Current approach to the diagnosis of IgG4-related disease – Combination of comprehensive diagnostic and organ-specific criteria

Abstract

IgG4-related disease (IgG4-RD) is a fascinating clinical entity proposed by Japanese investigators, and includes a wide variety of diseases, formerly diagnosed as Mikulicz's disease (MD), autoimmune pancreatitis (AIP), interstitial nephritis, prostatitis, retroperitoneal fibrosis, etc. Although all clinicians in every field of medicine may encounter this new disease, a unifying diagnostic criterion has not been established. In 2011, the Japanese IgG4 team, organized by the Ministry of Health, Labor and Welfare (MHLW) of Japan, published comprehensive diagnostic criteria for IgG4-RD. Several problems with these criteria have arisen in clinical practice, however, including the difficulty obtaining biopsy samples from some patients, and the sensitivity and the specificity of techniques used to measure serum IgG4 concentrations. Although serum IgG4 concentration is an important clinical marker for IgG4-RD, its diagnostic utility in differentiating IgG4-RD from other diseases, called IgG4-RD mimickers, remains unclear. This review describes the current optimal approach for the diagnosis of IgG4-RD, based on both comprehensive and organ-specific diagnostic criteria, in patients with diseases such as IgG4-related pancreatitis (AIP), sclerosing cholangitis, and renal, lung and orbital diseases.

Keywords:

• IgG4-RD
• diagnostic criteria
• Mikulicz’s disease
• autoimmune pancreatitis
• sclerosing cholangitis
• orbital disease

Acknowledgements

The authors sincerely thank the many contributing researchers and collaborators who participated in all Japan IgG4 team.

Conflict of interest

None.

Additional information

Funding

This work was supported by Intractable Diseases, the Health and Labor Sciences Research Grants from Ministry of Health, Labour and Welfare, Japan.