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Response to: ‘Treatment adherence of patients with sytemic rheumatic diseases in COVID-19 pandemic’ by Fragoulis et al
  1. Hendrik Schulze-Koops1,
  2. Klaus Krueger2,
  3. Christof Specker3
  1. 1 Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig Maximilians University Munich, Munich, Germany
  2. 2 Praxiszentrum St. Bonifatius, Munich, Germany
  3. 3 Klinik für Rheumatologie und Klinische Immunologie, KEM Kliniken Essen-Mitte, Essen, Germany
  1. Correspondence to Professor Hendrik Schulze-Koops, Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig Maximilians University Munich, Munich 80336, Bayern, Germany; hendrik.schulze-koops{at}

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We read with interest the study of Fragoulis et al 1 about treatment adherence and behaviour changes of patients with autoimmune inflammatory rheumatic diseases (AIRD) in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/COVID-19 pandemic. In their study, only 11 out of the 500 patients with AIRD interviewed had discontinued antirheumatic treatment solely due to fear of immunosuppression, for example, for fear of an increased risk for SARS-CoV-2 infection. This is reassuring to note as interruption of clinically efficacious therapy in AIRD is associated with an increased risk of relapse2 which might lead to the necessity of intensifying immunosuppressive therapy, possibly beyond the original level. For this very apprehension and also for the accumulating cautious impression that patients with rheumatological diseases might not have a worse prognosis during COVID-19,3 4 …

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  • Handling editor Josef S Smolen

  • Contributors All authors wrote and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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  • Correspondence
    George E Fragoulis Gerasimos Evangelatos Aikaterini Arida Vasiliki-Kalliopi Bournia Kalliopi Fragiadaki Anastasios Karamanakos Evrydiki Kravvariti Katerina Laskari Stylianos Panopoulos Maria Pappa Maria G Tektonidou Petros P Sfikakis