Characterising those with incident polymyalgia rheumatica in primary care: results from the PMR Cohort Study.

Sara Muller,Samantha L Hider,Bhaskar Dasgupta,Christian D Mallen,Kevin Barraclough,Sarah Lawton,Toby Helliwell,Irena Zwierska

doi:10.1186/s13075-016-1097-8

Sara Muller, Samantha L Hider + Show 6 more

Open Access

https://doi.org/10.1186/s13075-016-1097-8

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Abstract

BackgroundThe aim was to characterise the sociodemographic, general health and polymyalgia rheumatica (PMR)-specific features of participants in a large inception cohort of patients with PMR diagnosed in UK primary care.MethodsPatients (n = 739) with a new diagnosis of PMR were referred into the study and mailed a questionnaire detailing their general health and sociodemographic characteristics in addition to the symptoms of and treatment for PMR. Characteristics of responders and non-responders were compared and descriptive statistics were used to characterise the health of the cohort.ResultsA total of 654 individuals responded to the questionnaire (adjusted response 90.1 %). Responders and non-responders were similar in age, gender and deprivation (based on postcode). The mean (standard deviation) age of the recruited cohort was 72.4 (9.3) years; 62.2 % were female. The sample reported high levels of pain and stiffness (8 out of 10 on numerical rating scales) and reported stiffness that lasted throughout the day. High levels of functional impairment, fatigue, insomnia and polypharmacy were also reported. Overall, women reported worse general and PMR-specific health than did men.ConclusionsThis first primary care cohort of patients with incident PMR is similar in demographic terms to cohorts recruited in secondary care. However, the extent of symptoms, particularly reported stiffness, is higher than has been described previously. Given the majority of patients with PMR are exclusively managed in primary care, this cohort provides important information on the course of PMR in the community that will help clinicians managing this painful and disabling condition.

Highlights

The aim was to characterise the sociodemographic, general health and polymyalgia rheumatica (PMR)-specific features of participants in a large inception cohort of patients with PMR diagnosed in UK primary care
The age and gender of responders (mean age 72.4 years (9.3), 62.2 % female) and non-responders (mean age 72.6 years (10.0), 62.5 % female) were similar overall, non responders were more likely to be in the highest tertile of deprivation (32.3 % responders vs 38.9 % non-responders)
It is clear that women report worse scores than men in almost all aspects of disease activity, functioning and mental health

Summary

Introduction

The aim was to characterise the sociodemographic, general health and polymyalgia rheumatica (PMR)-specific features of participants in a large inception cohort of patients with PMR diagnosed in UK primary care. Classic presentation involves rapid onset of bilateral pain and stiffness in the shoulders and hip girdle, usually in combination with raised inflammatory markers. Common, it has received relatively little research attention, in the primary care setting, where the majority of patients are diagnosed and managed [2, 3]. Our understanding of the epidemiology of PMR is not as advanced as for other inflammatory rheumatological conditions Those diagnosed with PMR are more likely to be female and have an average age at diagnosis of approximately 72 years [4]. Recent studies have identified increased risk of vascular disease [8] and cancer diagnosis [9] following a diagnosis of PMR, though the mechanisms behind these associations remain uncertain

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