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Immunoglobulin G4 Related Disease  -  IgG4-RD Study -

COVID-19 Update 27th March 2020: HIGH RISK GROUP - IgG4 Patients are in the vulnerable category and those over 70 and/or on immunosuppressive should shield as per government guidelines.

NHS England has identified a high-risk group of up to 1.5 million patients across England via NHS Digital coding, who are being asked to shield for their own protection and for whom they will provide a degree of enhanced support. There are some patients at high risk who will not be identified via this route. This includes patients who are taking certain combinations of immunosuppressive drugs (e.g. high-dose corticosteroids, azathioprine, mycophenolate, mercaptopurine). 

The British Society of Rheumatology have developed a risk stratification guide and scoring grid, which can be applied to patients with IgG4-related disease to help to identify which precautions patients should take. This advises on whether patients should shield, self-isolate or social distance at patient discretion or maintain social distance due to their level of risk. These categories are based on vulnerability due to condition(s) and medication(s). 

Patients practicing shielding should visit the Public Health England’s guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19.

Medications
All patients should continue to take their medication unless directed otherwise by their specialist team or GP. Patients on long-term glucocorticoids (steroids, prednisolone) should not stop these abruptly.  

Blood test monitoring
There needs to be some flexibility about blood test monitoring in those patients on stable doses of immunosuppressive medications to balance risk and benefit. These may be reduced to three-monthly in stable patients and will be guided by your physician. 

Appointments
Clinicians will aim to remove the need for patients to attend face-to-face appointments wherever possible. This might involve telephone appointments or video consultations. NHSX and the Information Commissioners Office have permitted the NHS to use WhatsApp/FaceTime/Skype for patients given the urgent nature of the situation.