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Cited by 13IgG4-Related and Inflammatory DiseasesSystemic Sclerosis and Related DiseasesImmunodeficiency and Autoimmune Disorders

Experience from the First UK Inter-Regional Specialist Multidisciplinary Meeting in the Diagnosis and Management of IgG4-Related Disease

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Goodchild, George, Peters, Rory JR, Cargill, Tamsin N, Martin, Harry, Fadipe, Adetokunbo, Leandro, Maria, Bailey, Adam, Collier, Jane +12 more·2020·Clinical Medicine
DOI 10.7861/clinmed.2019-0457PMC PMC7354052
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Abstract

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.

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  • This can result in unnecessary tests, delays, and misdiagnoses as patients are referred between specialists without a unified approach to diagnosis.

    “This can result in unnecessary tests, delays, and misdiagnoses as patients are referred between specialists without a unified approach to diagnosis [88,274].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [274]

    The Structure of the IgG4-RD MDM section says patients may see multiple specialists who struggle to unify a diagnosis, leading to delays. The Referral pathway reports an average of four specialists before MDM referral, and the Discussion describes patients treated for presumed cancer before IgG4-RD was diagnosed. The cited passages do not establish that this pathway results in unnecessary tests. (LLM, conf=0.86)

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  • Before an accurate diagnosis is made for IgG4-RD, unnecessary surgeries or treatments are usually conducted due to multiple referrals for misdiagnosed conditions.

    “Before an accurate diagnosis is made, unnecessary surgeries or treatments are usually conducted due to multiple referrals for misdiagnosed conditions [274].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [274]

    The Introduction says misdiagnosis can lead to unnecessary surgery or delayed treatment, and the Discussion reports two patients treated for presumed cancer before IgG4-RD was diagnosed. The Referral pathway says patients had seen an average of four specialists, but the paper does not say unnecessary procedures or treatments usually occurred, or that multiple referrals caused them. Page numbers are unavailable in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Patients with IgG4-related disease (IgG4-RD), a rare inflammatory condition with symptoms associated with cancers or autoimmune disorders, ultimately often consult multiple specialists.

    “For example, patients with IgG4-related disease (IgG4-RD), a rare inflammatory condition with symptoms associated with cancers or autoimmune disorders, ultimately often consult multiple specialists.”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [274]

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References 36 · Cited by 13

Research works printed but not linked: 32

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Authors
Goodchild, G., Peters, R. J., Cargill, T. N., Martin, H., Fadipe, A., Leandro, M., Bailey, A., Collier, J., Firmin, L., Chouhan, M., Rodriguez-Justo, M., Sadler, R., Chapman, R. W., Bungay, H., Fryer, E., David, J., Luqmani, R., Barnes, E., Webster, G. J., & Culver, E. L.
Affiliations
  • University College London Hospitals NHS Foundation Trust (GB)
  • University of Oxford (GB)
  • Oxford University Hospitals NHS Trust (GB)
ORCID
Venue
Clinical Medicine
Publisher
Elsevier BV
Published
2020-05
Volume
20
Issue
3
Pages
e32-e39
ISSN
1470-2118 (ISSN-L)
DOI
10.7861/clinmed.2019-0457
PMC
PMC7354052
OpenAlex
W3025324858
Cited by
13
References
36
Citations by year
2026: 4 · 2025: 2 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 1
FWCI
1.32
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute for Health and Care Research (ACF-2015-13-007, NF-SI-0617-10139)
  • Department of Health and Social Care
  • Academy of Medical Sciences (SGL020\1037)
  • University of Oxford
  • Oxford University Hospitals NHS Foundation Trust
Topics
  • Health Sciences › Medicine › Rheumatology › IgG4-Related and Inflammatory Diseases
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Systemic Sclerosis and Related Diseases
  • Life Sciences › Immunology and Microbiology › Immunology › Immunodeficiency and Autoimmune Disorders
Keywords
IgG4-related disease, multidisciplinary team meetings, fibroinflammatory disease, delayed diagnosis, misdiagnosis, treatment escalation, rituximab, multi-organ involvement, telemedicine, cross-specialty collaboration
MeSH terms
Immunoglobulin G4-Related Disease, United Kingdom, Humans, Immunoglobulin G, London, Specialization

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