AB0758 CLINICAL PROFILES DIFFER IN IGG4-RELATED DISEASE WITH AND WITHOUT ATOPY: A LARGE CASE-CONTROL STUDY IN CHINA
Authors: Z. Zhao, Y. Liu, Y. Su
Journal: Annals of the Rheumatic Diseases (2021)

Background: IgG4-related ophthalmic disease (IgG4-ROD) is one of the phenotypes of IgG4-related disease (IgG4-RD), and its lesions are mainly located in the ocular. Currently, there are few studies on IgG4-ROD and no study has compared the phenotypic differences between IgG4-ROD and non IgG4-ROD (nIgG4-ROD). Thus, it is difficult to establish the optimal treatment strategy for IgG4-ROD. Objectives: The aim of this study was to identify the disparities between the two groups and to clarify the risk factors for IgG4-ROD relapse. Methods: The IgG4-RD patients diagnosed at Peking University People’s Hospital between January 2009 and January 2020 were recruited in this study. Patients were divided into IgG4-ROD and nIgG4-ROD group according to the ophthalmic involvement. Demographic, clinical and laboratory data of two groups were collected and compared. Cox regression analysis was used to identify the independent risk factors for IgG4-ROD relapse. Results: Two hundred and fifty-five cases of IgG4-ROD were identified in 434 IgG4-RD patients in this study. IgG4-ROD group had almost equal sex ratio (male to female 0.96:1 vs 2.14:1, P &lt;0.001), younger age of disease onset (51.1±13.2 vs 55.5±13.5, P &lt;0.001) and diagnosis (54.4±12.6 vs 56.9±13.4, P =0.054) comparing with nIgG4-ROD patients. As compared to nIgG4-ROD group, higher percentage of IgG4-ROD patients met the 2019 American College of Rheumatology/European League Against Rheumatism classification criteria (AECC) for IgG4-RD (89.4% vs 64.8%, P &lt;0.001), moreover, IgG4-ROD patients had higher AECC scores (37.0±12.9 vs 27.2±14.0, P &lt;0.001) and IgG4-RD responder index (11.4±6.0 vs 10.2±6.3, P= 0.045). Allergic diseases (65.5% vs 26.3%, P &lt;0.001) and multiorgan involvement [6(4-7) vs 3(2-5), P &lt;0.001] were more common in IgG4-ROD group. IgG4-ROD was frequently associated with salivary gland (92.5% vs 45.3%, P &lt;0.01), paranasal sinuses (38.8% vs 12.8%, P &lt;0.01), lung (47.8% vs 32.4%, P &lt;0.01) and lymph node (64.3% vs 46.4%, P &lt;0.01) involvement, while retroperitoneal fibrosis (7.1% vs 21.2%, P &lt;0.01) and biliary system lesions (25.1% vs 35.2%, P &lt;0.05) were more common in nIgG4-ROD. IgG4-ROD patients had higher serum IgG4 levels [983(409-1838) vs 523(225-1370), P &lt;0.001], IgG4/IgG ratio [0.529(0.272-0.879) vs 0.294(0.143-0.629), P &lt;0.001], IgE levels [339.7(160.8-847.6) vs 259.4(83.1-653.3), P= 0.022] and lower CRP levels [2.24(1.00-4.70) vs 3.05(1.26-12.45), P= 0.004]. The initial glucocorticoid plus immunosuppressant was a protective factor for IgG4-ROD relapse (HR 0.279, 95%CI 0.165-0.470, P&lt;0.001), and IgG4-ROD patients treated with initial glucocorticoid plus immunosuppressant had longer relapse-free survival time than patients treated with initial glucocorticoid monotherapy (43 vs 17, P&lt;0.001). Conclusion: IgG4-ROD patients had distinctive clinical features compared with nIgG4-ROD patients. The initial glucocorticoid plus immunosuppressant was a protective factor for IgG4-ROD relapse, which could prolong the relapse-free survival time of IgG4-ROD patients. These findings may have important implications for understanding and management of IgG4-ROD. Disclosure of Interests: None declared