Department of Rheumatology and Allergy, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.
Mod Rheumatol Case Rep. 2024 Jul 8;8(2):339-343. doi: 10.1093/mrcr/rxae025.
Glucocorticoids (GC) are the standard of care for the induction and maintenance of remission in immunoglobulin G4 (IgG4)-related diseases. However, IgG4-related diseases often relapse with GC dose reduction, not only making GC dose reduction difficult but also necessitating GC dose escalation in many cases. Therefore, other immunosuppressive drugs are required to maintain remission. Here, we report a 39-year-old man with ulcerative colitis and IgG4-related disease who experienced a relapse of both diseases despite treatment with tacrolimus and 6-mercaptopurine. Following the initiation of tofacitinib, a Janus-associated kinase inhibitor, it was possible to reduce the GC dose while maintaining remission of both diseases. This case highlights the potential utility of Janus-associated kinase inhibitors in managing complex cases of IgG4-related disease, especially those with concurrent conditions such as ulcerative colitis.
糖皮质激素（GC）是免疫球蛋白 G4（IgG4）相关疾病诱导缓解和维持缓解的标准治疗方法。然而，IgG4 相关疾病经常在 GC 剂量减少时复发，这不仅使 GC 剂量减少变得困难，而且在许多情况下还需要 GC 剂量升级。因此，需要其他免疫抑制剂来维持缓解。在这里，我们报告了一例 39 岁男性，患有溃疡性结肠炎和 IgG4 相关疾病，尽管接受了他克莫司和 6-巯基嘌呤治疗，但两种疾病均复发。开始使用 Janus 相关激酶抑制剂托法替尼后，可在维持两种疾病缓解的同时减少 GC 剂量。该病例突出了 Janus 相关激酶抑制剂在治疗复杂 IgG4 相关疾病中的潜在作用，特别是那些伴有溃疡性结肠炎等合并症的病例。
