The epidemiology of polymyalgia rheumatica in primary care: a research protocol

Abstract

BackgroundPolymyalgia Rheumatica (PMR) is the commonest inflammatory condition seen in older patients in primary care. To date, however, research has been focused on secondary care cohorts rather than primary care where many patients are exclusively managed. This two year prospective inception cohort study of PMR patients will enable us to understand the full spectrum of this condition.MethodsPatients diagnosed with PMR in primary care will be identified via Read codes and mailed a series of postal questionnaires over a two-year period to assess their levels of pain, stiffness and functioning, as well as medication usage and other health-related and socio-demographic characteristics. In addition, participants will be asked for permission to link their survey data to their general practice electronic medical record and to national mortality and cancer registers.DiscussionThis will be the first large-scale, prospective, observational cohort of PMR patients in primary care. The combination of survey data with medical records and national registers will allow for a full investigation of the natural history and prognosis of this condition in the primary care setting, in which the majority of patients are treated, but where little research on the treatment and outcome of consultation has been undertaken. This will provide information that may lead to improved primary care management of PMR.

Cytokine secretion and the risk of depression development in patients with connective tissue diseases

“…Polymyalgia rheumatica (PMR), an inflammatory musculoskeletal disorder prevalent in the elderly population, classically manifests as bilateral hip and shoulder girdle stiffness . Given the inflammation and associated pain and disability in PMR, in addition to the chronic nature of the condition and long‐term glucocorticoids therapy, it is probable that patients will experience a decrease in QOL .…”

Association between characteristics of pain and stiffness and the functional status of patients with incident polymyalgia rheumatica from primary care

“…We examined patient reported baseline data from an inception cohort study of patients with newly diagnosed PMR in general practice. The methods of the PMR cohort study have been described elsewhere [ 9 ], but in summary, newly diagnosed PMR patients were recruited from 382 general practices from across England between June 2012 and June 2014. Patients agreeing to be contacted were mailed a postal questionnaire and consent form, with a reminder pack sent after 3 weeks for non-responders.…”

“…Participants were asked to rate the severity of their pain and stiffness using two separate 0–10 numerical rating scales (NRS), with 0 indicating no pain/stiffness and 10 the worst pain/stiffness imaginable. The anatomical location of pain and stiffness were elicited using two separate body manikins [ 9 ]. Participants were also asked whether they had difficulty raising their arms above their head, without reference to whether pain, stiffness or both limited such movement.…”

The real evidence for polymyalgia rheumatic as a paraneoplastic syndrome

“…However, this would still require clearly agreed definitions of both PMR and paraneoplastic syndrome. Furthermore, our experience of recruiting a representative, prospective PMR cohort in England suggests that whilst this is possible, it is not easy (7,8). Undoubtedly whether or not PMR is considered truly paraneoplastic requires further study, however the temporal relationship with malignancy, whether as a differential diagnosis of PMR itself or as a paraneoplastic phenomenon, supports the need for physicians to actively con- The real evidence for polymyalgia rheumatic as a paraneoplastic syndrome REPLY sider (and screen for) malignancy, as per UK guidelines.…”