학술논문
Experience from the first UK inter-regional specialist multidisciplinary meeting in the diagnosis and management of IgG4-related disease.
Document Type
Article
Author
Goodchild, George; Peters, Rory J. R.; Cargill, Tamsin N.; Martin, Harry; Fadipe, Adetokunbo; Leandro, Maria; Bailey, Adam; Collier, Jane; Firmin, Louisa; Chouhan, Manil; Rodriguez-Justo, Manuel; Sadler, Ross; Chapman, Roger W.; Bungay, Helen; Fryer, Eve; David, Joel; Luqmani, Raashid; Barnes, Eleanor; Webster, George J.; Culver, Emma L.
Source
Subject
*ACADEMIC medical centers
*DIAGNOSIS
*DIAGNOSTIC errors
*HEALTH care teams
*IMMUNOGLOBULINS
*MEDICAL errors
*MEDICAL specialties & specialists
*NATIONAL health services
*MEETINGS
*WORLD Wide Web
*RITUXIMAB
*
*
*
*
*
*
*
*
*
*
Language
ISSN
1470-2118
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a complex multisystem fibro-inflammatory disorder, requiring diagnostic differentiation from malignancy and other immunemediated 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. [ABSTRACT FROM AUTHOR]