I read with interest the case report of a patient with lupus enteritis in the February 2021 issue of The Rheumatologist, and I thought the diagnostic approach and final diagnosis were very well presented; however, I noticed an omission which in my view is quite relevant to this patient’s overall management and to so many other lupus and non-lupus patients. No comment is made about this patient’s poor adherence in terms of medication intake, regular follow-up visits and self-medication.
Regardless of what the intended audience for this periodical is, not commenting on these issues, is in my view, a major oversight. Abundant literature documents the negative impact of poor adherence in lupus and many other conditions.1-3 Empowering patients to take better control over their disease is crucial4; unfortunately, this is, oftentimes not performed or barely done during our busy time-pressured clinic encounters.5
Sincerely,
Graciela S. Alarcón, MD, MPH, MACR
Professor of Medicine, Emeritus
The University of Alabama at Birmingham, Birmingham, Alabama, USA
Professor of Medicine, Emeritus
Universidad Peruana Cayetano Heredia
Lima, Perú
References
- Alsowaida N, Alrasheed M, Mayet A, et al. Medication adherence, depression and disease activity among patients with systemic lupus erythematosus. Lupus. 2018 Feb;27(2):327–332.
- Williams EM, Zhang J, Zhou J, et al. Predictors of non-response and non-compliance in African American lupus patients: Findings from the Balancing Lupus Experiences with Stress Strategies (BLESS) study. Int J Med Biomed Sci. 2014 Feb;2(1):6–19.
- Costedoat-Chalumeau N, Pouchot J, Guettrot-Imbert G, et al. Adherence to treatment in systemic lupus erythematosus patients. Best Pract Res Clin Rheumatol. 2013 Jun;27(3):329–340.
- Street RL Jr., Gordon HS, Ward MM, et al. Patient participation in medical consultations: Why some patients are more involved than others. Med Care. 2005 Oct;43(10):960–969.
- Navarra SV, Zamora LD, Collante MTM. Lupus education for physicians in a research-limited setting. Clin Rheumatol. 2020 Mar;39(3):897–702.
The Authors Respond
Thank you for raising this important point in the management of patients with lupus and other autoimmune rheumatic conditions. For our patient, medication nonadherence was related to a complex family dynamic in which several family members with a wide range of medical knowledge influenced the patient in a way that made her less receptive to recommended therapies from her medical teams. We felt the complexity of her specific situation was beyond the scope of this article; however, we agree that medication nonadherence is an important consideration in each patient, notably driven by a different dynamic in each case, and it is often overlooked.
Emily Purcell, MD, Colin Ligon, MD, MHS, & Chris T. Derk, MD, MS
