Abstract
We aimed to examine the association between pain, stiffness and fatigue in newly diagnosed polymyalgia rheumatica (PMR) patients using baseline data from a prospective cohort study. Fatigue is a known, but often ignored symptom of PMR. Newly diagnosed PMR patients were recruited from general practice and mailed a baseline questionnaire. This included a numerical rating scale for pain and stiffness severity, manikins identifying locations of pain and stiffness and the FACIT-Fatigue questionnaire. A total of 652 PMR patients responded (88.5%). The mean age of responders was 72.6 years (SD 9.0) and the majority were female (62.0%). Manikin data demonstrated that bilateral shoulder and hip pain and stiffness were common. The mean fatigue score (FACIT) was 33.9 (SD 12.4). Adjusted regression analysis demonstrated that a higher number of pain sites (23-44 sites) and higher pain and stiffness severity were associated with greater levels of fatigue. In newly diagnosed PMR patients, fatigue was associated with PMR symptom severity.
Highlights
Polymyalgia rheumatica (PMR) is an inflammatory condition characterised by bilateral pain and stiffness in the shoulder and hip girdles
Fatigue is included as a core outcome measure for patients with rheumatoid arthritis (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
Though high levels of pain and stiffness severity were statistically associated with an increased experience of fatigue, differences between groups were smaller than the three-point minimal clinically important difference (MCID) suggested as being clinically important
Summary
Polymyalgia rheumatica (PMR) is an inflammatory condition characterised by bilateral pain and stiffness in the shoulder and hip girdles. 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. The general role of pain and stiffness, the cardinal symptoms of PMR, on fatigue in these patients’ remains unclear. Examining these associations at initial PMR diagnosis in primary care, where the majority of these patients receive their care, will allow us to better understand and characterise the early stages of PMR. Our aim was to describe how pain and stiffness at diagnosis were related to fatigue in PMR patients in primary care
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