Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011.
BACKGROUND
IgG4-related disease (IgG4-RD) is a novel clinical disease entity characterized by elevated serum IgG4 concentration and tumefaction or tissue infiltration by IgG4+ plasma cells. Although IgG4-RD is not rare and is clinically important, its clinical diagnostic criteria have not been established. Comprehensive diagnostic criteria for IgG4-RD, including the involvement of various organs, are intended for the practical use of general physicians and nonspecialists.


METHODS
Two IgG4-RD study groups, the Umehara and Okazaki teams, were organized by the Ministry of Health, Labor and Welfare Japan. As IgG4-RD comprises a wide variety of diseases, these groups consist of physicians and researchers in various disciplines, including rheumatology, hematology, gastroenterology, nephrology, pulmonology, ophthalmology, odontology, pathology, statistics, and basic and molecular immunology throughout Japan, with 66 and 56 members of the Umehara and Okazaki teams, respectively. Collaborations of the two study groups involved detailed analyses of clinical symptoms, laboratory results, and biopsy specimens of patients with IgG4-RD, resulting in the establishment of comprehensive diagnostic criteria for IgG4-RD.


RESULTS
Although many patients with IgG4-RD have lesions in several organs, either synchronously or metachronously, and the pathological features of each organ differ, consensus has been reached on two diagnostic criteria for IgG4RD: (1) serum IgG4 concentration >135 mg/dl, and (2) >40% of IgG+ plasma cells being IgG4+ and >10 cells/high powered field of biopsy sample. Although the comprehensive diagnostic criteria are not sufficiently sensitive for the diagnosis of type 1 IgG4-related autoimmune pancreatitis (IgG4-related AIP), they are adequately sensitive for IgG4-related Mikulicz's disease (MD) and kidney disease (KD). In addition, the comprehensive diagnostic criteria, combined with organ-specific diagnostic criteria, have increased the sensitivity of diagnosis to 100% for IgG4-related MD, KD, and AIP.


CONCLUSIONS
Our comprehensive diagnostic criteria for IgG4-RD are practically useful for general physicians and nonspecialists.
Department of Hematology and Immunology, Kanazawa Medical University, Kanazawa, Ishikawa, Japan. umehara@kanazawa-med.ac.jp
Hisanori
H
Umehara
Kazuichi
K
Okazaki
Yasufumi
Y
Masaki
Mitsuhiro
M
Kawano
Motohisa
M
Yamamoto
Takako
T
Saeki
Shoko
S
Matsui
Tadashi
T
Yoshino
Shigeo
S
Nakamura
Shigeyuki
S
Kawa
Hideaki
H
Hamano
Terumi
T
Kamisawa
Toru
T
Shimosegawa
Akira
A
Shimatsu
Seiji
S
Nakamura
Tetsuhide
T
Ito
Kenji
K
Notohara
Takayuki
T
Sumida
Yoshiya
Y
Tanaka
Tsuneyo
T
Mimori
Tsutomu
T
Chiba
Michiaki
M
Mishima
Toshifumi
T
Hibi
Hirohito
H
Tsubouchi
Kazuo
K
Inui
Hirotaka
H
Ohara
D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007400:Interprofessional Relations; D008297:Male; D008882:Mikulicz' Disease / Q000175:diagnosis / Q000276:immunology; D009395:Nephritis, Interstitial / Q000175:diagnosis / Q000276:immunology; D010195:Pancreatitis / Q000175:diagnosis / Q000276:immunology; D010950:Plasma Cells / Q000276:immunology / Q000473:pathology*
D007074:Immunoglobulin G