Harwood, Rupert, Wincup, Chris, D'Cruz, David et al. · Lupus · 2025 · DOI
This study looked at why people with lupus (SLE) often wait a long time to get diagnosed. Researchers found that doctors sometimes overlook or misinterpret lupus symptoms, attributing them instead to other causes like mental health problems, ME/CFS, or fibromyalgia. This "diagnostic overshadowing" can add years to someone's diagnostic journey and delay the treatment they need.
This study is important for ME/CFS patients and researchers because it identifies ME/CFS (along with fibromyalgia and mental health conditions) as a potential diagnostic roadblock that delays recognition of other serious conditions. The findings highlight how misdiagnosis or premature diagnostic closure can harm patients by preventing them from receiving appropriate investigation and treatment. Understanding diagnostic overshadowing may help clinicians avoid similar pitfalls when evaluating patients with complex, multisystem symptoms.
This study does not prove that ME/CFS diagnoses are incorrect or that all ME/CFS patients actually have lupus—it only shows that in some SLE cases, an ME/CFS diagnosis was given before or instead of the correct SLE diagnosis. The study does not establish causation or quantify how often this misdiagnosis occurs. Because the study relied on patient recollection and was limited to SLE patients, findings may not generalize to how often diagnostic overshadowing occurs in ME/CFS populations.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Harwood, Rupert, Wincup, Chris, D'Cruz, David, & Sloan, Melanie (2025). Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study.. Lupus. https://doi.org/10.1177/09612033251345184
BibTeX
@article{mecfsatlas-harwood-2025-diagnostic-overshadowing,
author = {Harwood, Rupert and Wincup, Chris and D'Cruz, David and Sloan, Melanie},
title = {Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study.},
journal = {Lupus},
year = {2025},
doi = {10.1177/09612033251345184},
note = {PubMed: 40491080},
url = {https://www.mecfsatlas.com/evidence/harwood-2025-diagnostic-overshadowing},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/harwood-2025-diagnostic-overshadowing
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