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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

Arthritis Research & Therapy 1/2018

Treatment of immunoglobulin G4-related sialadenitis: outcomes of glucocorticoid therapy combined with steroid-sparing agents

Zeitschrift:
Arthritis Research & Therapy > Ausgabe 1/2018
Autoren:
Xia Hong, Yan-Yan Zhang, Wei Li, Yan-Ying Liu, Zhen Wang, Yan Chen, Yan Gao, Zhi-Peng Sun, Xin Peng, Jia-Zeng Su, Zhi-Gang Cai, Lei Zhang, Jing He, Li-Min Ren, Hong-Yu Yang, Zhan-Guo Li, Guang-Yan Yu
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:https://​doi.​org/​10.​1186/​s13075-017-1507-6) contains supplementary material, which is available to authorized users.

Abstract

Background

Immunoglobulin G4-related sialadenitis (IgG4-RS) is a newly recognized immune-mediated systemic disease. Despite its good response to steroid therapy, its treatment protocol is not standardized and the long-term outcome is controversial. The study was conducted to determine the short-term and long-term outcomes of IgG4-RS patients treated with glucocorticoids and steroid-sparing immunosuppressive agents, to analyze secretory function, serological and radiological changes in salivary glands and to assess the usefulness of serum IgG4 level as an indicator of disease activity.

Methods

IgG4-RS patients who were treated for more than 3 months were enrolled. Serological tests, salivary gland function assessment and computed tomography (CT) were performed before treatment and during follow up. The treatment outcomes in the short and the long term were evaluated, and the relationship between serum IgG4 level and salivary gland volume was analyzed.

Results

Glucocorticoids were used in all 43 patients and steroid-sparing immunosuppressive agents in 38 patients (88.4%). The follow-up period was 24.6 ± 14.9 months. Clinical remission was achieved in all patients after induction therapy. During short-term observation, salivary gland secretion significantly increased, and the serum IgG4 levels, the volumes and CT values of submandibular and parotid gland decreased significantly (P < 0.001). For long term, relapse occurred in 32.5% patients within 55 months in the regularly treated group, while all seven irregularly treated patients relapsed. However, the relapse-free survival curves were not significantly different between the steroid monotherapy and the combination therapy groups (P = 0.566). Submandibular glands, lacrimal glands, sublingual glands, nasal and paranasal cavity were commonly relapsing organs. In clinically stable patients, a serologically unstable condition occurred in 54.9% patients within 55 months and medication adjustment was performed accordingly. Volume changes in the submandibular and parotid glands were associated with serum IgG4 levels and time of follow up (R2adjusted = 0.905, P < 0.0001 and R2adjusted = 0.9334, P < 0.0001, respectively).

Conclusions

The combination of glucocorticoid and steroid-sparing agents could be effective for treating IgG4-RS, and restoring salivary gland function. Serum IgG4 levels could predict disease activity.
Zusatzmaterial
Additional file 1: Detailed information on scintigraphy assessments. (PDF 194 kb)
13075_2017_1507_MOESM1_ESM.pdf
Additional file 2: Supplementary figure for volume rendering of submandibular and parotid glands before and after treatment. (PDF 285 kb)
13075_2017_1507_MOESM2_ESM.pdf
Additional file 3: Supplementary figure for relationship between the short-term IgG4 levels after treatment and the baseline levels. (PDF 289 kb)
13075_2017_1507_MOESM3_ESM.pdf
Additional file 4: Supplementary tables for comparing the baseline features between different groups. (PDF 298 kb)
13075_2017_1507_MOESM4_ESM.pdf
Literatur
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