Compromiso oftálmico en enfermedad relacionada con IgG4

Luisina Victoria Zunino; Romina Calvo; Alejandro Varizat; María Marcela Schmid; Jesica Gallo; Alberto Ortiz; Sergio Paira

doi:10.47196/rar.v34i2.730

Luisina Victoria Zunino Hospital José María Cullen, Santa Fe, Argentina
Romina Calvo Hospital José María Cullen, Santa Fe, Argentina
Alejandro Varizat Hospital José María Cullen, Santa Fe, Argentina
María Marcela Schmid Hospital Regional de Reconquista, Santa Fe, Argentina
Jesica Gallo Hospital Ángela Iglesia de Llano, Corrientes, Argentina
Alberto Ortiz Hospital José María Cullen, Santa Fe, Argentina
Sergio Paira Hospital José María Cullen, Santa Fe, Argentina

DOI: https://doi.org/10.47196/rar.v34i2.730

Palabras clave: enfermedad relacionada con IgG4, enfermedad ocular, enfermedades orbitarias

Resumen

Introducción: la enfermedad oftálmica relacionada con IgG4 (EOR-IgG4) presenta una frecuencia del 11-59%. Pocos estudios describen las disparidades con los pacientes con ER-IgG4 extraoftálmica (NO EOR-IgG4). Objetivos: describir las características clínicas, imagenológicas, anatomopatológicas, resultados de laboratorio y tratamiento de la EOR-IgG4, y compararlas con las de los pacientes NO EOR-IgG4. Materiales y métodos: se realizó un estudio descriptivo sobre una cohorte de 54 pacientes con ER-IgG4. Se reclutaron 16 pacientes con EOR-IgG4 y 38 con NO EOR-IgG4. Se compararon ambos grupos. Resultados: la EOR-IgG4 predominó en mujeres. El 75% presentó afectación oftálmica bilateral. El antecedente de asma se asoció al grupo NO EOR-IgG4 (p=0,018). Los pacientes con EOR-IgG4 presentaron niveles séricos menores de IgE e IgG total, y la glándula lagrimal fue la estructura más afectada. Predominó el infiltrado linfoplasmocitario y eosinofílico, siendo la fibrosis estoriforme más frecuente que la no estoriforme en el grupo EOR-IgG4. Conclusiones: si bien los resultados fueron similares a lo reportado previamente, en discordancia con otras series, encontramos asociación negativa entre el asma y los niveles de IgG total sérica en los pacientes EOR-IgG4.

Biografía del autor/a

Luisina Victoria Zunino, Hospital José María Cullen, Santa Fe, Argentina

Servicio de Reumatología

Romina Calvo, Hospital José María Cullen, Santa Fe, Argentina

Servicio de Reumatología

Alejandro Varizat, Hospital José María Cullen, Santa Fe, Argentina

Servicio de Diagnóstico por Imágenes

María Marcela Schmid, Hospital Regional de Reconquista, Santa Fe, Argentina

Servicio de Reumatología

Jesica Gallo, Hospital Ángela Iglesia de Llano, Corrientes, Argentina

Servicio de Reumatología

Alberto Ortiz, Hospital José María Cullen, Santa Fe, Argentina

Servicio de Reumatología

Sergio Paira, Hospital José María Cullen, Santa Fe, Argentina

Servicio de Reumatología

Citas

I. Wallace ZS, Deshpande V, Mattoo H, et al. IgG4-related disease: baseline clinical and laboratory features in 125 patients with biopsy-proven disease. Arthritis Rheumatology Hoboken NJ 2015;67:2466-75.

II. Ebbo M, Paciente M, Grados A, Groh M, Desblaches J, Hachulla E, Saadoun D, Audia S, Rigolet A, Terrier B, et al. Ophthalmic manifestations in IgG4-related disease. Medicine (Baltimore) 2017;96(10):e6205.

III. Zhao Z, Mou D, Wang Z, et al. Clinical features and relapse risks of IgG4-related ophthalmic disease: a single-center experience in China. Arthritis Res Ther 2021;23,98.

IV. Gan L, Luo X, Fei Y, et al. Ophthalmic involvement disparities in clinical characteristics of IgG4-related disease: a retrospective study of 573 patients. BMC Ophthalmol 2021 Dec 27;21(1):447.

V. Umehara H, Okazaki K, Masaki Y, et al. Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011. Mod Rheumatol Jpn Rheum Assoc 2012;22:21-30.

VI. Umehara H, Okazaki K, Kawa S, et al.; Research Program for Intractable Disease by the Ministry of Health, Labor and Welfare (MHLW) Japan. The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. Mod Rheumatol 2021 May;31(3):529-533.

VII. Wallace ZS, Naden RP, Chari S, Choi H, Della-Torre E, Dicaire JF, et al. The 2019 American College of Rheumatology/European League Against Rheumatism Classification Criteria for IgG4-Related Disease. Ann Rheum Dis 2020 Jan;79(1):77-87. VIII. Goto H, Takahira M, Azumi A; Japanese Study Group for IgG4-Related Ophthalmic Disease. Diagnostic criteria for IgG4-related ophthalmic disease. Jpn J Opthalmol 2015; 59(1):1-7.

VIII. Goto H, Takahira M, Azumi A; Japanese Study Group for IgG4-Related Ophthalmic Disease. Diagnostic criteria for IgG4-related ophthalmic disease. Jpn J Opthalmol 2015; 59(1):1-7.

IX. Miller A, Green M, Robinson D. Simple rule for calculating normal erythrocyte sedimentation rate. Br Med J (Clin Res Ed) 1983 Jan 22;286(6361):266.

X. Culver EL, et al. Elevated serum IgG4 levels in diagnosis, treatment response, organ involvement, and relapse in a prospective IgG4-related disease UK cohort. Am J Gastroenterol 2016 May;111(5):733-43.

XI. Chan ASY, Mudhar H, et al. Serum IgG2 and tissue IgG2 plasma cell elevation in orbital IgG4-related disease (IgG4-RD): potential use in IgG4-RD assessment. Br J Ophtahlmol 2017 Nov;101(11):1576-1582.

XII. Wallace ZS, Zhang Y, Perugino CA, et al. Clinical phenotypes of IgG4-related disease: an analysis of two international cross-sectional cohorts. Ann Rheum Dis 2019 Mar;78(3):406-412.

XIII. Kubota T, Moritani S. Orbital IgG4-related disease: clinical features and diagnosis. ISRN. Rheumatol 2012; 2012:412896.

XIV. Zachary S, Wallace Z, Deshpande V, Stone JH. Ophthalmic manifestations of IgG4-related disease: single-center experience and literature review. Semin Arthritis Rheum 2014;43:806-817.

XV. Gan L, Luo X, Fei Y, Peng L, et al. Long-term outcomes of IgG4-related ophthalmic disease in a Chinese IgG4related disease cohort. Front Med 2021;8:784520.

XVI. Wang L, Zhang P, Zhang X, et al. Sex disparities in clinical characteristics and prognosis of immunoglobulin G4-related disease: a prospective study of 403 patients. Rheumatology 2019;58(5):820-830.

XVII. Stone JH, Zen Y, Deshpande V. IgG4-Related Disease. N Engl J Med 2012;366 (6):539-51.

XVIII. Wu A, Andrew NH, McNab AA, Selva D. Bilateral IgG4- related ophthalmic disease: a strong indication for systemic imaging. Br J Ophthalmol 2016;100(10):1409-11.

XIX. Gan L, Luo X, Fei Y, Peng L, et al. Ophthalmic involvement disparities in clinical characteristics of IgG4-related disease: a retrospective study of 573 patients. BMC Ophthalmol 2021 Dec 27;21(1):447.

XX. Tiegs-Heiden LJ, Eckel CH, Hunt FE, et al. Immunoglobulin G4-related disease of the orbit: imaging features in 27 patients. American Journal of Neuroradiology July 2014; 35(7):1393-1397.

XXI. Wong AJ, et al. IgG4 immunostaining and its implications in orbital inflammatory disease. PLoS One 2014;9(10):e109847.

XXII. Sato Y, Notohara K, Kojima M, Takata K, Masaki Y, Yoshino T. IgG4-related disease: historical overview and pathology of hematological disorders. Pathology International 2010;60(4):247-258.

XXIII. Khosroshahi A, Wallace ZS, et al. International consensus guidance statement on the management and treatment of IgG4-related disease. Arthritis Rheumatol 2015;67(7):1688.

XXIV. Carruthers MN, Topazian MD, Khosroshahi A, Witzig TE, Wallace ZS, Hart PA, Deshpande V, Smyrk TC, Chari S, Stone JH. Rituximab for IgG4-related disease: a prospective, open-label trial. Ann Rheum Dis 2015;74(6):1171. Epub 2015 Feb 9.

XXV. Wang L, Zhang P, Wang M, et al. Failure of remission induction by glucocorticoids alone or in combination with immunosuppressive agents in IgG4-related disease: a prospective study of 215 patients. Arthritis Res Ther 2018;20:65.

XXVI. Carruthers MN, Stone JH, Deshpande V, Khosroshahi A. Development of an IgG4-RD responder index. Int J Rheumatol 2012;259408.