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Autoantibodies directed against the contractile elements of striated muscle are found in 30% of adult patients with myasthenia gravis and in 80% of those with thymoma. These antibodies may also be detected in patients with: Lambert-Eaton myasthenic syndrome, small-cell lung carcinoma, breast carcinoma, patients treated with D-penicillamine, bone marrow transplant recipients having graft-versus-host disease, and autoimmune liver disorders.
While this test is used as a serological aid in the diagnosis of thymoma, especially in patients with onset of myasthenia gravis (MG) younger than 45 years, it is more predictive of thymoma when accompanied by a muscle acetylcholine receptor (AChR) modulating antibody value of > or =90% AChR loss and is most predictive of thymoma when accompanied by CRMP-5-IgG. Serial measurements are useful after treatment of thymoma. Measurements of muscle AChR binding, muscle AChR modulating antibody, and CRMP-5-IgG (if initially positive) are also recommended.
As a serological aid in the diagnosis of thymoma, especially in patients with onset of myasthenia gravis (MG) younger than 45 years
As a screening test for MG in older patients, especially when tests for muscle AChR antibodies are negative
Serial measurements are useful in monitoring the efficacy of immunosuppressant treatment in patients with MG
Serial measurements are useful after treatment of thymoma
Serial measurements in recipients of D-penicillamine or bone marrow allografts may be useful in monitoring autoimmune complications and graft-versus-host disease, respectively
Striational antibodies occur in approximately:
-14% of patients with thymoma without clinical evidence of MG
-30% of patients with acquired (autoimmune) myasthenia gravis (MG)
-74% of patients with thymoma in association with MG
-25% of rheumatoid arthritis (RA) patients treated with D-penicillamine, 4% in untreated RA patients
-5% of patients with Lambert-Eaton myasthenic syndrome (LES) and/or small-cell lung carcinoma (SCLC) (MGLES / Myasthenia Gravis [MG]/Lambert-Eaton Syndrome [LES] Evaluation and PAVAL / Paraneoplastic Autoantibody Evaluation, Serum)
-In some bone marrow recipients with graft-versus-host disease
The incidence in healthy subjects is <1%.
A rising titer after removal of thymoma may be indicative of tumor recurrence.
A negative result does not exclude the presence of thymoma (20% are negative).
1. Cikes N, Momoi MY, Williams CL, et al: Striational autoantibodies: quantitative detection by enzyme immunoassay in myasthenia gravis, thymoma, and recipients of D-penicillamine or allogeneic bone marrow. Mayo Clin Proc 1988 May;63(5):474-481
2. Lennon VA: Serological profile of myasthenia gravis and distinction from the Lambert-Eaton myasthenic syndrome. Neurology 1997;48(Suppl 5):S23-S27
3. Vernino S, Lennon VA: Muscle and neuronal autoantibody markers of thymoma: neurological correlations. Ann NY Acad Sci 2003 Sep;998:359-361