Background: Stereotyping and bias are common in medical care, especially for patients with chronic health conditions or from marginalized backgrounds [1, 2]. While there is extensive research on bias in conditions like fibromyalgia and chronic pain, less is known about how these biases impact patients with autoimmune rheumatic diseases, such as systemic lupus erythematosus (SLE). Systemic autoimmune rheumatic diseases (SARDs) are influenced by genetic, environmental, and socioeconomic factors, but stereotypes about these patients may also play a role in delayed care [3]. This study aims to address the gap in understanding by identifying and documenting specific stereotypes that healthcare professionals associate with patients with SARDs, which may contribute to delayed diagnosis and treatment.

Objectives: The primary objective of this study was to document stereotypes of patients with rheumatic diseases in early career trainees.

Methods: Between April and May 2024, Internal Medicine Residents at University of Arizona College of Medicine - Phoenix were invited via email and academic sessions to participate in a voluntary, anonymous survey on trainee bias, stereotyping, confidence, and knowledge of common rheumatic diseases. After consenting, participants completed a newly developed survey to assess their awareness of stereotypes related to patients with SLE, rheumatoid arthritis, fibromyalgia, and chronic pain. Respondents were asked about their awareness of “the stereotypes that are commonly overheard when caring for people with…” Respondents were also presented with four clinical vignettes, validated by rheumatologists, to assess their management of patients with suspected SLE. The vignettes tested diagnostic accuracy, treatment choices, and management of complications. Participants provided demographic information, including training year, post-training plans, and whether they identified as having a chronic illness or disability. Only respondents who completed the entire survey were included in the analysis.

Results: A total of 75 internal medicine residents were sent the survey, with 22 completing the survey in its entirety (29% response rate). Respondents demonstrated varying levels of awareness regarding stereotypes associated with chronic illnesses (Figure 1). For SLE, participants largely were aware of positive stereotypes, with resilience (45%) as a commonly heard stereotype and 32% as strong, though 36% identified a stereotype of non-compliance and 64% recognized anxiety as a stereotype in patients with lupus. For rheumatoid arthritis, respondents recognized a mix of stereotypes, with 27% associating strength or resilience with patients, while 36% indicated a stereotype of non-compliance and only 9% referenced laziness. Fibromyalgia and chronic pain elicited predominantly negative stereotypes. Respondents frequently associated fibromyalgia with non-compliance (59%) and laziness (50%), while awareness of resilience (5%) or strength (0%) was low. Similarly, chronic pain was often linked to stereotypes of non-compliance (73%) and laziness (41%), with some awareness of resilience (18%) and strength (14%). For general chronic illness or disability, respondents frequently noted stereotypes of non-compliance (91%) and laziness (50%), though awareness of resilience (41%) and strength (27%) was also present. These findings suggest that stereotypes of non-compliance and laziness are particularly prevalent for fibromyalgia and chronic pain, while lupus and rheumatoid arthritis are more frequently associated with positive traits like resilience and strength. For all disease states respondents indicated that females experience more distressing symptoms than male patients. In knowledge-based questions aimed at assessing the residents as primary care physician’s perspective, 59% of respondents correctly identified appropriate timing for referring a patient to rheumatology, 32% referred a patient with a severe lupus flare to the emergency department for urgent evaluation, 82% accurately determined when to order an ANA, and 82% correctly recognized when to treat and monitor the patient in the primary care office.

Conclusion: The present work provides important insight into stereotype awareness for patients with rheumatic disease in early career trainees. Confirming revealing biases toward conditions like fibromyalgia and chronic pain, while lupus and rheumatoid arthritis are seen more favorably. These biases can adversely impact patient care and contribute to health disparities, particularly for those with chronic pain conditions. By uncovering these stereotypes among early-career clinicians, this research provides valuable insights to inform targeted interventions aimed at reducing bias and promoting equitable care for patients with autoimmune rheumatic diseases [4].

REFERENCES: [1] Bean MG, Focella ES, Covarrubias R, Stone J, Moskowitz GB, Badger TA. Author Manuscript; Available in PMC . Vol 7.; 2015.

[2] Fitzgerald C, Hurst S. Implicit bias in healthcare professionals: A systematic review. BMC Med Ethics . 2017;18(1). doi:10.1186/s12910-017-0179-8.

[3] Hasan B, Fike A, Hasni S. Health disparities in systemic lupus erythematosus—a narrative review. Clin Rheumatol . 2022;41(11):3299-3311. doi:10.1007/s10067-022-06268-y.

[4] Stone J, Moskowitz GB. Non-conscious bias in medical decision making: What can be done to reduce it? Med Educ . 2011;45(8):768-776. doi:10.1111/j.1365-2923.2011.04026.x.

Figure 1.

Awareness of stereotypes for rheumatic diseases in early career trainees.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.