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IgG4 surge predicts relapse in IgG4-RD

Nature Reviews Rheumatology (2026)Cite this article

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Increased serum levels of IgG4 over time can indicate relapse in IgG4-related disease (IgG4-RD). Now, findings from a longitudinal cohort study indicate an optimal change threshold in IgG4 levels for predicting relapse.

The study involved 155 patients with active IgG4-RD, who had ≥6 months of follow-up and at least three IgG4 measurements. IgG4 levels assessed at a single time point were not associated with relapse. However, relapse was predicted by an ‘IgG4 surge’, defined as an increase in IgG4 level of >60% between assessments over a median 3-month interval. Fluctuations in IgG4 were common; 61% of patients whose IgG4 levels had previously normalized regained IgG4 positivity.

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  • Peyronel, F. et al. IgG4-related disease and other fibro-inflammatory conditions. Nat. Rev. Rheumatol. 21, 275–290 (2025)

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  1. Nature Reviews Rheumatology http://www.nature.com/nrrheum/

    Holly Webster

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  1. Holly Webster
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Correspondence to Holly Webster.

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Webster, H. IgG4 surge predicts relapse in IgG4-RD. Nat Rev Rheumatol (2026). https://doi.org/10.1038/s41584-026-01368-4

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