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Fatigue as a precursor to polymyalgia rheumatica: an explorative retrospective cohort study

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Oregonjohn-UK
Oregonjohn-UK

DJ Green, S Muller, CD Mallen, and SL Hider posted online on November 4, 2014

Objectives: Polymyalgia rheumatica (PMR) is the commonest inflammatory disorder of older adults. Although not part of the recently published classification criteria, patients with PMR frequently complain of fatigue. We compared consultation for fatigue and sleep problems between individuals with and without PMR.

Method: Consulters receiving a Read-coded diagnosis of PMR at nine general practices between 2000 and 2009 were matched by age, gender, general practice, and year of consultation to four patients without PMR. Fatigue and sleep problems were defined using Read codes. Cox regression was used to determine the association between PMR diagnosis and consultation for a fatigue/sleep problem.

Results: In total, 549 PMR patients were identified. Their mean (SD) age was 73.9 (8.6) years and 71% of the participants were female. Prior to the index date, 33 PMR patients and 80 matched non-PMR patients consulted with fatigue (0.43 vs. 0.25 consultations per 10 000 person-years, p = 0.006). PMR was associated with significantly more multiple fatigue consultations in the 12 months before PMR diagnosis [hazard ratio (HR) 1.95, 95% confidence interval (CI) 1.23–3.08]; no significant difference was seen in rates of consultations for sleep problems between patients with and without PMR.

Conclusions: PMR patients were significantly more likely to have had multiple fatigue consultations before being diagnosed with PMR. Given the overproduction of inflammatory cytokines seen in PMR, this fatigue may represent a prodromal phase prior to consulting with more classical musculoskeletal symptoms. This suggests that clinicians should consider PMR as a potential diagnosis in older patients consulting with fatigue.

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  • Oregonjohn-UK
    Oregonjohn-UK

    Posted

    Professor Christian Mallen and Professor Bhaskar Dasgupta have worked together recently?

     

    • EileenH
      EileenH Oregonjohn-UK

      Posted

      Why do you ask? Christian Mallen, Rod Hughes and Sarah Mackie are part of an OMERACT working group that I'm involved in but Dasgupta isn't  to my knowledge. Not really sure what else Christian mallen does though.
    • lodgerUK_NE
      lodgerUK_NE EileenH

      Posted

      Eileen,  Dasgupta and Mallen are on the Eular/Arc for new guidelines.
    • lodgerUK_NE
      lodgerUK_NE EileenH

      Posted

      Meant to add he works out of Keele, who are doing major research as  you know and he is classed as a PMR Expert. You can see photos of him using your search engine.
    • Oregonjohn-UK
      Oregonjohn-UK EileenH

      Posted

      Hi Eileen - got this from Keele:

      I am involved in two large randomised controlled trials. The TATE study is investigating the use of TENS for people with tennis elbow, whilst the POST study is a large cluster randomised trial looking at the effects of screening older consulters with joint pain for anxiety and depression symptoms in the consultation.

      I have active research collaborations with the University of Birmingham (Dr Karim Raza - early diagnosis of rheumatoid arthritis) and University of Essex (Professor Dasgupta - polymyalgia rheumatica) and am a member of the Brisbane Initiative.

      My work is funded by Arthritis Research UK, the National Institute for Health research (Research for Patient Benefit, Programme Grant, National School for Primary Care Research) and the North Staffordshire Medical Institute.

      I have been awarded three Fellowships by Arthritis Research UK, an RCGP Great Expectations Award and a prize for best patient involvement in research.

  • misdiagnose
    misdiagnose Oregonjohn-UK

    Posted

    Thank you for this Oregonjohn. I had ME for 30 years which did not endear me to doctors, nor them to me. At that time 1982, it was in the tabloids as 'yuppie flu' and people were considered to be malingering. (I had a 60 hour a week job, a huge mortgage, was getting married and hoped to have children, my weight went down to beneath 6 stones. It was a very distressing time). However, over time, it got a bit better, changed about 8 years ago when I had difficulty bending and getting up again, getting out of the bath and out of bed, getting into a 4 x 4, getting up and down kerbs, hanging out the washing, doing the washing up, etc., etc. I didn't go to my doctor until I had joint stiffness in my upper jaw, tenderness in my left jugular area, a headache in my left temple, tenderness across my scalp and over my forehead towards my left eye. During my treatment, the headache spread to my other temple, and I had ear-aches and ringing in my ears. My GCA was very poorly managed and I have had all kinds of heart pain, bladder discomfort, bowel problems, the list is endless and even minimal exercise is hard. It's very hard after all this time because I can't ever remember feeling well. I'm still alive though which is a miracle, so am philosophical and tick along for the time being. Sunshine is such a joy to me, the flowers excite me, the narcissi and hyacinths smell so wonderful I could faint with happiness. Hearing the thrush, robin and blackbird brings tears to my eyes. In many ways I could not be happier. Carlos Casteneda said of Don Juan that we should 'live with life on one shoulder and death on the other', and in this way really know the meaning of life and I think I agree about that because every day is hugely precious. Though my sight and hearing has deteriorated, I am full of optimism about the day. Sending best wishes to you also for a comfortable week ahead.
    • Oregonjohn-UK
      Oregonjohn-UK misdiagnose

      Posted

      I'm at the forture end so very sorry to hear of your saga with doctors.  My PRM was diagnosed very quickly and I have been able to resume exercise howbeit not at the same level as before.  I have not had any real problems with the medications except AA which I stopped in consultation with my GP - I have not had a dexascan so why preccribe?  As you can see I like to do research so I know whats best for me to manage my condition - 'knowledge is power'.  It's good to see that there is now a lot more research being carried out with reference to PRM/GCA it just needs to be filtered down to the primary care level (Our GP's)
    • elizabeth20640
      elizabeth20640 misdiagnose

      Posted

      Hi I had a daughter who suffered with ME for probably 8 years. Again I think it's to do with a virus (which I think PMR and GCA may well be ) my daughter forgot what it was like to feel normal but she has recovered to 95% . I took her to healers. Worked on her diet. There was a guy that made her up a herb drink. She was from bed to armchair. We had to take her out of school she was 13 at time. She had been in hospital for a week (And to be honest I didn't believe her I watched her coming out of school and could see she was struggling to walk. I came down with PMR in jan this year started with pain in neck and flu like symptoms then developed a pain in thighs got so bad I couldn't walk, I had blood taking and CRP was 83 and other levels were up. So went to A and E and seen a good doctor and she got rheumatologist her see me so they put me on 20mg and I attended the clinic following mon. But it was only when I was reduced to 12.5 that I got severe headache and arteries swollen at side of temples and very sore and jaw pain so went to A and E and I was admitted. They did a biopsy the next day and confirmed GLA. I was put on 60 mg but after a week I had tempory sight loss which was very frightening in my right eye so they up the dose to 80mg that was 3 weeks ago. I have reduced to 60mg now but have pain in temples. What treatment are you receiving love to hear from you take care
    • tina-uk_cwall
      tina-uk_cwall elizabeth20640

      Posted

      Elizabeth, if you have renewed pain in your temples following a reduction in medication then that is telling you that the inflamation is not yet under control. Please go back to your GP. I would be inclined to go back up to the higher dose for a while longer, then try again. Regards, christina 
    • lodgerUK_NE
      lodgerUK_NE elizabeth20640

      Posted

      Elizabeth,

      I do so hope  you took Christina's advice, particularly as you had to have 80mg because of temporary sight loss.   You should immediately have gone back to your GP,  Rheumy or A&E.   Until you are free of pain no reduction, if you reduce and the pain returns it is too soon.

      Did you reduce to 60mg on your own or after a blood test and a consultation?

    • elizabeth20640
      elizabeth20640 tina-uk_cwall

      Posted

      Thanks Christina  I'm just so angious to get off the high dose, it's kinda like a pulsation headache on my right side, but it's not there all the time, I was going to ring hospital and talk to someone off the team, thanks again
    • elizabeth20640
      elizabeth20640 lodgerUK_NE

      Posted

      Thanks Lodger no that was on the hospital instructions. I was to come down 10mg a week until I got to 30mg and I'm due back at hospital, in 2 weeks but they did say if I felt any pain to go back up the dose
    • EileenH
      EileenH elizabeth20640

      Posted

      No-one likes to be on the high doses - but put it in context: high dose pred or risk going blind. If you lose the sight in one eye the sight in the other usually goes within a few weeks unless you are very very lucky with immediate treatment. Against that risk, the awfullness of high dose pred isn't half so bad.
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