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A clinical overview of IgG4-related systemic disease

Khosroshahi, Arezou; Stone, John H

Current Opinion in Rheumatology: January 2011 - Volume 23 - Issue 1 - p 57–66
doi: 10.1097/BOR.0b013e3283418057
Systemic disorders with rheumatic manifestations: Edited by John Stone and Arezou Khosroshahi

Purpose of review To summarize the existing knowledge of various clinical presentations of IgG4-related systemic disease (IgG4-RSD) and to review the evolving list of organs affected by IgG4-RSD.

Recent findings The term IgG4-RSD encompasses a variety of clinical entities once regarded as being entirely separate diseases. The list of organs associated with this condition is growing steadily. Tissue biopsies reveal striking histopathological similarity, regardless of which organ is involved, although subtle differences across organs exist. Diffuse lymphoplasmacytic infiltrates, presence of abundant IgG4-positive plasma cells and extensive fibrosis are the hallmark pathology findings. Tumorous swelling, eosinophilia, and obliterative phlebitis are other frequently observed features. Polyclonal elevations of serum IgG4 are found in most but not all patients.

Summary IgG4-RSD is an underrecognized condition about which knowledge is now growing rapidly. Yet there remain many unknowns with regard to its cause, pathogenesis, various clinical presentations, approach to treatment, disease monitoring, and long-term outcomes. A wide variety of organs can be involved in IgG4-RSD. Clinicians should be aware of this entity and consider the diagnosis in the appropriate settings.

Rheumatology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence to Arezou Khosroshahi, MD, Rheumatology Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA Tel: +1 617 726 2870; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.