{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T17:35:03Z","timestamp":1761240903362,"version":"build-2065373602"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Autoimmune diseases (ADs) frequently coexist with myasthenia gravis (MG), suggesting shared genetic and immunological mechanisms. However, the impact of comorbid ADs on MG prognosis remains unclear. This study aimed to investigate the prevalence, clinical characteristics, and prognosis of MG patients with comorbid ADs in a Turkish cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 302 MG patients treated at a tertiary center between 2010 and 2024. Patients were grouped based on the presence of comorbid ADs. Clinical characteristics, disease severity, treatment response, and prognosis were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 302 MG patients, 41 (13.6%) had at least one comorbid AD, with autoimmune thyroid disease (AITD) being the most common (10.6%). ADs were more frequent in females. Patients with and without comorbid ADs showed no significant differences in MG severity, thymectomy rates, myasthenic exacerbations, or overall outcomes (p\u2009&gt;\u20090.05). However, female patients with ADs experienced more frequent myasthenic exacerbations and had a higher rate of rituximab use (p\u2009&lt;\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Comorbid ADs do not significantly impact MG severity or prognosis. Female MG patients with ADs have a higher frequency of myasthenic exacerbations and rituximab use, warranting further research. Early identification of ADs remains essential for optimal patient management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0334434","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T17:32:04Z","timestamp":1761240724000},"page":"e0334434","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Myasthenia gravis and autoimmune overlap: Prognostic insight"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0465-4218","authenticated-orcid":true,"given":"Emel","family":"Oguz-Akarsu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarra El hamida","family":"Lazrak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4006-3263","authenticated-orcid":true,"given":"Deniz","family":"Sigirli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gizem","family":"Gullu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasemin","family":"Din\u00e7","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5945-2317","authenticated-orcid":true,"given":"Furkan","family":"Saridas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Necdet","family":"Karli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"pone.0334434.ref001","first-page":"185","article-title":"Is there a common genetic basis for autoimmune diseases?","volume":"13","author":"J-M Anaya","year":"2006","journal-title":"Clin Dev Immunol"},{"issue":"3","key":"pone.0334434.ref002","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/S1568-9972(03)00006-5","article-title":"The epidemiology of autoimmune diseases","volume":"2","author":"GS Cooper","year":"2003","journal-title":"Autoimmun Rev"},{"issue":"6","key":"pone.0334434.ref003","doi-asserted-by":"crossref","first-page":"362","DOI":"10.3109\/08916934.2015.1030614","article-title":"Complicating autoimmune diseases in myasthenia gravis: a review","volume":"48","author":"A Nacu","year":"2015","journal-title":"Autoimmunity"},{"issue":"11","key":"pone.0334434.ref004","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.3390\/jcm10112235","article-title":"Myasthenia gravis: epidemiology, pathophysiology and clinical manifestations","volume":"10","author":"L Dresser","year":"2021","journal-title":"J Clin Med"},{"issue":"9","key":"pone.0334434.ref005","doi-asserted-by":"crossref","first-page":"102349","DOI":"10.1016\/j.autrev.2019.102349","article-title":"HLA in myasthenia gravis: from superficial correlation to underlying mechanism","volume":"18","author":"H Zhong","year":"2019","journal-title":"Autoimmun Rev"},{"key":"pone.0334434.ref006","doi-asserted-by":"crossref","first-page":"790941","DOI":"10.3389\/fneur.2021.790941","article-title":"Comorbid autoimmune diseases in patients with myasthenia gravis: a retrospective cross-sectional study of a Chinese cohort","volume":"12","author":"J Shi","year":"2021","journal-title":"Front Neurol"},{"key":"pone.0334434.ref007","doi-asserted-by":"crossref","first-page":"1223322","DOI":"10.3389\/fimmu.2023.1223322","article-title":"Clinical features of myasthenia gravis with neurological and systemic autoimmune diseases","volume":"14","author":"Y Zhu","year":"2023","journal-title":"Front Immunol"},{"issue":"10","key":"pone.0334434.ref008","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.autrev.2012.02.001","article-title":"Updated assessment of the prevalence, spectrum and case definition of autoimmune disease","volume":"11","author":"SM Hayter","year":"2012","journal-title":"Autoimmun Rev"},{"key":"pone.0334434.ref009","unstructured":"Heinze G, Ploner M, Dunkler D, Southworth H. logistf: firth\u2019s bias-reduced logistic regression. 2024."},{"issue":"11","key":"pone.0334434.ref010","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1111\/j.1468-1331.2004.00968.x","article-title":"Associated conditions in myasthenia gravis: response to thymectomy","volume":"11","author":"JF T\u00e9llez-Zenteno","year":"2004","journal-title":"Eur J Neurol"},{"issue":"3","key":"pone.0334434.ref011","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1111\/j.1600-0404.1995.tb00432.x","article-title":"Associated autoimmune diseases in myasthenia gravis. 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