Malin Petersson, Daniel Jons, Amalia Feresiadou, Andreea Ilinca, Fredrik Lundin, Rune Johansson, Anna Budzianowska, Anna-Karin Roos, Viktor Kagstrom, Martin Gunnarsson, Peter Sundström, Lars Klareskog, Tomas Olsson, Ingrid Kockum, Fredrik Piehl, Lars Alfredsson, Susanna Brauner
{"title":"Nicotine, Alcohol Consumption, and Risk of Myasthenia Gravis: Results From the Swedish Nationwide GEMG Study.","authors":"Malin Petersson, Daniel Jons, Amalia Feresiadou, Andreea Ilinca, Fredrik Lundin, Rune Johansson, Anna Budzianowska, Anna-Karin Roos, Viktor Kagstrom, Martin Gunnarsson, Peter Sundström, Lars Klareskog, Tomas Olsson, Ingrid Kockum, Fredrik Piehl, Lars Alfredsson, Susanna Brauner","doi":"10.1212/WNL.0000000000213771","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Myasthenia gravis (MG), an autoimmune disease characterized by fluctuating muscle weakness, is believed to result from complex gene-environment interactions, yet few risk factors have been identified. The objective of this study was to determine the effect of nicotine and alcohol on MG disease risk.</p><p><strong>Methods: </strong>The Genes and Environment in Myasthenia Gravis study is a Swedish, nationwide cross-sectional case-control study where prevalent patients with MG were invited to submit an extensive questionnaire on lifestyle and environment. Data collection took place between November 2018 and August 2019, and cases were matched by sex and year of birth to population controls. Year of disease onset was used as index year. Associations between use of alcohol, tobacco smoke, Swedish snuff, and MG risk were investigated using multivariable logistic regression.</p><p><strong>Results: </strong>A total of 1,067 patients with MG (mean age at onset 48 (SD 21) years, 53% female) were matched to 2,087 controls. Any alcohol consumption was associated with a lower MG risk compared with not drinking at all (odds ratio [OR] 0.48, 95% CI 0.39-0.59, <i>p</i> < 0.001, exposed cases n = 616). Effects were observed in a similar direction across disease subtypes, with the strongest association in the late-onset MG group (onset ≥50 years). Although neither cigarette smoke nor use of Swedish snuff affected the disease risk of the whole group, subset specific effects were observed. Smoking at onset was associated with an increased risk of early-onset MG (EOMG, onset 18-49 years; OR 1.60, 95% CI 1.17-2.20, <i>p</i> = 0.003, n = 133), which was accentuated in acetylcholine receptor antibody-positive EOMG (OR 2.08, 95% CI 1.34-3.25, <i>p</i> = 0.001, n = 74). Use of Swedish snuff, which contains high levels of nicotine, at disease onset was also associated with an increased risk of EOMG (OR 1.61, 95% CI 1.02-2.54, <i>p</i> = 0.039, n = 43).</p><p><strong>Discussion: </strong>We observed an inverse correlation of MG risk and alcohol consumption. Furthermore, smoking and the use of Swedish snuff at disease onset were positively associated with EOMG. We recognize limitations related to retrospective data and limited number of available controls. However, multiple sensitivity analyses were performed supporting the robustness of our results.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213771"},"PeriodicalIF":7.7000,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165285/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1212/WNL.0000000000213771","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/10 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objectives: Myasthenia gravis (MG), an autoimmune disease characterized by fluctuating muscle weakness, is believed to result from complex gene-environment interactions, yet few risk factors have been identified. The objective of this study was to determine the effect of nicotine and alcohol on MG disease risk.
Methods: The Genes and Environment in Myasthenia Gravis study is a Swedish, nationwide cross-sectional case-control study where prevalent patients with MG were invited to submit an extensive questionnaire on lifestyle and environment. Data collection took place between November 2018 and August 2019, and cases were matched by sex and year of birth to population controls. Year of disease onset was used as index year. Associations between use of alcohol, tobacco smoke, Swedish snuff, and MG risk were investigated using multivariable logistic regression.
Results: A total of 1,067 patients with MG (mean age at onset 48 (SD 21) years, 53% female) were matched to 2,087 controls. Any alcohol consumption was associated with a lower MG risk compared with not drinking at all (odds ratio [OR] 0.48, 95% CI 0.39-0.59, p < 0.001, exposed cases n = 616). Effects were observed in a similar direction across disease subtypes, with the strongest association in the late-onset MG group (onset ≥50 years). Although neither cigarette smoke nor use of Swedish snuff affected the disease risk of the whole group, subset specific effects were observed. Smoking at onset was associated with an increased risk of early-onset MG (EOMG, onset 18-49 years; OR 1.60, 95% CI 1.17-2.20, p = 0.003, n = 133), which was accentuated in acetylcholine receptor antibody-positive EOMG (OR 2.08, 95% CI 1.34-3.25, p = 0.001, n = 74). Use of Swedish snuff, which contains high levels of nicotine, at disease onset was also associated with an increased risk of EOMG (OR 1.61, 95% CI 1.02-2.54, p = 0.039, n = 43).
Discussion: We observed an inverse correlation of MG risk and alcohol consumption. Furthermore, smoking and the use of Swedish snuff at disease onset were positively associated with EOMG. We recognize limitations related to retrospective data and limited number of available controls. However, multiple sensitivity analyses were performed supporting the robustness of our results.
背景和目的:重症肌无力(MG)是一种以波动性肌肉无力为特征的自身免疫性疾病,被认为是复杂的基因-环境相互作用的结果,但很少有危险因素被确定。本研究的目的是确定尼古丁和酒精对MG疾病风险的影响。方法:重症肌无力的基因和环境研究是一项瑞典全国性的横断面病例对照研究,该研究邀请重症肌无力的流行患者提交一份关于生活方式和环境的广泛问卷。数据收集于2018年11月至2019年8月期间进行,病例按性别和出生年份与人口控制相匹配。发病年作为指标年。使用多变量logistic回归研究了饮酒、吸烟、瑞典鼻烟和MG风险之间的关系。结果:共有1067例MG患者(平均发病年龄48岁(SD 21岁),53%为女性)与2087例对照。与完全不饮酒相比,任何饮酒都与MG风险降低相关(优势比[OR] 0.48, 95% CI 0.39-0.59, p < 0.001,暴露病例n = 616)。在疾病亚型中观察到的影响方向相似,在迟发性MG组(发病≥50年)中相关性最强。虽然吸烟和使用瑞典鼻烟都不影响整个组的疾病风险,但观察到特定子集的影响。发病时吸烟与早发性MG (EOMG,发病18-49岁;OR为1.60,95% CI为1.17-2.20,p = 0.003, n = 133),在乙酰胆碱受体抗体阳性的EOMG中更为明显(OR为2.08,95% CI为1.34-3.25,p = 0.001, n = 74)。发病时使用含有高水平尼古丁的瑞典鼻烟也与EOMG的风险增加相关(OR 1.61, 95% CI 1.02-2.54, p = 0.039, n = 43)。讨论:我们观察到MG风险与饮酒呈负相关。此外,发病时吸烟和使用瑞典鼻烟与EOMG呈正相关。我们认识到与回顾性数据和有限数量的可用对照有关的局限性。然而,我们进行了多重敏感性分析来支持我们结果的稳健性。
期刊介绍:
Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology.
As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content.
Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.