Experience from the first UK inter-regional specialist multidisciplinary meeting in the diagnosis and management of IgG4-related disease

Abstract

Immunoglobulin G4-related disease (IgG4-RD) is a complex multisystem fibro-inflammatory disorder, requiring diagnostic differentiation from malignancy and other immunemediated 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 ABSTRACT 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, crossspecialty 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.

Physician-led in-hospital multidisciplinary team conferences with multiple medical specialities present - A scoping review

“…The choice of outcomes were grouped into process indicators and outcome indicators. The process indicators included changes in diagnostic confirmation, 26 , 27 , 29 , 31 as well as therapeutic strategy and management. 26 , 27 , 29 , 30 All studies reporting process indicators demonstrated significant changes before and after the MDT ( Table 1 ).…”

“…The process indicators included changes in diagnostic confirmation, 26 , 27 , 29 , 31 as well as therapeutic strategy and management. 26 , 27 , 29 , 30 All studies reporting process indicators demonstrated significant changes before and after the MDT ( Table 1 ). The outcome indicators were composite measures of complications rates (e.g.…”

“…Types of studies included. The majority of studies were nonrandomised studies (n=7), [25][26][27][28][29][30][31] and one was a noninferiority randomised clinical trial. 32 One study reported both quantitative and qualitative data, 25 and one study was exclusively qualitative.…”

“…Some of the included studies reported a compromise, where the MDT consisted of predefined core members with the possibility of drawing in visiting specialists, depending on the patient at hand. 29 , 31 …”

“…bedside MDTs not described in the abstract), or ongoing study (n=1), thus including 6 studies. [25][26][27][28][29][30] After using CoCites on these 6 studies 2 further studies were found eligible for inclusion. 31,32 This led to a total of 8 studies included in the scoping review [25][26][27][28][29][30][31][32] (Figure 1).…”