Daijiworld Media Network - Cambridge
Cambridge, Oct 15: Women with autoimmune diseases are more likely than men to have their symptoms misdiagnosed as psychiatric or psychosomatic conditions, and they also face longer delays in receiving a correct diagnosis, according to a study involving 6,607 patients.
The international study, published in The Lancet’s eClinicalMedicine, was led by researchers from the University of Cambridge and the University of East Anglia (UEA). It examined patients’ reported experiences during their diagnostic journeys and highlighted differences between men and women in how their symptoms were interpreted.
The study found that 43% of women reported that their autoimmune symptoms had previously been attributed to a psychiatric condition, compared with 33% of men. Similarly, 34% of women said their symptoms had been misdiagnosed as psychosomatic, compared with 22% of men.
After accounting for factors including age, disease group, continent and household finances, researchers found that women were almost 50% more likely than men to report a psychiatric misdiagnosis and nearly 75% more likely to report a psychosomatic misdiagnosis. However, men were slightly more likely to report being misdiagnosed with another physical condition, at 48%, compared with 44% of women.
Autoimmune diseases occur when the immune system mistakenly attacks the body's own tissues. Conditions include rheumatoid arthritis, lupus and multiple sclerosis, several of which are more common among women. Diagnosis can be challenging because symptoms such as fatigue, pain, sleep disturbances and low mood are common in the general population. Symptoms may also affect multiple parts of the body and change over time.
The researchers found that women generally reported longer periods between the onset of symptoms and receiving a diagnosis, as well as more healthcare consultations. For men, the most frequently reported time to diagnosis was less than three months, while women most commonly reported waiting one to two years.
Shaista Tayabali, a co-author and patient partner, said the differences suggested that historical gender biases continued to affect the diagnostic process. She noted that women often faced greater difficulties in having their symptoms taken seriously and accurately assessed.
Dr Melanie Sloan of the University of Cambridge and Norwich Medical School at UEA said autoimmune diseases could initially present with symptoms that were difficult to explain medically, sometimes taking months or years to diagnose. She said psychological explanations could be given too early, with women appearing particularly vulnerable to such misdiagnoses.
The researchers stressed that psychiatric diagnoses are not necessarily incorrect in every case. People can experience both autoimmune and psychiatric conditions, and some autoimmune diseases, including lupus, can directly affect the brain and cause psychiatric symptoms.
Professor David D’Cruz, a consultant rheumatologist at Guy’s Hospital, said clinicians should remain open to the possibility of an underlying autoimmune disease when symptoms persist, evolve or affect multiple body systems. He emphasised the importance of listening to patients and reconsidering diagnoses when new symptoms or information emerge.
Unlike studies based solely on medical records, this research focused on patients’ own accounts of their diagnostic experiences, including the time taken to receive a diagnosis, the number of healthcare consultations and the diagnoses they received beforehand.
The researchers said patient perspectives were particularly important for diseases in which symptoms may not be visibly apparent or where no single definitive diagnostic test exists. They recommended acknowledging diagnostic uncertainty, providing clear guidance on when further assessment may be needed, ensuring continuity of care and revisiting earlier diagnoses when appropriate.
Dr Sloan said the team’s next step would be to explore patients’ experiences in greater depth and work with patients and clinicians to identify ways to reduce diagnostic delays and improve care.
The study was funded by The Lupus Trust, Vasculitis UK, Sjögren’s UK, Lupus UK and SRUK.