• George Goodchild, Rory Jr Peters, Tamsin N Cargill, Harry Martin, Adetokunbo Fadipe, Maria Leandro, Adam Bailey, Jane Collier, Louisa Firmin, Manil Chouhan, Manuel Rodriguez-Justo, Ross Sadler, Roger W Chapman, Helen Bungay, Eve Fryer, Joel David, Raashid Luqmani, Eleanor Barnes, George J Webster, and Emma L Culver.
• University College London Hospitals NHS Foundation Trust, London, UK.
• Clin Med (Lond). 2020 May 1; 20 (3): e32e39e32-e39.

AbstractImmunoglobulin G4-related disease (IgG4-RD) is a complex multisystem fibro-inflammatory disorder, requiring diagnostic differentiation from malignancy and other immune-mediated 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.© Royal College of Physicians 2020. All rights reserved.

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