Yanying Liu1, Qiaozhu Zeng1, Lijuan Zhu2, Jingyuan Gao3, Ziqiao Wang1, Zhenfan Wang1, Fei Yang4, Kunkun Wang5, Da Chen1, Changsheng Xia6, Shanshan Zhang7, Yi Wang8, Danhua Shen4, Guangyan Yu9, Zhan-Guo Li1. 1. Department of Rheumatology and Immunology, Peking University People's Hospital, BeijingChina. 2. Department of Rheumatology and Immunology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, HenanChina. 3. Department of Rheumatology and Immunology, Affiliated Hospital of North China University of Science and Technology, Tangshan, HebeiChina. 4. Department of Pathology, Peking University People's Hospital, BeijingChina. 5. Department of Rheumatology and Immunology, Tengzhou Central People's Hospital, Tengzhou, ShandongChina. 6. Department of Clinical LaboratoryPeking University People's Hospital, Beijing, China. 7. Department of UltrasoundPeking University People's Hospital, Beijing, China. 8. Department of Radiology, Peking University People's Hospital, Beijing, China. 9. Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing, China.
Abstract
OBJECTIVES: Patients with IgG4-related disease (IgG4-RD) typically respond well to initial glucocorticoid therapy, but always relapse with tapered or maintenance dosage of steroid. We aimed to identify the risk factors for relapse of IgG4-RD and explore the impact of active intervention on the serologically unstable condition. METHODS: We performed a retrospective study of 277 IgG4-RD patients at Peking University People's Hospital from February 2012 through February 2019. They were all followed for >4 months. The primary outcome was patient relapse. Data on recurrence of IgG4-RD symptoms, laboratory and image findings were recorded, along with information on treatment in the serologically unstable condition. RESULTS: The cumulative relapse rate was 12.86%, 27.84% and 36.1% at 12, 24 and 36 months, respectively. Younger age at onset, younger age at diagnosis, longer time from diagnosis to treatment and history of allergy were associated with relapse. Identified independent risk factors were longer time from diagnosis to treatment and history of allergy. When serum IgG4 level was 20%, 50% or 100% higher than that of the remission period, similar percentages of patients finally relapsed, regardless of whether they were in the immunosuppression intensified or non-intensified group. Median duration from serum IgG4 level instability to relapse in the intensified and non-intensified group was not statistically different. CONCLUSION: The risk factors of relapse were longer time from diagnosis to treatment and history of allergy. Intervention in the serologically unstable condition was not helpful for reducing relapse rate.
OBJECTIVES:Patients with IgG4-related disease (IgG4-RD) typically respond well to initial glucocorticoid therapy, but always relapse with tapered or maintenance dosage of steroid. We aimed to identify the risk factors for relapse of IgG4-RD and explore the impact of active intervention on the serologically unstable condition. METHODS: We performed a retrospective study of 277 IgG4-RD patients at Peking University People's Hospital from February 2012 through February 2019. They were all followed for >4 months. The primary outcome was patient relapse. Data on recurrence of IgG4-RD symptoms, laboratory and image findings were recorded, along with information on treatment in the serologically unstable condition. RESULTS: The cumulative relapse rate was 12.86%, 27.84% and 36.1% at 12, 24 and 36 months, respectively. Younger age at onset, younger age at diagnosis, longer time from diagnosis to treatment and history of allergy were associated with relapse. Identified independent risk factors were longer time from diagnosis to treatment and history of allergy. When serum IgG4 level was 20%, 50% or 100% higher than that of the remission period, similar percentages of patients finally relapsed, regardless of whether they were in the immunosuppression intensified or non-intensified group. Median duration from serum IgG4 level instability to relapse in the intensified and non-intensified group was not statistically different. CONCLUSION: The risk factors of relapse were longer time from diagnosis to treatment and history of allergy. Intervention in the serologically unstable condition was not helpful for reducing relapse rate.