title: Cigarette Smoking and Activities of Daily Living in Ocular Myasthenia Gravis.
abstract: BACKGROUND
  Myasthenia gravis is an autoimmune disease of the neuromuscular junction, commonly affecting the ocular muscles. Cigarette smoking has been shown to influence many autoimmune diseases, including multiple sclerosis and rheumatoid arthritis, but its effect on myasthenia gravis has not been well studied. We sought to determine whether cigarette smoking influenced disease-related symptoms in ocular myasthenia gravis (OMG).
  
  
  METHODS
  We performed a prospective, clinic-based cross-sectional study in a single academic neuro-ophthalmology practice. All patients diagnosed with OMG between November 2006 and April 2014 were included. A prospective telephone survey was administered to determine smoking status and myasthenia gravis-related symptom severity. The main outcome measure was the myasthenia gravis-specific activities of daily living (MG-ADL) score, a well-validated marker of symptoms and quality of life in myasthenia gravis.
  
  
  RESULTS
  Forty-four patients were included in the analysis. Comparison of MG-ADL ocular subscores between current smokers (3.4 ± 2.6), former smokers (1.8 ± 2.1), and never smokers (1.1 ± 1.5) revealed a statistically significant relationship (P = 0.031) where current smokers had the highest MG-ADL ocular subscores and never smokers the lowest. Comparison of MG-ADL total scores revealed the same relationship (current 5.6 ± 4.5, former 2.9 ± 3.1, never 1.4 ± 2.5, P = 0.003). There were borderline significant correlations of pack years with MG-ADL ocular subscore (r = 0.27, P = 0.074) and MG-ADL total score (r = 0.30, P = 0.051).
  
  
  CONCLUSIONS
  Our findings indicate an association between cigarette smoking and symptom severity in OMG. This association suggests that smoking cessation in OMG patients may lead to improved symptom-related quality of life.
authors.affiliation: Bascom Palmer Eye Institute (SMG, AMH, WJF, BLL), University of Miami-Miller School of Medicine, Miami, Florida; Departments of Neurology and Cognitive Neuroscience (SMG) and Ophthalmology (SMG), University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Gratton
authors.forename: Angela M
authors.initials: AM
authors.lastname: Herro
authors.forename: William J
authors.initials: WJ
authors.lastname: Feuer
authors.forename: Byron L
authors.initials: BL
authors.lastname: Lam
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D009801:Oculomotor Muscles / Q000503:physiopathology*; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D011729:Pyridostigmine Bromide / Q000627:therapeutic use; D011950:Receptors, Cholinergic / Q000276:immunology; D012907:Smoking / Q000503:physiopathology*; D016540:Smoking Cessation; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D002800:Cholinesterase Inhibitors; D005938:Glucocorticoids; D011950:Receptors, Cholinergic; D011729:Pyridostigmine Bromide; D011241:Prednisone