Medical Bulletin 05/ March/ 2025 - Video

A ‘chasm of misunderstanding and miscommunication’ is often experienced between clinicians and patients, leading to autoimmune diseases such as lupus and vasculitis being wrongly diagnosed as psychiatric or psychosomatic conditions, with a profound and lasting impact on patients, researchers have found.

A study involving over 3,000 participants – both patients and clinicians – found that these misdiagnoses (sometimes termed “in your head” by patients) were often associated with long term impacts on patients’ physical health and wellbeing and damaged trust in healthcare services. Dr Melanie Sloan from the University of Cambridge led a study exploring patient-reported experiences from two large groups, each of over 1,500 patients, and in-depth interviews with 67 patients and 50 clinicians. The results are published in Rheumatology. Patients who reported that their autoimmune disease was misdiagnosed as psychosomatic or a mental health condition were more likely to experience higher levels of depression and anxiety, and lower mental wellbeing.

More than 80% said it had damaged their self-worth and 72% of patients reported that the misdiagnosis still upset them, often even decades later. Misdiagnosed patients also reported lower levels of satisfaction with every aspect of medical care and were more likely to distrust doctors, downplay their symptoms, and avoid healthcare services. Following these types of misdiagnoses, patients often then blamed themselves for their condition,

Clinicians highlighted how hard it was to diagnose autoimmune rheumatic diseases and that there was a high risk of misdiagnosis. Some doctors said they hadn’t really thought about the long-term problems for patients, but others talked about the problems in regaining trust.

The study authors recommend several measures for improving support for patients with autoimmune rheumatological diseases.

Ref: Sloan, M, et al. “I still can’t forget those words”: mixed methods study of the persisting impacts of psychosomatic and psychiatric misdiagnoses. Rheumatology; 3 Mar 2025; DOI: 10.1093/rheumatology/keaf115

A clinical trial has found that the medication omalizumab, marketed as Xolair, treated multi-food allergy more effectively than oral immunotherapy (OIT) in people with allergic reactions to very small amounts of common food allergens. OIT, the most common approach to treating food allergy, involves eating gradually increasing doses of a food allergen to reduce the allergic response to it.

The findings were published in an online supplement to The Journal of Allergy and Clinical Immunology and presented at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.

The study team enrolled 177 children and adolescents ages 1 to 17 years and three adults ages 18 to 55 years, all with confirmed allergy to less than half a peanut and similarly small amounts of at least two other common foods among milk, egg, cashew, wheat, hazelnut or walnut. After completing the first stage of the trial, 117 individuals entered the second stage of the trial.

It was found that 36% percent of study participants who received an extended course of omalizumab could tolerate 2 grams or more of peanut protein, or about eight peanuts, and two other food allergens by the end of the treatment period, but only 19% of participants who received multi-food OIT could do so. Researchers attributed this difference primarily to the high rate of allergic reactions and other intolerable side effects among the participants who received OIT, leading a quarter of them to discontinue treatment. When the participants who discontinued therapy were excluded from the analysis, however, the same proportion of each group could tolerate at least 2 grams of all three food allergens.

These results showed that omalizumab was more effective than OIT at treating multi-food allergy in people who originally had a very low tolerance to common food allergens. Investigators attributed this outcome mainly to the high rate of allergic reactions and other side effects leading to treatment discontinuation among the OIT-treated participants, despite receiving omalizumab before and during the early months of therapy.

Ref: RA Wood et al. Treatment of multi-food allergy with omalizumab compared to omalizumab-facilitated multi-allergen OIT. Journal of Allergy and Clinical Immunology DOI: 10.1016/j.jaci.2024.12.1022 (2025).

People with obstructive sleep apnea have an increased risk of Parkinson’s disease, but if started early enough, continuous positive airway pressure (CPAP) may reduce that risk, according to a preliminary study released recently, that will be presented at the American Academy of Neurology’s 77th Annual Meeting. The study found using CPAP within two years of a sleep apnea diagnosis reduced the risk of Parkinson’s.

Obstructive sleep apnea is common and previous research has found when untreated, it is associated with an increased risk of heart attack and stroke,” said study author Gregory D. Scott, MD, PhD, of the VA Portland Health Care System in Oregon. “While our study found an increased risk of Parkinson’s disease, the good news is people can do something about it, by using CPAP as soon as they are diagnosed with the sleep disorder.”

For the study, researchers reviewed more than 20 years of medical records to identify nearly 1.6 million veterans who had obstructive sleep apnea and nearly 10 million veterans who did not.

Researchers then identified which participants developed Parkinson’s disease. Of those with sleep apnea, 5,284 people, or 3.4%, developed Parkinson’s disease within five years compared to 37,873 people, or 3.8% of those who did not have sleep apnea.

Researchers found similar rates among people with sleep apnea who started CPAP after two years as those who did not use CPAP, with 9.5 and 9.0 cases of Parkinson’s disease per 1,000 people respectively. However, researchers found a lower rate of Parkinson’s among those who started CPAP early, within two years of diagnosis, with 2.3 fewer cases per 1,000 people when compared to people who did not use CPAP.

“It is encouraging to know that while obstructive sleep apnea may increase the risk of Parkinson’s disease, treating it right away with CPAP may reduce that risk,” said Scott. “Future studies are needed to follow people more closely after receiving a sleep apnea diagnosis and over longer periods of time.”

Ref: American Academy of Neurology’s 77th Annual Meeting