Patel Utkarsh, Saxena Ayushi, Patel Dhara, Ayesha Ismat E, Monson Neetha R, Klair Nimra, Yu Ann Kashmer
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2023 Sep 11;15(9):e45044. doi: 10.7759/cureus.45044. eCollection 2023 Sep.
This research presents a systematic review focusing on rituximab's therapeutic applications in immunoglobulin G4 (IgG4)-related disease (IgG4-RD), a rare condition characterized by immune-mediated systemic inflammation and tissue fibrosis, as well as the clinical features of IgG4-RD. While the disease commonly affects organs such as the bile ducts, lymph nodes, retroperitoneum, pancreas, and salivary glands, it can potentially involve other organs. This intricacy often leads to diagnostic challenges due to clinical overlaps with cancer, infections, and other autoimmune disorders. The diagnosis of IgG4-RD necessitates a comprehensive approach involving laboratory tests, imaging studies, and clinical assessments. Symptoms can vary, ranging from lymphadenopathy to jaundice, affecting multiple organs. Although elevated blood IgG4 levels and findings of tissue involvement and fibrosis on imaging can be suggestive, they lack the specificity for a definitive diagnosis. Early diagnosis is crucial for initiating corticosteroids and immunosuppressive to prevent further damage from IgG4-RD. This study highlights the therapeutic role of rituximab in managing this condition. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, the research identifies and evaluates relevant literature across various electronic databases, including PubMed, ScienceDirect, and Google Scholar. This review includes 14 selected publications, comprising three systematic reviews, three observational studies, four narrative reviews, and four case reports. The study design ensures a comprehensive evaluation of rituximab's potential efficacy in treating IgG4-RD and its associated clinical characteristics. Based on this study, it can be concluded that IgG4-RD can potentially be treated with rituximab, particularly in cases of relapse and maintaining remission.
本研究进行了一项系统综述,重点关注利妥昔单抗在免疫球蛋白G4(IgG4)相关疾病(IgG4-RD)中的治疗应用,IgG4-RD是一种罕见疾病,其特征为免疫介导的全身炎症和组织纤维化,同时还关注了IgG4-RD的临床特征。虽然该疾病通常影响胆管、淋巴结、腹膜后、胰腺和唾液腺等器官,但也可能累及其他器官。由于与癌症、感染及其他自身免疫性疾病存在临床重叠,这种复杂性常常导致诊断困难。IgG4-RD的诊断需要综合运用实验室检查、影像学研究和临床评估。症状各异,从淋巴结病到黄疸,可累及多个器官。虽然血液中IgG4水平升高以及影像学上显示的组织受累和纤维化结果具有一定提示作用,但缺乏确诊的特异性。早期诊断对于启动皮质类固醇和免疫抑制治疗以预防IgG4-RD造成进一步损害至关重要。本研究强调了利妥昔单抗在治疗该疾病中的作用。该研究遵循系统评价和Meta分析的首选报告项目(PRISMA)标准,在包括PubMed、ScienceDirect和谷歌学术等多个电子数据库中识别并评估相关文献。本综述纳入了14篇选定的出版物,包括3篇系统综述、3篇观察性研究、4篇叙述性综述和4篇病例报告。该研究设计确保了对利妥昔单抗治疗IgG4-RD的潜在疗效及其相关临床特征进行全面评估。基于本研究,可以得出结论,IgG4-RD有可能用利妥昔单抗治疗,特别是在复发和维持缓解的情况下。