Objectives
To evaluate the influence of the SARS-CoV-2 pandemic on the adherence of patients with inflammatory rheumatic diseases (IRD) to their immunomodulatory medication during the three-months lockdown in Germany.
Methods
From March 16th until June 15th 2020, IRD patients from private practices and rheumatology departments were asked to answer a questionnaire addressing their behaviour with respect to their immunomodulating therapy. Eight private practices and nine rheumatology departments which included rheumatology primary care centres and university hospitals participated. 4252 questionnaires were collected and evaluated.
Results
The majority of patients (54%) were diagnosed with rheumatoid arthritis, followed by psoriatic arthritis (14%), ankylosing spondylitis (10%), connective tissue diseases (12%) and vasculitides (6%). The majority of patients (84%) reported to continue their immunomodulatory therapy. Termination of therapy was reported by only 3% of the patients. The results were independent from the type of IRD, the respective immunomodulatory therapy and by whom the patients were treated (private practices vs rheumatology departments). Younger patients (<60 years) reported just as often as older patients to discontinue their therapy.
Conclusion
The data show that most of the patients continued their therapy in spite of the pandemic. A significant change in behavior with regard to their immunomodulatory therapy was not observed during the three months of observation. The results support the idea that the immediate release of recommendation of the German Society of Rheumatology were well received, supporting the well-established physician-patient-relationship in times of a crisis.
In the current case study we present a patient with type 1 diabetes mellitus and bulimia nervosa who reported intentionally restricting her insulin intake in order to avoid hypoglycaemic episodes. However, she was not concerned about the occurrence of the typical symptoms of hypoglycaemia such as shaking, sweating, drowsiness, nausea, poor motor coordination, mental confusion or unconsciousness. Her fear of hypoglycaemia was solely based on her perception that hypoglycaemia would inevitably lead to binge eating.
With the help of regular food intake, optimised insulin treatment and psychological help, the patient succeeded in reducing the number of binge eating episodes and in achieving a better control of her bulimic symptoms as well as of her diabetes mellitus.
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