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Martín-Nares E, Baenas DF, Cuellar Gutiérrez MC, Hernández-Molina G, Ortiz AC, Neira O, Gutiérrez MA, Calvo R, Saad EJ, Elgueta Pinochet S, Gallo J, Herrera Moya A, Mansilla Aravena BA, Crespo Espíndola ME, Cairoli E, Bertoli AM, Córdoba M, Wurmann Kiblisky P, Basualdo Arancibia WJ, Badilla Piñeiro MN, Gobbi CA, Berbotto GA, Pisoni CN, Juárez V, Cosatti MA, Aste NM, Airoldi C, Llanos C, Vergara Melian CF, Erlij Opazo D, Goecke A, Pastenes Montaño PA, Tate P, Pirola JP, Stange Núñez L, Burgos PI, Mezzano Robinson MV, Michalland H S, Silva Labra F, Labarca Solar CH, Lencina MV, Izquierdo Loaiza JH, Del Castillo Gil DJ, Caeiro F, Paira S. Clinical and Serological Features in Latin American IgG4-Related Disease Patients Differ According to Sex, Ethnicity, and Clinical Phenotype. J Clin Rheumatol 2022; 28:285-292. [PMID: 35612589 DOI: 10.1097/rhu.0000000000001858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/OBJECTIVE Data on IgG4-related disease (IgG4-RD) come almost exclusively from cohorts from Asia, Europe, and North America. We conducted this study to describe the clinical presentation, phenotype distribution, and association with sex, ethnicity, and serological markers in a large cohort of Latin American patients with IgG4-RD. METHODS We performed a multicenter medical records review study including 184 Latin American IgG4-RD patients. We assigned patients to clinical phenotypes: group 1 (pancreato-hepato-biliary), group 2 (retroperitoneal/aortic), group 3 (head and neck-limited), group 4 (Mikulicz/systemic), and group 5 (undefined). We focused the analysis on how sex, ethnicity, and clinical phenotype may influence the clinical and serological presentation. RESULTS The mean age was 50.8 ± 15 years. Men and women were equally affected (52.2% vs 48.8%). Fifty-four patients (29.3%) were assigned to group 1, 21 (11.4%) to group 2, 57 (30.9%) to group 3, 32 (17.4%) to group 4, and 20 (10.8%) to group 5. Male sex was associated with biliary tract (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.36-8.26), kidney (OR, 3.4; 95% CI, 1.28-9.25), and retroperitoneal involvement (OR, 5.3; 95% CI, 1.45-20). Amerindian patients presented more frequently with atopy history and gallbladder involvement. Group 3 had a female predominance. CONCLUSIONS Latin American patients with IgG4-RD were younger, and men and women were equally affected compared with White and Asian cohorts. They belonged more commonly to group 1 and group 3. Retroperitoneal and aortic involvement was infrequent. Clinical and serological features differed according to sex, ethnicity, and clinical phenotype.
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Affiliation(s)
- Eduardo Martín-Nares
- From the Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Diego Federico Baenas
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | | | - Gabriela Hernández-Molina
- From the Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | | | | | - Miguel A Gutiérrez
- Departamento de Reumatologia, Hospital Naval Almirante Nef, Universidad de Valparaíso, Viña del Mar, Chile
| | - Romina Calvo
- Sección de Reumatología, Hospital José María Cullen, Santa Fe, Argentina
| | - Emanuel José Saad
- Departamento de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Sergio Elgueta Pinochet
- Departamento de Medicina, Sección Reumatología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Jesica Gallo
- Sección de Reumatología, Hospital Central de Reconquista, Reconquista, Santa Fe, Argentina
| | - Alejandra Herrera Moya
- Departamento de Inmunología Clínica y Reumatología, Pontificia Universidad Católica de Chile, Santiago
| | | | | | | | - Ana María Bertoli
- Servicio de Reumatología, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Mercedes Córdoba
- Servicio de Reumatología, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Pamela Wurmann Kiblisky
- Sección Reumatología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | | | - Carla Andrea Gobbi
- Cátedra de Clínica Médica I, Hospital Córdoba, Facultad de Ciencias Médicas, UNC, Córdoba
| | | | - Cecilia N Pisoni
- Sección Reumatología e Inmunología, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno," CABA, Buenos Aires
| | | | - Micaela Ana Cosatti
- Sección Reumatología e Inmunología, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno," CABA, Buenos Aires
| | | | - Carla Airoldi
- Reumatología, Hospital Provincial, Rosario, Argentina
| | - Carolina Llanos
- Departamento de Inmunología Clínica y Reumatología, Pontificia Universidad Católica de Chile, Santiago
| | | | - Daniel Erlij Opazo
- Departamento de Medicina Oriente, Hospital del Salvador, Universidad de Chile
| | - Annelise Goecke
- Servicio de Reumatología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago
| | | | | | | | | | - Paula I Burgos
- Departamento de Inmunología Clínica y Reumatología, Pontificia Universidad Católica de Chile, Santiago
| | | | | | - Francisco Silva Labra
- Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Hospital Padre Hurtado, Santiago, Chile
| | | | | | | | | | - Francisco Caeiro
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Sergio Paira
- Sección de Reumatología, Hospital José María Cullen, Santa Fe, Argentina
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Peng L, Zhang P, Li J, Liu Z, Lu H, Zhu L, Wang X, Teng F, Li X, Guo H, Fei Y, Zhang W, Zhao Y, Zeng X, Zhang F. IgG4-related aortitis/periaortitis and periarteritis: a distinct spectrum of IgG4-related disease. Arthritis Res Ther 2020; 22:103. [PMID: 32366271 PMCID: PMC7197178 DOI: 10.1186/s13075-020-02197-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Large vessels could be involved in immunoglobulin (Ig)-G4-related disease (IgG4-RD). This study aimed to clarify the clinical features and evaluate the treatment efficacy for IgG4-RD with aortitis/periaortitis and periarteritis (PAO/PA). METHODS This study prospectively enrolled 587 patients with IgG4-RD with a follow-up time of more than 6 months. The distribution of IgG4-related PAO/PA was classified into four types: type 1, thoracic aorta; type 2a, abdominal aorta; type 2b, abdominal aorta and iliac artery; type 2c, iliac artery; type 3, thoracic and abdominal aorta; and type 4, other arteries. Patient's demographic data, clinical characteristics, laboratory parameters, and treatment efficacy were analyzed. RESULTS Of 587 IgG4-RD patients, 89 (15.2%) had PAO/PA. The average age was 58.3 ± 11.1 years, with male predominance (85.4%). Vessels affected were as follows: abdominal aorta (83.1%), iliac artery (70.8%), thoracic aorta (13.5%), and other vessels (13.5%). The most prevalent distribution type of IgG4-related PAO/PA was type 2b, with 74 (83.1%) patients, followed by type 2a, type 2c, type 3, and type 1. Fifty-five (61.8%) PAO/PA patients had hydronephrosis, with renal insufficiency occurring in 43 (48.3%), and 31 (34.8%) PAO/PA patients had D-J stent drainage due to severe ureteral obstruction. After treatment with a glucocorticoid and immunosuppressants, 82% patients achieved remission with shrinking of the perivascular mass by more than 30%. CONCLUSIONS IgG4-RD with PAO/PA was distinct from non-PAO/PA in demographic features, organ involvement distribution, inflammatory markers, and serum IgG4 and IgE. The most common affected vessel was the abdominal aorta, and most patients responded well with treatment.
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Affiliation(s)
- Linyi Peng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Panpan Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Jieqiong Li
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Zheng Liu
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Hui Lu
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Liang Zhu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiaorong Wang
- Department of Rheumatology, The First People's Hospital of Yangquan, Yangquan, China
| | - Fei Teng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Huifang Guo
- Department of Rheumatology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yunyun Fei
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Wen Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.
| | - Yan Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
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Arafat AA, Torky MA, Elhamshary M, Aboelnasr M. Immunoglobulin G4 Thymic Tumor. Ann Thorac Surg 2019; 108:e229-e231. [PMID: 30914283 DOI: 10.1016/j.athoracsur.2019.02.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 12/24/2022]
Abstract
Thymic immunoglobulin G4 (IgG4) is a rare entity that can mimic anterior mediastinal tumors. Preoperative diagnosis is essential to prevent unnecessary surgery. Little is known about disease presentation, diagnosis, and response to therapy. A 40-year-old man presented with retrosternal chest pain. A roentgenogram showed an anterior mediastinal mass. Intraoperatively, dense adhesions to the phrenic nerve, aorta, and pulmonary artery deemed the tumor unresectable. Thymic IgG4 disease was diagnosed on the basis of tissue biopsy. The patient's postoperative serum IgG4 level was elevated, and no other organ was affected. The patient responded to prednisolone therapy, and after 18 months of follow-up, there was no recurrence or involvement of other organs.
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Affiliation(s)
- Amr A Arafat
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt.
| | - Mohammad A Torky
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | | | - Mohamed Aboelnasr
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
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