How do you approach a patient with IgG4-related disease who has failed rituximab and mycophenolate and continues to rely on high-dose steroids?

Most cases of IgG4-RD respond to rituximab similar to the steroid treatment. When there is a lack of response to moderate dose steroid or rituximab, either the diagnosis is not IgG4-RD or the manifestation is not due to active IgG4-RD. In many cases, if treatment is delayed, fibrosis takes over the gland and in that stage, the patient does not respond to steroid or rituximab treatment. Your patient seems to respond to high dose steroid which makes it less likely to be late stage fibrosis of the ...