From Psoriatic Arthritis, Fibromyalgia to SLE: Sequential Misdiagnosis and the Autoimmune Continuum in a Pakistani Female Student

Abstract

Systemic Lupus Erythematous (SLE) poses a significant challenge in diagnosis particularly when the condition exhibits other rheumatological disorders and thus cannot be diagnosed succinctly due to its multisystem involvement of medical professionals and the clinical presentation of the symptoms overlap with other Auto-Immune conditions, specifically rheumatological and pain related conditions/disorders. This self-reported case study presents a case of a woman in her late twenties in Pakistan, aiming to describe her diagnostic journey who had been having a misdiagnosis of psoriatic arthritis and fibromyalgia 12-15 months prior to being diagnosed with SLE. This case study signifies that the diagnosis of autoimmune diseases is complex, the referred autoimmune overlap syndromes are frequent, and the peculiarities of working with female patients in health care facilities with few resources is inevitable when the symptoms of the illness are likely to overlap with the psychological ones, gender-related diagnostic bias. The delay in the diagnosis was associated with substantial difficulties that she had gone throughout the delay and the psychological impact/distress, systematic complications, the process of 12-15 visits to different physicians in different areas of specialty, spent a lot of money, and reached the limits of educational and psychological health before finding the clarity of diagnosis with tenacious advocacy and complete immunological testing.Beyond the health care system trajectories, this case study also aims to illustrate the process of grief and trauma associated with chronic autoimmune conditions and the processes of resilience.

Keywords: Systemic Lupus Erythematosus, Psoriatic Arthritis, Fibromyalgia, Misdiagnosis, Autoimmune Continuum, Diagnostic Delay, Resilience, Chronic Illnesses.