Objective To investigate the difference in the expression profile of microRNAs (miRNAs) in peripheral blood mononuclear cells (PBMCs) between patients with myasthenia gravis with acetylcholine receptor antibodies (AchR-MG) and healthy controls, predict the possible pathways involved in the development of AchR-MG, and to lay a foundation for further research on the pathogenesis of AchR-MG.Methods A case-control study was performed to screen out specifically expressed miRNAs in AchR-MG patients based on high-throughput sequencing. TargetScan and miRanda were used for cross-prediction of target genes, and gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed.Results A total of 28 differentially expressed miRNAs were screened out, among which 17 were upregulated and 11 were downregulated. The top 5 differentially expressed miRNAs were mmu-miR-3968, miR-4785, miR-210-3p, miR-664a-3p, and miR-2277-5p. A total of 395 target genes, such as METTL22, TMEM38A, ZNF324, ITGB4, and CDC34, were predicted for miR-4785. A total of 319 GO terms were identified (P<0.01), and 119 risk pathways were obtained (P<0.05).Conclusions A total of 28 specifically expressed miRNAs are found in AchR-MG, including miR-4785, miR-210-3p, miR-664a-3p, and miR-2277-5p. Multiple pathways, including the Wnt signaling pathway, may be involved in the pathogenesis of AchR-MG.