{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T01:39:18Z","timestamp":1788485958283,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T00:00:00Z","timestamp":1680480000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction\/Aims<\/jats:title><jats:p>Descriptions of the clinical characteristics of anti\u2010AChR\u2010MuSK\u2010LRP4 antibody\u2010negative myasthenia gravis (triple\u2010negative myasthenia gravis, TNMG) are lacking in the current literature. Therefore, we investigated the clinical characteristics of TNMG in Chinese patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed 925 patients with MG registered in the Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences from January 2015 to March 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred six patients diagnosed with TNMG were included in the study. The average age of onset was 32.4\u2009y, with a male\u2010to\u2010female ratio of 1:1. The age of onset showed a bimodal distribution: 0\u20139\u2009y and 40\u201349\u2009y. Adult patients were more likely to have weakness of limb and bulbar muscles (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05). Thymic hyperplasia was found in 20.2% of the patients. Younger patients were more likely to relapse. The rate of adult early\u2010onset myasthenia gravis reaching complete stable remission and pharmacological remission was 47.6%, and the prognosis was better than that in juvenile\u2010onset myasthenia gravis (<jats:italic>p<\/jats:italic>\u2009=\u2009.019). Older age of onset was the only risk factor for the development of generalized TNMG from ocular TNMG (<jats:italic>R<\/jats:italic>\u2009=\u20091.046, <jats:italic>p<\/jats:italic>\u2009=\u2009.002, 95% confidence interval 1.017\u20131.077).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This study showed that the clinical characteristics of patients with TNMG varied among the different age groups. Significant findings included a bimodal distribution of onset age, coexisting thymic hyperplasia, and a generally favorable prognosis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mus.27822","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T06:44:52Z","timestamp":1679467492000},"page":"481-488","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical characteristics of <scp>anti\u2010AChR\u2010MuSK\u2010LRP4<\/scp> antibody\u2010negative myasthenia gravis in China"],"prefix":"10.1002","volume":"67","author":[{"given":"Wenbo","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurology The Second Affiliated Hospital of Zhengzhou University  Zhengzhou China"},{"name":"Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences Zhengzhou University  Zhengzhou 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