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A case of IgG4oligoarthritis mimicking psoriatic arthritis
  1. Ziad Farah,
  2. Neil Mo
  1. Department of Rheumatology, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Ziad Farah, z.farah{at}


IgG4-related disease (IgG4-RD) is a rare but rapidly emerging immune-mediated fibroinflammatory condition that can affect almost any organ. It is typically associated with involvement of organs such as lymph nodes, submandibular glands, orbits, periaortic region and pancreas. However, IgG4-RD presenting primarily as an inflammatory arthritis is much less recognised. We present a rare case of IgG4-RD mimicking psoriatic arthritis. In spite of normal circulating IgG4 plasma levels, a clinical index of suspicion was required to obtain a histopathological diagnosis. The patient’s aggressive arthritis disease did not initially respond to typical disease- modifying agents such as methotrexate. Instead, we report a dramatic response to B cell depletion with rituximab. It is important to emphasise this case as a rare presentation of a rare disease. IgG4-RD is a rapidly emerging condition and the diagnosis should be considered when the alternatives do not seem to fit.

  • rheumatology
  • drugs: musculoskeletal and joint diseases
  • biological agents
  • immunology

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  • Contributors Both authors managed the patient in clinic and on the ward during his admission. Both authors summarised the case, performed a literature review and wrote the case report. ZF is the corresponding author and NM is the senior author of this submission.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.