{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T06:54:01Z","timestamp":1793170441299,"version":"4.5.0"},"reference-count":41,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100018817","name":"LUPUS UK","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100018817","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lupus"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>SLE diagnostic journeys can be protracted, with negative impacts on long-term health. This study explored the role of diagnostic overshadowing (DOS) in delaying SLE diagnoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative analysis of 268 completed SLE patient surveys and 25 in-depth interviews purposively selected from the 2018-2021 Cambridge University Systemic Autoimmune Rheumatic Disease (SARD) studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The majority of participants appear to have experienced DOS and there were indications that sustained DOS (S-DOS) may add years to some SLE diagnostic journeys. Symptom misattributions which contributed to S-DOS included: (1) \u201c\n                      <jats:italic toggle=\"yes\">Medical mystery<\/jats:italic>\n                      \u201d, particularly when the clinician indicated that it was too expensive to keep investigating. (2)\n                      <jats:italic toggle=\"yes\">Negative misattributions<\/jats:italic>\n                      (e.g. \u201cnothing seriously wrong\u201d), often due to a failure to connect multiple symptoms as possible indicators of an underlying condition. (3\n                      <jats:italic toggle=\"yes\">) Diagnostic roadblocks,<\/jats:italic>\n                      including, in the case of some participants, a mental health, psychosomatic, ME\/CFS or fibromyalgia (mis)diagnosis. (4)\n                      <jats:italic toggle=\"yes\">Moral misattributions,<\/jats:italic>\n                      such as to \u201cmalingering\u201d, which could undermine patient help-seeking and\/or clinician help-giving.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our data suggests that DOS may be an important factor in diagnostic delay in patients with SLE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09612033251345184","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:37:53Z","timestamp":1750639073000},"page":"819-831","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3831-7465","authenticated-orcid":false,"given":"Rupert","family":"Harwood","sequence":"first","affiliation":[{"name":"Swansea University Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Wincup","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"D\u2019Cruz","sequence":"additional","affiliation":[{"name":"Guys\u2019 and St Thomas\u2019 Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Sloan","sequence":"additional","affiliation":[{"name":"University of Cambridge"},{"name":"University of East Anglia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,9]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23021"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/0961203317749746"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/rap\/rkaa006"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/1363459313488008"},{"key":"e_1_3_6_6_2","volume-title":"\u201cI noticed something wrong\u201d: lived experiences of women of color who faced a protracted journey to diagnosis with lupus","author":"McNeil JN","year":"2017","unstructured":"McNeil JN. \u201cI noticed something wrong\u201d: lived experiences of women of color who faced a protracted journey to diagnosis with lupus. 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