Fatigue as a precursor to polymyalgia rheumatica: an explorative retrospective cohort study
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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
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EileenH Oregonjohn-UK
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lodgerUK_NE EileenH
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lodgerUK_NE EileenH
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Oregonjohn-UK EileenH
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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 Oregonjohn-UK
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Oregonjohn-UK misdiagnose
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judytal misdiagnose
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elizabeth20640 misdiagnose
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tina-uk_cwall elizabeth20640
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lodgerUK_NE elizabeth20640
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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 tina-uk_cwall
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elizabeth20640 lodgerUK_NE
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tina-uk_cwall elizabeth20640
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EileenH elizabeth20640
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