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

Abstract

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 ¼ 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.

Polymyalgia rheumatica following infective triggersor vaccinations: a different subset of disease?

“…Further studies could be useful to determine whether this subset of PMR patient should be reclassified as having definite immunological deregulation and HPA axis impairment, where low doses of GC constitute a substitutive hormonal therapy [9,10]. A prodromal phase to musculoskeletal symptoms, with fatigue and sleep problems, has been previously described, and it could be consistent with this immune-endocrinologic deregulation [18].…”

Sleep problems and psychological symptoms as predictors of musculoskeletal conditions in children and adolescents

“…date of first consultation for the exposure) and matched with up to five controls ('unexposed individuals'). Individuals were matched on age at index date (up to ±2 years), gender and general practice, following previous methodology (Green, Muller, Mallen, & Hider, 2015;Muller, Hider, Belcher, Helliwell, & Mallen, 2014). Matched individuals were assigned an 'index date' that was equivalent to the date of first consultation for the exposure variable.…”

The association of pain and stiffness with fatigue in incident polymyalgia rheumatica: baseline results from the polymyalgia rheumatica cohort study

“…The experience of fatigue in other inflammatory conditions, such as rheumatoid arthritis (RA), suggests it is common and is associated with several condition-specific factors, including levels of pain and stiffness (Nikolaus et al ., 2013). As such, fatigue is included as a core outcome measure for patients with RA (Kirwan et al ., 2007), but the current evidence describing the presence of fatigue in PMR patients is mixed (Chuang et al ., 1982; Green et al ., 2014; Levy et al ., 2015) and has not examined the role of key associated symptoms such as pain and stiffness.…”