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International Journal of Rheumatology
Volume 2012, Article ID 597643, 4 pages
http://dx.doi.org/10.1155/2012/597643
Review Article

Treatment of Autoimmune Pancreatitis with the Anecdotes of the First Report

1Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
2Pancreas Research Foundation of Japan, Tokyo 164-0011, Japan
3Department of Gastroenterology, Tokyo Women's Medical University, Tokyo 162-8666, Japan

Received 22 November 2011; Accepted 4 February 2012

Academic Editor: Kazuichi Okazaki

Copyright © 2012 Terumi Kamisawa and Tadashi Takeuchi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The first case that led researchers to put forward a new concept of autoimmune pancreatitis (AIP) was treated with steroids by gastroenterologists in Tokyo Women’s Medical University. It is important to differentiate AIP from pancreatic cancer before treatment with steroids is started. Today, steroids are standard therapy for AIP worldwide. In the Japanese consensus guidelines, steroid therapy is indicated for symptomatic AIP. After management of glucose levels and obstructive jaundice, oral prednisolone is initiated at 0.6 mg/kg/day for 2–4 weeks and is gradually tapered to a maintenance dose of 2.5–5 mg/day over 2-3 months. To prevent relapse, maintenance therapy with low-dose prednisolone is used. For relapsed AIP, readministration or increased doses of steroids are effective. The presence of proximal bile duct stenosis and elevated serum IgG4 levels may be predictive of relapse of AIP. It is necessary to verify the validity of the Japanese regimen of steroid therapy for AIP. The necessity, drugs, and duration of maintenance therapy for AIP need to be clarified by prospective studies.