Abstract

This paper aims to examine the relationship between different characteristics of pain and stiffness and the functional status of patients with newly diagnosed polymyalgia rheumatica (PMR). Baseline analysis of an inception cohort study was conducted. Patients aged ≥18 years, with a new diagnosis of PMR were recruited from 382 English general practices. Participants were mailed a baseline questionnaire, including separate pain and stiffness manikins and numerical rating scales (NRS), a question on their ability to raise their arms above their head and the modified Health Assessment Questionnaire (mHAQ) to examine participants’ functional status. Linear regression analysis, reported as regression co-efficients (95% confidence intervals (95% CI)), was used to assess the association of pain and stiffness with function, initially unadjusted and then adjusted for age, gender, deprivation status, smoking status, BMI, anxiety and depression. Six hundred fifty two patients responded to the baseline survey (88.5%). The majority (88.2%) reported no, or mild impairment in their functional status. Adjusted linear regression analysis demonstrated that high (NRS ≥8) pain (0.20 (95% CI 0.10–0.28)) or stiffness (0.18 (0.09–0.26)) ratings, an increasing number of sites of pain (0.18 (0.06–0.29)) or stiffness (0.19 (0.08–0.31)) and shoulder pain (0.18 (0.05–0.31)), stiffness (0.10 (0.01–0.20)) and difficulty raising arms above one’s head (0.19 (0.10–0.28)) were all associated with increased functional impairment. The majority of newly diagnosed PMR patients reported no or minimal functional difficulty. However, those who experience severe or widespread pain or stiffness often have significant functional limitation in performing their daily activities and may be a subset worthy of additional focus in primary care.

Highlights

  • Polymyalgia rheumatica (PMR) is an inflammatory condition seen in patients aged over 50 years, with incidence increasing with age and peaking between 70 and 80 years

  • Our aim was to examine the relationship between different characteristics of pain and stiffness and the functional status of newly diagnosed patients with PMR, hypothesising that increased pain or stiffness would be associated with a reduced ability to perform daily activities

  • The mean modified Health Assessment Questionnaire (mHAQ) score was 0.57 (SD 0.57), with 269 (42.8%) responders categorised as having normal functioning with no impairment, 285 (45.4%) had a mild functional deficit, 50 (8.0%) had moderate and 24 (3.8%) had a severe functional deficit

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Summary

Introduction

Polymyalgia rheumatica (PMR) is an inflammatory condition seen in patients aged over 50 years, with incidence increasing with age and peaking between 70 and 80 years. PMR is characterised by bilateral pain and stiffness in the shoulders, upper arms or pelvic region, with raised inflammatory markers and a rapid response to glucocorticoid treatment (commonly prednisolone in the UK). It is often associated with constitutional symptoms such as fatigue, malaise and weight loss [1, 2]. Functional status is an important indicator of patient health, both in isolation and with other outcome measures. This is positively correlated to C reactive protein (CRP) [4] and is a strong predictor of mortality in both the general population and for patients with rheumatoid arthritis (RA) [5]

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