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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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  • misdiagnose
    misdiagnose Oregonjohn-UK

    Posted

    Prednisolone helped me enormously with my decades of chronic fatigue. ME symptoms for about 30 years, with symptoms of fibromyalgia, then 6 years of polymyalgic symptoms before being put on prenisolone for GCA and a flare up in polymyalgia just over 18 months ago. It's hardly surprising that patients with pain, stiffness and weakness in the major muscle groups end up feeling exhausted. Problems getting our of bed and bath, walking upstairs, bending, ect., hardly  lend themselves to feeling energetic. I felt better in the first 2 weeks of prednisolone than I had felt for 30 years!
    • linda17563
      linda17563 misdiagnose

      Posted

      My husband likened me to a car with a new engine on Pred (same health problems as you for years)......sadly the mileage only lasted a few months...wink
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