PT  - JOURNAL ARTICLE
AU  - George Goodchild
AU  - Rory JR Peters
AU  - Tamsin N Cargill
AU  - Harry Martin
AU  - Adetokunbo Fadipe
AU  - Maria Leandro
AU  - Adam Bailey
AU  - Jane Collier
AU  - Louisa Firmin
AU  - Manil Chouhan
AU  - Manuel Rodriguez-Justo
AU  - Ross Sadler
AU  - Roger W Chapman
AU  - Helen Bungay
AU  - Eve Fryer
AU  - Joel David
AU  - Raashid Luqmani
AU  - Eleanor Barnes
AU  - George J Webster
AU  - Emma L Culver
TI  - Experience from the first UK inter-regional specialist multidisciplinary meeting in the diagnosis and management of IgG4-related disease
AID  - 10.7861/clinmed.2019-0457
DP  - 2020 May 01
TA  - Clinical Medicine
PG  - e32--e39
VI  - 20
IP  - 3
4099  - http://www.rcpjournals.org/content/20/3/e32.short
4100  - http://www.rcpjournals.org/content/20/3/e32.full
SO  - Clin Med2020 May 01; 20
AB  - 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