Dr Liz Lightstone: Lupus Nephritis Misconceptions Contributing to Underdiagnosis, Low-Value Care

Liz Lightstone, MBBS, PhD, FRCP, professor of Renal Medicine for the Faculty of Medicine, Imperial College London, discussed how sexism and other factors cause certain symptoms of lupus nephritis to be overlooked, contributing to delays in diagnosis and care.

Discrepancies in how we manage women’s health impacts the diagnosis of lupus nephritis and causes certain symptoms of the disease to be overlooked, said Liz Lightstone, MBBS, PhD, FRCP, professor of Renal Medicine for the Faculty of Medicine, Imperial College London.


What is a misconception on lupus nephritis among patients and clincians?

I don't know. I mean, there are assumptions about who gets it. So, if you see a young Black woman with a rash and joint pains, you may well think of lupus. But equally I would say they're often underdiagnosed. So, the biggest problem I face is that because it's women, and it's women of childbearing age, a lot of their early symptoms are, you're tired, you're busy with your kids, it's your hormones—all that rubbish that comes into the discrepancies in how we look after women, which we know now impact on cardiovascular disease, impact on everything.

So, that sexism if you like, everyday sexism, that impacts on how someone who's coming in saying I'm really not well, and somebody listening and hearing that there's a pattern and this is out of the ordinary. Just doing a blood test and dipping the urine, you might find you've got an answer. I also think people find lupus really difficult. So, in a way that would be good if they then just refer them to someone who didn't find it so difficult. But if you hang on to the patient and you're not treating them properly, you're doing them in enormous disservice. And the biggest problem I have is people who will just stick someone on sterapred and a few weeks later refer them, and you sit there and go, oh you could have done better.

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