P187 Fatigue in people with polymyalgia rheumatica: a key unmet need?

Abstract

Abstract Background/Aims Polymyalgia rheumatica (PMR) is common in older adults, causing severe pain and stiffness, particularly in the shoulder and hip girdles. Glucocorticoids treatment generally focusses on reducing pain and stiffness, but there are other aspects to quality of life. Fatigue is a well-recognised symptom in other inflammatory rheumatological conditions and has been highlighted by people with PMR as a neglected symptom. Methods People with newly diagnosed PMR in English general practice (2012-2014, n = 652) were recruited to a postally-administered cohort study. Surveys included items relating to PMR, general health and well-being. The FACIT-Fatigue questionnaire was included in the survey at diagnosis, 1, 12, 24 and (mean) 61 months follow-ups. Latent class growth analysis was used to define trajectories, based on FACIT-Fatigue scores over time. Trajectories were characterised and compared at baseline and over time. Results 244 people participated at 24 months and 197 at 61 months. Individuals were allocated to one of five fatigue trajectories. Each represented a different average level of fatigue at diagnosis that remained stable over time (Table). From least to most fatigued, trajectory sizes were 111, 122, 211, 133 and 75. Two thirds of the cohort (the three “worst” trajectories) were, on average, more fatigued than reported in the general population. Worse fatigue trajectory was associated with female sex, higher pain and stiffness, higher levels of anxiety, depression, insomnia, and poorer physical function at baseline and throughout. Conclusion Fatigue is common in inflammatory conditions, but under-recognised in PMR. Fatigue severity at the time of diagnosis appears indicative of fatigue levels up to five years later and is associated with a broad range of health constructs at diagnosis and later. This represents an unmet need in a sizable proportion of those with PMR, who may need more help to manage their condition and allow them to return to full function. These findings also present a potential avenue for early identification of those with a poor prognosis related to their PMR. Disclosure S. Muller: None. J. Belcher: None. S. Hider: None. T. Helliwell: None. C.D. Mallen: None.