Experience from the first UK inter-regional specialist multidisciplinary meeting in the diagnosis and management of IgG4-related disease
George Goodchild, Rory JR Peters, Tamsin Cargill, Harry Martin, Adetokunbo Fadipe, Maria Leandro, Adam Bailey, Jane Collier, Louisa Firmin, Manil Chouhan, Manuel Rodriguez‐Justo, Ross Sadler, Roger W. Chapman, Helen Bungay, Eve Fryer, Joel David, Raashid Luqmani, Eleanor Barnes, George Webster, Emma Culver
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a complex multisystem fibro-inflammatory disorder, requiring diagnostic differentiation from malignancy and other immune-mediated conditions, and careful management to minimise glucocorticoid-induced toxicity and prevent progressive organ dysfunction. We describe the experience of the first inter-regional specialist IgG4-RD multidisciplinary team meeting (MDM) incorporating a broad range of generalists and specialists, held 6-weekly via web-link between Oxford University Hospitals NHS Foundation Trust and University College London Hospitals NHS Foundation Trust. Over 3 years, there were 206 discussions on 156 patients. Of these, 97 (62%) were considered to have definite or possible IgG4-RD; 67% had multi-organ involvement and 23% had a normal serum IgG4. The average number of specialist opinions sought prior to MDM was four per patient. Management was changed in the majority of patients (74%) with the treatment escalation recommended in 61 cases, including 19 for rituximab. Challenges arose from delays and misdiagnosis, cross-specialty presentation and the management of sub-clinical disease. Our cross-discipline IgG4-RD MDM enabled important diagnostic and management decisions in this complex multisystem disorder, and can be used as a model for other centres in the UK.