Prednisone use in concurrent autoimmune diseases
Y. Harati and B. M. Patten
A 40-year-old woman with clinical and laboratory features of myasthenia
gravis, hyperthyroidism, and polymyositis responded to treatment with
prednisone alone. Symptoms of myasthenia gravis appeared first followed by
hyperthyroid symptoms. Triiodothyronine, thyroxine, and thyroid uptake were
elevated as were serum levels of CPK, SGOT, SGPT, and LDH. Muscle biopsy
specimen showed mild type II fiber atrophy and a small focus of
inflammatory cells. Two weeks after initiation of prednisone, 100 mg every
other day, the ESR declined from 44 to 12 mm/hr, serum enzyme values became
normal, and the weakness improved. Over the ensuing four months, the
thyroid function values returned to normal and the patient no longer needed
any anticholinesterase drug. At present, she is functionally normal except
for mild defects in eye movement and she takes no medication. Physicians
should consider treating patients who have several concurrent autoimmune
diseases with prednisone to see if all conditions can be brought under
control with one simple therapy.