{"id":3004,"date":"2018-11-16T12:07:47","date_gmt":"2018-11-16T11:07:47","guid":{"rendered":"https:\/\/choosingwiselyitaly.org\/?post_type=raccomandazione-prof&#038;p=3004"},"modified":"2025-10-09T18:31:26","modified_gmt":"2025-10-09T16:31:26","slug":"specific-autoantibodies-achr-musk-lrp4-should-not-be-required-as-a-profile-when-myasthenia-gravis-is-suspected-but-the-initial-test-is-represented-only-by-anti-achr-antibodies-the-determination","status":"publish","type":"raccomandazione-prof","link":"https:\/\/choosingwiselyitaly.org\/en\/raccomandazione-prof\/specific-autoantibodies-achr-musk-lrp4-should-not-be-required-as-a-profile-when-myasthenia-gravis-is-suspected-but-the-initial-test-is-represented-only-by-anti-achr-antibodies-the-determination\/","title":{"rendered":"When myasthenia gravis is suspected, specific autoantibodies (AChR, MuSK, Lrp4) should not be searched as a profile, but the initial test is represented only by anti-AchR antibodies."},"content":{"rendered":"<p>Since the three autoantibodies are mutually exclusive, it is not useful to simultaneously request the determination of all three antibodies, because about 80% of patients with myasthenia have only anti-AChR, 16% only anti-MuSK and the remaining 4% only anti-Lrp4 antibodies. The determination of anti-Musk antibodies should then be reserved for anti-AChR negative patients, while that of anti-Lrp4 antibodies should be limited to anti-AChR and anti-MuSK negative patients.<\/p>\n","protected":false},"featured_media":3022,"template":"","meta":{"_edit_lock":["1760027360:2"],"_edit_last":["2"],"_wpml_media_featured":["1"],"_wpml_media_duplicate":["1"],"_thumbnail_id":["3022"],"_wpml_word_count":["111"],"_yoast_wpseo_primary_eta":[""],"_yoast_wpseo_primary_disciplina":["124"],"_yoast_wpseo_primary_tipologia":[""],"wpcf-pacchetto":["SIPMeL #3"],"wpcf-bibliografia":["1. Leite MI, Waters P, Vincent A. Diagnostic use of autoantibodies in myasthenia gravis. Autoimmunity 2010; 43:371-9. doi: 10.3109\/08916930903541208.\r\n2. Evoli A. Myasthenia gravis: new developments in research and treatment. Curr Opin Neurol 2017; 30:464-70. doi: 10.1097\/WCO.0000000000000473.\r\n3. Gilhus NE. Myasthenia gravis. N Engl J Med 2016; 375:2570-81. doi: 10.1056\/NEJMra1602678.\r\n4. Zisimopoulou P, Evangelakou P, Tzartos J, et al. A comprehensive analysis of the epidemiology and clinical characteristics of anti-LRP4 in myasthenia gravis. J Autoimmun 2014; 52:139-45. doi: 10.1016\/j.jaut.2013.12.004.\r\n5. Spagni G, Gastaldi M, Businaro P, et al. Comparison of fixed and live cell-based assay for the detection of AChR and MuSK antibodies in myasthenia gravis. 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