Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011

Hisanori Umehara, Kazuichi Okazaki, Yasufumi Masaki, Mitsuhiro Kawano, Motohisa Yamamoto, Takako Saeki, Shoko Matsui, Tadashi Yoshino, Shigeo Nakamura, Shigeyuki Kawa, Hideaki Hamano, Terumi Kamisawa, Toru Shimosegawa, Akira Shimatsu, Seiji Nakamura, Tetsuhide Ito, Kenji Notohara, Takayuki Sumida, Yoshiya Tanaka, Tsuneyo MimoriTsutomu Chiba, Michiaki Mishima, Toshifumi Hibi, Hirohito Tsubouchi, Kazuo Inui, Hirotaka Ohara

Research output: Contribution to journalArticlepeer-review

1597 Citations (Scopus)


Background: IgG4-related disease (IgG4-RD) is a novel clinical disease entity characterized by elevated serum IgG4 concentration and tumefaction or tissue infiltration by IgG4+ plasma cells. Although IgG4-RD is not rare and is clinically important, its clinical diagnostic criteria have not been established. Comprehensive diagnostic criteria for IgG4-RD, including the involvement of various organs, are intended for the practical use of general physicians and nonspecialists. Methods: Two IgG4-RD study groups, the Umehara and Okazaki teams, were organized by the Ministry of Health, Labor and Welfare Japan. As IgG4-RD comprises a wide variety of diseases, these groups consist of physicians and researchers in various disciplines, including rheumatology, hematology, gastroenterology, nephrology, pulmonology, ophthalmology, odontology, pathology, statistics, and basic and molecular immunology throughout Japan, with 66 and 56 members of the Umehara and Okazaki teams, respectively. Collaborations of the two study groups involveddetailed analyses of clinical symptoms, laboratory results, and biopsy specimens of patients with IgG4-RD, resulting in the establishment of comprehensive diagnostic criteria for IgG4-RD. Results: Although many patients with IgG4-RD have lesions in several organs, either synchronously or metachronously, and the pathological features of each organ differ, consensus has been reached on two diagnostic criteria for IgG4RD: (1) serum IgG4 concentration >135 mg/ dl, and (2) >40% of IgG+ plasma cells being IgG4+ and >10 cells/high powered field of biopsy sample. Although the comprehensive diagnostic criteria are not sufficiently sensitive for the diagnosis of type 1 IgG4-related autoimmune pancreatitis (IgG4-related AIP), they are adequately sensitive for IgG4-related Mikulicz's disease (MD) and kidney disease (KD). In addition, the comprehensive diagnostic criteria, combined with organ-specific diagnostic criteria, have increased the sensitivity of diagnosis to 100% for IgG4-related MD, KD, and AIP. Conclusion: Our comprehensive diagnostic criteria for IgG4-RD are practically useful for general physicians and nonspecialists.

Original languageEnglish
Pages (from-to)21-30
Number of pages10
JournalModern Rheumatology
Issue number1
Publication statusPublished - Feb 2012

All Science Journal Classification (ASJC) codes

  • General Medicine


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