Early Therapeutic Intervention for IgG4-related Dacryoadenitis and Sialadenitis: The Balance Between Risk of Observation Only and Therapeutic Adverse Effects

Immunoglobulin G4-related disease (IgG4-RD) is a systemic, chronic, and fibroinflammatory disorder1,2. Some problems remain to be resolved in IgG4-RD. We consider here the indication of therapeutic intervention for IgG4-RD. The correct time to initiate treatment remains unclear. Prescription of glucocorticoids is recommended for patients with clinical symptoms such as abdominal pain and obstructive jaundice, or other organ involvement in autoimmune pancreatitis3. One of the reasons is that such lesions show spontaneous improvement, although the frequency is low. We have previously reported steroid treatment for patients having IgG4-related sialadenitis more than 2 years, but that failed to improve salivary gland function4. We concluded that delayed therapeutic intervention in those cases had progressed to irreversible fibrosis in the involved organs. We have mainly treated IgG4-related dacryoadenitis and sialadenitis (IgG4-DS) in our department. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. All study-related recruitment and procedures were approved by the Sapporo Medical University Hospital Institutional Review Board (282-205). Participants provided written informed consent for … Address correspondence to Dr. M. Yamamoto, Department of Rheumatology and Clinical Immunology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido 0608543, Japan. E-mail: mocha{at}cocoa.plala.or.jp