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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.

5 likes, 55 replies

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  • lodgerUK_NE
    lodgerUK_NE Oregonjohn-UK

    Posted

    Not only for Oregonjohn for all of  you.

    How I wish that everyone who has PMR and/or GCA would register with their GP that they would be willing to take part in any Research Trial taking place on these two illnesses.

    If you every get the chance to participate - take it  - the treatment is first class.

    We will be putting an article about taking part in research on our updated website within the next two months.

    • Oregonjohn-UK
      Oregonjohn-UK lodgerUK_NE

      Posted

      I filled out an online survey not long after being diagnosed but can't remember were it was located?  Quite a compressive survey with some interesting results - I believe it was on a US website?
    • lodgerUK_NE
      lodgerUK_NE Oregonjohn-UK

      Posted

      Oregonjohn

      It was an International Survey run by PMR&GCA UK Northeast Support and Elliot  who lives in the USA and runs a large survey company for big companies,  Elliot had PMR and we talked to him and the survey was designed by patients and medics.  It has now been running for 5 years.

      The link is on our website.

  • snapperblue
    snapperblue Oregonjohn-UK

    Posted

    Thanks for posting.  Though I had very sudden onset of severe PMR pain in mid December, I have been pondering about poorly I had been functioning for several months prior to then.  Much of the problem I am having coping now is because of the backlog of “routine maintenance” activity that had built up since last summer.

     

    • Oregonjohn-UK
      Oregonjohn-UK snapperblue

      Posted

      In hindsight a lot of folks on this forum can look back and see a pattern and a build-up of fatigue in the months leading up to the final PMR muscle symptoms which laid all of us low -  pre the preds.  I certainly can!
    • pat73046
      pat73046 snapperblue

      Posted

      Snapperblue, I agree with you. I had 2 hip replacements one year into PMR and one

      Month later my husband started displaying signs of his PD but wasn't" diagnosed until 2012--2 years later. My house is basically a wreck. I manage to do laundry and dishes, change sheets, and occas. Vacuum but everything has piled up. Anything that I have prolonged standing for gets put off. I am validated that you may have experienced something similar. My husbands sisters have never offered to help just criticize. Last spring I sometimes had six appts a week with his physical therapy and other doctor visits. I am going to senior caregiver support group tomorrow . hope to hire a cleaner. I hope you have someone to help you so you can rest. Many prayers to you. Thank you for your response.

    • tina-uk_cwall
      tina-uk_cwall pat73046

      Posted

      Hi pat, sorry to barge in this conversation but what does PD stand for?

      one thing I can help you with though is your messy house!! Who cares!!

      although I'm very methodical I am terrible when it comes to dust and hoovering and cleaning etc. 

      my dear mother who is no longer with me used to say that I was a bohemian. I looked up the word and went back to her and thanked her for the compliment!! All the best to you both, regards, christina 

    • lodgerUK_NE
      lodgerUK_NE pat73046

      Posted

      Pat

      Sounds to me like you need to apply for an Attendance Allowance, the forms can be found online.  I know quite a few people who have PMR and/or GCA and some have other problems.  They applied and were successful.  No harm trying.

    • EileenH
      EileenH tina-uk_cwall

      Posted

      Parkinson's Disease if I remember rightly.

      I'm lucky I suppose - we are such boring people nothing really gets untidy - but I doubt either of you has a dustier house than I do lol

    • pat73046
      pat73046 lodgerUK_NE

      Posted

      Thank you lodger, I appreciate you answering my complaining post. I live in the USA and I don' know what attendance allowance is. I am 67 though and get Social Security. I can pay for help with house cleaning . I just would like to work with an individual not an agency. But I might have to change my feelings on that. This forum is a life saver . I really have only a handful of friends to talk to and only one my age. I really do appreciate your comments. Pat
    • pat73046
      pat73046 tina-uk_cwall

      Posted

      Eileen said PD is Parkinson' disease and she is correct for my meaning. He has a type they think is Multiple system atrophy-- Johnny Cash the singer was supposed to have been diagnosed with this also. His problems are balance , stiffness of gait, very little tremor, mild dementia,uses a walker.Presently he can't urinate on his own and needs catheterization 2 times a day.thank you for asking . hope I am not too long winded. Pat
    • tina-uk_cwall
      tina-uk_cwall pat73046

      Posted

      Dear Pat, I'm so sorry to hear of all your additional problems. Just last week I was reading about one of our members whose husband has MS. I simply don't know how you both manage when you yourselves have PMR/GCA. When my dog Katie sits in the window ledge and barks and barks at passers by, I will never get mad at her again!!

      what a lot of burden you and your husband are going through, I wish you both all the best, christina

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