Letter to the Editor: IgG4-Related Orbital Disease from a Rheumatologist’s Perspective

Öz

This letter discusses the recently published case report titled “Understanding IgG4-Related Orbital Disease: A Rheumatologist’s Perspective” in the Osmangazi Journal of Medicine. The report highlights the diagnostic complexity and multidisciplinary management of IgG4-related disease. Key histopathologic features and MRI findings are emphasized, along with the therapeutic value of corticosteroids and steroid-sparing agents. Rituximab is underscored as a promising second-line therapy in refractory cases, while long-term follow-up is essential to detect relapse or lymphoma transformation.

Anahtar Kelimeler

• IgG4-related disease
• orbital inflammation
• rheumatology
• corticosteroid
• rituximab

IgG4 İlişkili Orbital Hastalık: Romatoloji Perspektifinden Editöre Mektup

Öz

Bu editöre mektup, Osmangazi Tıp Dergisi’nde yayımlanan “IgG4 İlişkili Orbital Hastalık: Romatoloji Perspektifinden” başlıklı olgu sunumuna ilişkin görüşleri içermektedir. Çalışma, IgG4 ilişkili hastalığın tanısal güçlüklerini ve multidisipliner yönetim gerekliliğini vurgulamaktadır. Histopatolojik doğrulama, MRG bulguları ve kortikosteroid tedavisine yanıt süreci dikkatle tartışılmıştır. Ayrıca, rituksimab gibi B-hücre hedefli tedavilerin dirençli olgularda umut verici seçenekler sunduğu ve lenfoma gelişimi açısından uzun dönem izlem gerekliliği belirtilmiştir.

Anahtar Kelimeler

• IgG4 ilişkili hastalık
• orbital inflamasyon
• romatoloji
• kortikosteroid
• rituksimab

Kaynakça

1. 1. Bulut Gökten D, Mercan R. Understanding IgG4 Related Orbital Disease: A Rheumatologist’s Perspective. Osmangazi J Med. 2024;46(5):807-812.
2. 2. Umehara H, Okazaki K, Kawa S, et al. The 2020 Revised Comprehensive Diagnostic Criteria for IgG4-Related Disease. Mod Rheumatol. 2021;31(3):529-533.
3. 3. McNab AA, McKelvie P. IgG4-Related Ophthalmic Disease: Clinical Aspects. Ophthalmic Plast Reconstr Surg. 2015;31(3):167-178.
4. 4. Soussan JB, Deschamps R, Sadik J, et al. Infraorbital Nerve Involvement on MRI in IgG4-Related Ophthalmic Disease. Eur Radiol. 2017;27(4):1335-1343.
5. 5. Detiger SE, Karim AF, Verdijk RM, van Hagen PM, van Laar JAM, Paridaens D. Treatment Outcomes in IgG4-Related Orbital Disease: Systematic Review. Acta Ophthalmol. 2019;97(5):451-459.
6. 6. Wallace ZS, Deshpande V, Stone JH. Ophthalmic Manifestations of IgG4-Related Disease. Semin Arthritis Rheum. 2014;43(6):806-817.
7. 7. Khosroshahi A, Wallace ZS, Crowe JL, et al. International Consensus Guidance on Management and Treatment of IgG4-Related Disease. Arthritis Rheumatol. 2015;67(7):1688-1699.
8. 8. Masaki Y, Matsui S, Saeki T, et al. A Multicenter Phase II Trial of Glucocorticoid Therapy for Untreated IgG4-RD. Mod Rheumatol. 2017;27(5):849-854.

9. 9. Ohno K, Sato Y, Ohshima K-i, et al. A Subset of Ocular Adnexal Marginal Zone Lymphomas May Arise in Association with IgG4-RD. Sci Rep. 2015;5:13539.
10. 10. Wu A, Andrew NH, McNab AA, Selva D. Bilateral IgG4-Related Ophthalmic Disease: Strong Indication for Systemic Imaging. Br J Ophthalmol. 2016;100(10):1409-1411.