Optimizing myasthenia gravis management in practice: integrating clinical scales and classification systems

Myasthenia gravis is an antibody-mediated disorder of the neuromuscular junction. Fatigability and fluctuations are hallmarks of the disease, posing a challenge: evaluation through a single physical examination may not reflect disease control. A shift towards patient-reported Outcomes is a new paradigm in the current practice, and these outcomes are usually assessed through validated scales. In the present paper, we discuss some of the most used scales in the clinical practice, such as the Myasthenia Gravis Foundation of America (MGFA) scale, the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale, and the 15-Item Myasthenia Gravis Quality of Life (MG-QOL15) scale. Definitions of remission, minimal manifestation, high-burden disease, highly-active disease, and others are reviewed, and correlations involving these definitions and the scales are presented. Guidance on how to assess disease severity, therapeutic response, and a rationale for treatment escalation are explored.