International Consensus Guidance Statement on the Management and Treatment of IgG4-Related Disease

Published on Jul 1, 2015in Arthritis & Rheumatism9.586
· DOI :10.1002/ART.39132
Arezou Khosroshahi31
Estimated H-index: 31
(Emory University),
Zachary S. Wallace27
Estimated H-index: 27
(Harvard University)
+ 39 AuthorsJohn H. Stone94
Estimated H-index: 94
(Harvard University)
Sources
Abstract
A. Khosroshahi, Z. S. Wallace, J. L. Crowe, T. Akamizu, A. Azumi, M. N. Carruthers, S. T. Chari, E. Della-Torre, L. Frulloni, H. Goto, P. A. Hart, T. Kamisawa, S. Kawa, M. Kawano, M. H. Kim, Y. Kodama, K. Kubota, M. M. Lerch, M. L€ ohr, Y. Masaki, S. Matsui, T. Mimori, S. Nakamura, T. Nakazawa, H. Ohara, K. Okazaki, J. H. Ryu, T. Saeki, N. Schleinitz, A. Shimatsu, T. Shimosegawa, H. Takahashi, M. Takahira, A. Tanaka, M. Topazian, H. Umehara, G. J. Webster, T. E. Witzig, M. Yamamoto, W. Zhang, T. Chiba, and J. H. Stone
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Objectives To evaluate the efficacy of rituximab (RTX) in IgG4-related disease (IgG4-RD) in an open-label pilot trial. Methods We treated 30 IgG4-RD patients with two doses of RTX (1000 mg each). The participants were either treated with RTX alone (n = 26; 87%) or required to discontinue baseline glucocorticoids (GC) within 2 months (n = 4; 13%). Disease activity was measured by the IgG4-RD Responder Index (IgG4-RD RI) and physician9s global assessment (PGA). Disease response was defined as the ...
325 CitationsSource
#1Mollie N. Carruthers (Harvard University)H-Index: 15
#2Arezou Khosroshahi (Emory University)H-Index: 31
Last. John H. Stone (Harvard University)H-Index: 94
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Objectives We evaluated the sensitivity, specificity and positive and negative predictive values of elevated serum IgG4 concentrations for the diagnosis of IgG4-RD. Methods Between 2001 and 2011, 190 unique patients had elevated serum IgG4 measurements. We reviewed electronic medical records to determine the indication for IgG4 measurement and underlying clinical diagnosis. Additionally, we reviewed the records of 190 other randomly selected patients from a pool of 3360 with normal results, to e...
257 CitationsSource
#1Zachary S. Wallace (Harvard University)H-Index: 27
#2Hamid Mattoo (Harvard University)H-Index: 23
Last. John H. Stone (Harvard University)H-Index: 94
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Objectives We examined the utility of circulating total and IgG4+ plasmablasts as biomarkers of diagnosis and disease activity in IgG4-related disease (IgG4-RD). Materials methods We evaluated patients with active, untreated, biopsy-proven IgG4-RD affecting various organs. Flow cytometry was used to measure total plasmablast and IgG4+ plasmablast counts by gating peripheral blood for CD19lowCD38+CD20−CD27+ cells and CD19lowCD38+CD20−CD27+IgG4+ cells. Serum IgG4 concentrations were measured by ne...
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Abstract IgG4-related dacryoadenitis and sialoadenitis (IgG4-DS) is characterized by serum IgG4 elevation and the infiltration of IgG4-positive plasma cells in glandular tissues. For definitive diagnosis of IgG4-DS, biopsies of local lesions are recommended to exclude Sjogren's syndrome (SS), malignant tumours, and similar disorders. In this study, we examined the diagnostic utility of submandibular gland (SMG) and labial salivary gland (LSG) biopsies in IgG4-DS. Fourteen patients presenting wit...
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#1Hamid Mattoo (Harvard University)H-Index: 23
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Background IgG 4 -related disease (IgG 4 -RD) is a poorly understood, multiorgan, chronic inflammatory disease characterized by tumefactive lesions, storiform fibrosis, obliterative phlebitis, and accumulation of IgG 4 -expressing plasma cells at disease sites. Objective The role of B cells and IgG 4 antibodies in IgG 4 -RD pathogenesis is not well defined. We evaluated patients with IgG 4 -RD for activated B cells in both disease lesions and peripheral blood and investigated their role in disea...
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#1Ichiro Mizushima (Kanazawa University)H-Index: 13
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Introduction: Immunoglobulin G4 (IgG4)–related aortitis/periaortitis and periarteritis are vascular manifestations of IgG4-related disease. In this disease, the affected aneurysmal lesion has been suspected to be at risk of rupture. In this study, we aimed to clarify the clinical course after corticosteroid therapy in IgG4-related aortitis/periaortitis and periarteritis. Methods: We retrospectively evaluated clinical features, including laboratory data, imaging findings and the course after cort...
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#1Hiroyuki TakahashiH-Index: 13
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Abstract Objectives This study aimed to evaluate the utility of imaging techniques, including 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), in immunoglobulin (IgG)4-related disease (IgG4-RD). Methods We reviewed eight IgG4-RD patients who were referred to our hospital between August 2006 and April 2012. All cases underwent FDG-PET/CT and brain magnetic resonance imaging (MRI) and endobronchial ultrasonography (EBUS) were also performed in five cases and on...
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#1Carmela Caputo (St. Vincent's Health System)H-Index: 8
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Last. Warrick J. Inder (UQ: University of Queensland)H-Index: 30
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Purpose Fifteen cases of lymphocytic hypophysitis due to IgG4-related disease have been reported demonstrating marked improvement with corticosteroid therapy. This is the first case of IgG4-related hypophysitis demonstrating improvement with azathioprine, where corticosteroids were initially tried but ceased due to concern regarding enlargement of the pituitary infiltrate.
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Background: More recently, autoimmune pancreatitis (AIP) in association with IgG4-positive cholangitis (IAC) has been recognised as a new and challenging entity. Currently, initiation of high dose steroids (e. g., prednisolone 0.5 − 1 mg/kg/day) followed by a steroid dose taper in combination with purine antagonists (e. g., azathioprine or 6-mercaptopurine) after resolution has been recommended as standard therapy. Case Report: A 68-year-old male patient was referred to our institution in Februa...
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#1Shigeyuki Kawa (Shinshu University)H-Index: 67
#2Kazuichi Okazaki (Kansai Medical University)H-Index: 85
Last. Tooru Shimosegawa (Tohoku University)H-Index: 95
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Shigeyuki Kawa • Kazuichi Okazaki • Terumi Kamisawa • Keishi Kubo • Hirotaka Ohara • Osamu Hasebe • Yasunari Fujinaga • Atsushi Irisawa • Kenji Notohara • Tetsuhide Ito • Kazuo Inui • Hiroyuki Irie • Takayoshi Nishino • Isao Nishimori • Shigeki Tanaka • Toshimasa Nishiyama • Koichi Suda • Keiko Shiratori • Masao Tanaka • Tooru Shimosegawa • The Working Committee of the Japan Pancreas Society and the Research Committee for Intractable Pancreatic Disease supported by the Ministry of Health, Labour...
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#2J.-Matthias LöhrH-Index: 19
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#1Ichiro Mizushima (Kanazawa University)H-Index: 13
#2Masahiro Konishi (Kanazawa University)
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The outcomes of patients with immunoglobulin G4 (IgG4)-related disease (IgG4-RD) who are not treated are unclear. This study aimed to clarify these outcomes and identify the factors related to them. We retrospectively evaluated various clinical features including laboratory data and involved organs at diagnosis in 107 patients with IgG4-RD, who were followed up for more than 6 months, at a single center in Japan. We compared the clinical features of the 27 untreated patients with those of the 80...
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#1Atsushi Tanaka (Teikyo University)H-Index: 33
#2Kenji NotoharaH-Index: 41
Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is a chronic inflammatory disease that simultaneously or consecutively involves multiple organs of the body. It is characterized by elevated serum IgG4 levels and massive infiltration of IgG4+ plasma cells in the damaged tissues. IgG4-related autoimmune hepatitis (IgG4-AIH) and IgG4-hepatopathy are relatively new entities that have been proposed as a phenotype of IgG4-RD in the liver. Immunoglobulin G4-AIH is defined as a disorder with serologic...
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#1S. Andrew Skillington (WashU: Washington University in St. Louis)H-Index: 5
#2M. Allison Ogden (WashU: Washington University in St. Louis)H-Index: 7
IgG4-related disease is a rare, immune-mediated, systemic disease that is characterized by soft tissue lymphocyte infiltration and resultant fibrosis. The salivary glands are among the most commonly affected organs. Patients present with subacute submandibular and/or parotid swelling and sialadenitis. Diagnosis incorporates clinical, serologic, radiologic, and pathologic findings. Most cases respond quickly to systemic glucocorticoids. IgG4-related disease mimics many infectious, inflammatory, a...
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#1Benjamin P. Gummlich (GAU: University of Göttingen)
#2Philipp StröbelH-Index: 31
Last. Harald Schwörer (GAU: University of Göttingen)H-Index: 20
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BACKGROUND Immunoglobulin (Ig) G4-related disease is a rare disease of unknown pathophysiology, which can affect multiple organs leading to tissue fibrosis and organ failure. The present case report describes a patient with systemic IgG4-related disease (IgG4-RD) that occurred over a 1-year period and affected multiple organs at different times. Imaging studies, interventional procedures, changes in laboratory parameters, and histopathology demonstrate the novel and known aspects of this disease...
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#1Jin-Mei Zhang (Sichuan University)
#2Lei Zhao (Sichuan University)H-Index: 5
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BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is a chronic inflammatory systemic disease of unknown etiology that can affect one or multiple organs. The disease can mimic many infectious and inflammatory diseases, mainly causing organ enlargement or hyperplasia. Its diagnosis primarily relies on clinical, serologic, and histological features (lymphoplasmacytic infiltrates, storiform fibrosis, and obliterative phlebitis of IgG4 + plasma cells). Here, we report a rare case of IgG4-related...
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IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory disease characterised by dense lymphoplasmacytic infiltration rich in IgG4-positive plasma cells, storiform fibrosis and obliterative phlebitis. Serum IgG4 levels are typically elevated but half of the patients had normal serum IgG4 levels. IgG4-RD represents a spectrum of diseases that involve various organs such as the pancreas, liver, kidneys, and salivary glands often manifesting as diffuse organ enlargement or a mass-like lesion...
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A case of intractable IgG4-related orbital disease (IgG4-ROD) was successfully treated by debulking surgery combined with low-dose prednisolone and azathioprine as maintenance therapy. A 64-year-old man visited our clinic with progressive bilateral upper eyelid swelling and right eye fullness of a year’s duration. He was previously treated with systemic corticosteroids for the IgG4-ROD and experienced a partial clinical response but relapsed upon prednisolone cessation. The patient underwent deb...
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