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IgG4-related disease in a multi-ethnic community: Clinical characteristics and association with malignancy

QJM: An International Journal of Medicine, ISSN: 1460-2393, Vol: 112, Issue: 10, Page: 763-769
2019
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Article Description

Background: Immunoglobulin-G4-related disease (IgG4-RD) is a recently recognized fibro-inflammatory condition that can affect multiple organs. Despite growing interest in this condition, the natural history and management of IgG4-RD remain poorly understood. Aim: To describe the clinical characteristics, treatment and outcomes of IgG4-RD in a multi-ethnic UK cohort, and investigate its possible association with malignancy. Design: Retrospective analysis of case-note and electronic data. Methods: Cases were identified from sub-specialty cohorts and a systematic search of an NHS trust histopathology database using 'IgG4' or 'inflammatory pseudotumour' as search terms. Electronic records, imaging and histopathology reports were reviewed. Results: In total, 66 identified cases of IgG4-RD showed a similar multi-ethnic spread to the local population of North West London. The median age was 59 years and 71% of patients were male. Presenting symptoms relating to mass effect of a lesion were present in 48% of cases and the mean number of organs involved was 2.4. Total of 10 patients had reported malignancies with 6 of these being haematological. 83% of those treated with steroids had good initial response; however, 50% had relapsing-remitting disease. Rituximab was administered in 11 cases and all achieved an initial serological response. Despite this, seven patients subsequently relapsed after a mean duration of 11 months and four progressed despite treatment. Conclusions: We report a large UK-based cohort of IgG4-RD that shows no clear ethnic predisposition and a wide range of affected organs. We discuss the use of serum IgG4 concentrations as a disease marker in IgG4-RD, the association with malignant disease and outcomes according to differing treatment regimens.

Bibliographic Details

S. X. Poo; C. S.W. Tham; J. Lee; T. Cairns; J. Galliford; J. B. Levy; S. P. McAdoo; F. Wernig; J. C. Mason; C. D. Pusey; F. W.K. Tam; J. A.P. Tomlinson; S. Hamdulay; M. Jacyna; C. Smith; C. Roufosse

Oxford University Press (OUP)

Medicine

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