American Board of Internal Medicine (ABIM) Certification Practice Exam

Initial management of IgG4-related disease typically involves which medication?

1. Methotrexate

2. Prednisone

3. Rituximab

4. Mycophenolate mofetil

The correct answer is: Prednisone

The initial management of IgG4-related disease commonly involves the use of corticosteroids, with prednisone being the standard treatment choice. Prednisone is effective in reducing inflammation and controlling the symptoms associated with this condition, which can include organ dysfunction and significant pain. The rationale for using prednisone lies in its anti-inflammatory properties, which can quickly alleviate symptoms by dampening the immune response that characterizes IgG4-related disease. Given the conditions often involve a chronic inflammatory process, the prompt initiation of steroid therapy can lead to rapid improvement in patient symptoms and can help prevent the complications that arise from prolonged inflammation. In contrast, while other medications like methotrexate, rituximab, and mycophenolate mofetil can be relevant in treating autoimmune diseases or even some cases of IgG4-related disease as adjunctive or second-line therapies for those who may not tolerate steroids well or who have more refractory cases, they are not typically the first-line treatment. Their onset of action is slower, and they may not provide the rapid improvement necessary for managing acute presentations of the disease.