01
SF-36 Physical Function	-0.45**	<0.01
SF-36 Role—Physical	-0.75**	<0.01
SF-36 Bodily Pain	-0.12	0.32
SF-36 General Health	-0.46**	<0.01
SF-36 Vitality	-0.46**	<0.01
SF-36 Social Functioning	-0.24*	0.04
SF-36 Role—Emotional	-0.23*	0.04
SF-36 Mental Health	-0.22	0.06

Variables	Rho or Z	p-value
Gender	-0.14^* * Mann-Whitney U test (nonparametric categorical variables - two variables);	0.87
First symptom	<0.01^ Kruskal-Wallis test (non-parametric categorical variables - three variables);	0.76
Main symptom	<0.01^ Kruskal-Wallis test (non-parametric categorical variables - three variables);	0.23
MGFA Classification	<0.01^* ***** one-way ANOVA (parametric categorical variables - three variables).	0.29
Thymectomy	-0.81^* * Mann-Whitney U test (nonparametric categorical variables - two variables);	0.41
Myasthenic crisis	-0.81^* * Mann-Whitney U test (nonparametric categorical variables - two variables);	0.41
Age	-0.01	0.88
Treatment time	0.06	0.60
MGC	0.60	<0.01
Pyridostigmine (dose)	-0.14	0.22
Prednisone (dose)	0.36	<0.01
Azathioprine (dose)	0.01	0.90
HAD Anxiety subscale score	0.38	<0.01
HAD Depression subscale score	0.45	<0.01

Continuous variables	B coefficient	p-value	95% confidence interval
MGC	0.93	<0.01	0.45 – 1.41
Prednisone (dose)	0.12	0.04	0.03 – 0.24
HAD Anxiety subscale score	0.77	0.03	0.05 – 1.49
HAD Depression subscale score	0.69	<0.01	0.18 – 1.21

[1] Mourão AM, Gomez RS, Barbosa LS, Freitas DS, Comini-Frota ER were involved in subject recruitment, data collection and interpretation of the results. Kummer A, Lemos SM and Teixeira AL designed the research, supervised data collection and assisted in statistical analyses. Mourão AM, Kummer A and Teixeira AL drafted the original manuscript, which was read and amended when necessary. The final manuscript was approved by all authors.

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Determinants of quality of life in Brazilian patients with myasthenia gravis

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