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Prednisone for Myasthenia Gravis: How does it work? How is it consumed? Is it safe? Who shouldn't take it? Side effects? Research studies? Evidence?

Myasthenia Gravis (referred to as MG in the article) is an autoimmune disorder in the nerves and muscles, which is known for its symptoms of weakness and very rapid fatigue of voluntary muscles. It is often managed by a corticosteroid called prednisone, due its potent immunosuppressive and anti-inflammation properties. 

Prednisone is a synthetic corticosteroid which acts a lot like cortisol, the human stress hormone produced by the adrenal caps. Basically, it reduces inflammation and suppresses the immune system in different ways. It suppresses the immune system by decreasing the activity and volume of lymphocytes (aka the immune cells), thus reducing production of antibodies. This is related to MG, since patients of MG have acetylcholine receptors on cells which keep getting attacked by antibodies. By reducing antibody production, pain is reduced in patients.

It also works by inhibiting the release of inflammatory cytokines (a cell signaling molecule) and mediators, this reduces the inflammation and edema in affected muscles. It even manages to bind to glucocorticoid receptors, which affect expression of genes involved in inflammation. 

The medication is administered orally in the form of tablets. The dosage is dependent on various factors as decided by medical advisors of the patient. Initially, high doses of the medicine are usually prescribed to fix the problem quickly, and then stabilized to match the new requirements of the patient's body. They are also continually tested by using blood tests, bone density scans and glucose level monitoring. 

People who are advised to not take prednisone include people with systemic fungal vaccines or those receiving live vaccines, since it is, after all, an immunosuppressant that can worsen infections. It is even advised that people with hypertension, diabetes, osteoporosis, peptic ulcer disease, or any psychiatric disorder not take the medicine, since it can exacerbate symptoms as well. 

Side effects of the medicine include weight gain due to increased fluid retention and appetite, mood changes, higher blood pressure in long term use, higher blood sugar levels, lower bone health, and some more infection risk. 

However, prednisone is highly recommended by many doctors due to its advanced effect on MG, as is proven through multiple studies. For example, a key study by the Journal of Neurology (2004) titled as "Corticosteroid therapy in Myasthenia Gravis" found that provisions of prednisone resulted in significant improvements in muscular health and disease severity. However, importance was provided to the dosages, so as to avoid the side effects listed above. 

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