Synovitis in a Patient with IgG4-related Disease

Abstract

A 71-year-old man was admitted to our department due to arthralgia and renal dysfunction. A physical examination disclosed swelling of the right shoulder and left wrist joints. Laboratory tests showed elevated serum IgG4 and creatinine levels, and magnetic resonance imaging of the wrist revealed bone erosion and synovitis. In addition, fluorodeoxyglucose positron emission tomography showed uptake in the submandibular glands, pancreas, kidneys, and affected joints and a renal biopsy revealed tubulointerstitial nephritis with the infiltration of IgG4+ plasma cells. The patient was subsequently diagnosed with IgG4-related disease (IgG4-RD) and successfully treated with corticosteroid therapy. This case suggests that erosive arthritis may occur in patients with IgG4-RD.

A case of IgG4oligoarthritis mimicking psoriatic arthritis

“…The most commonly associated organs affected by IgG 4 disease include submandibular glands, lymph nodes, orbits, periaortic region in relation to retroperitoneal fibrosis3 and pancreas in the context of autoimmune pancreatitis 1 4. However, IgG 4 -RD resulting in inflammatory arthritis is a much less recognised disease process 5. We present a case of an aggressive oligoarthritis related to IgG 4 that was difficult to treat but responded to B cell depletion with rituximab.…”