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 ...