DJ Green, S Muller, CD Mallen, and SL Hider posted online on November 4, 2014
Objectives: Polymyalgia rheumatica (PMR) is the commonest inflammatory disorder of older adults. Although not part of the recently published classification criteria, patients with PMR frequently complain of fatigue. We compared consultation for fatigue and sleep problems between individuals with and without PMR.
Method: Consulters receiving a Read-coded diagnosis of PMR at nine general practices between 2000 and 2009 were matched by age, gender, general practice, and year of consultation to four patients without PMR. Fatigue and sleep problems were defined using Read codes. Cox regression was used to determine the association between PMR diagnosis and consultation for a fatigue/sleep problem.
Results: In total, 549 PMR patients were identified. Their mean (SD) age was 73.9 (8.6) years and 71% of the participants were female. Prior to the index date, 33 PMR patients and 80 matched non-PMR patients consulted with fatigue (0.43 vs. 0.25 consultations per 10 000 person-years, p = 0.006). PMR was associated with significantly more multiple fatigue consultations in the 12 months before PMR diagnosis [hazard ratio (HR) 1.95, 95% confidence interval (CI) 1.23–3.08]; no significant difference was seen in rates of consultations for sleep problems between patients with and without PMR.
Conclusions: PMR patients were significantly more likely to have had multiple fatigue consultations before being diagnosed with PMR. Given the overproduction of inflammatory cytokines seen in PMR, this fatigue may represent a prodromal phase prior to consulting with more classical musculoskeletal symptoms. This suggests that clinicians should consider PMR as a potential diagnosis in older patients consulting with fatigue.
Professor Christian Mallen and Professor Bhaskar Dasgupta have worked together recently?
Thank you for this Oregonjohn. I had ME for 30 years which did not endear me to doctors, nor them to me. At that time 1982, it was in the tabloids as 'yuppie flu' and people were considered to be malingering. (I had a 60 hour a week job, a huge mortgage, was getting married and hoped to have children, my weight went down to beneath 6 stones. It was a very distressing time). However, over time, it got a bit better, changed about 8 years ago when I had difficulty bending and getting up again, getting out of the bath and out of bed, getting into a 4 x 4, getting up and down kerbs, hanging out the washing, doing the washing up, etc., etc. I didn't go to my doctor until I had joint stiffness in my upper jaw, tenderness in my left jugular area, a headache in my left temple, tenderness across my scalp and over my forehead towards my left eye. During my treatment, the headache spread to my other temple, and I had ear-aches and ringing in my ears. My GCA was very poorly managed and I have had all kinds of heart pain, bladder discomfort, bowel problems, the list is endless and even minimal exercise is hard. It's very hard after all this time because I can't ever remember feeling well. I'm still alive though which is a miracle, so am philosophical and tick along for the time being. Sunshine is such a joy to me, the flowers excite me, the narcissi and hyacinths smell so wonderful I could faint with happiness. Hearing the thrush, robin and blackbird brings tears to my eyes. In many ways I could not be happier. Carlos Casteneda said of Don Juan that we should 'live with life on one shoulder and death on the other', and in this way really know the meaning of life and I think I agree about that because every day is hugely precious. Though my sight and hearing has deteriorated, I am full of optimism about the day. Sending best wishes to you also for a comfortable week ahead.
I'm at the forture end so very sorry to hear of your saga with doctors. My PRM was diagnosed very quickly and I have been able to resume exercise howbeit not at the same level as before. I have not had any real problems with the medications except AA which I stopped in consultation with my GP - I have not had a dexascan so why preccribe? As you can see I like to do research so I know whats best for me to manage my condition - 'knowledge is power'. It's good to see that there is now a lot more research being carried out with reference to PRM/GCA it just needs to be filtered down to the primary care level (Our GP's)
Thank you for this info... I 've had fatigue for years that came and went... Thyroid surgery...then TSH was off...switched MD's. He "fixed" TSH but continued to have fatigue. ... Then in August came the pain...hips painful, stiff, shoulders, neck...
on Prednisone... Pain gone but fatigue biggest challenge...
thanks again
Great attitude and I appreciate your sharing
Hello oregonjohn, your above post is most interesting. I was diagnosed at the age of 52, December 2013, although I had been suffering from ALL the symptoms since the September. My problem is that I am not a good patient. I hadn't been to visit a GP in over 5 years and throughout that time had suffered various colds and coughs, migraine, etc but never went because I always considered myself as essentially well. However, my faith in Drs was tested throughout the 3 months of undiagnoses as I was suffering from all the symptoms but my GP "simply for the life of her, couldn't imagine what was wrong with me". I told her that if she didn't have a clue then she best refer me to someone who did. Following my rheumatologist consultation he told me that he believed I had PMR and if the medication worked initially within the first 24 hours followed by further improvement there on then PMR is what I had.
when I got home I immediately looked up PMR on the Internet and was absolutely shocked to see that I suffered from everyone of the symptoms yet my GP had no idea what could be wrong with me! And, further to his words on how I would improve if I did take the medication - I was almost to my normal self within 4 hours of my first dose of preds, yet only the previous day my husband had had to help me in and out of the car simply to attend my first rheumatologist appointment.
i suffered terribly from fatigue but always kept going almost denying myself that I could have something wrong with me. Then when all the symptoms kicked in pre diagnosis I simply thought it was because I was in so much pain that I was luckly if I got 21 hours sleep in a week.
i also read that PMR is the most common inflamatory condition occurring in the elderly, and so I am still shocked that so little research work was conducted. This situation appears to be changing. Everyday I log onto this forum and there always seems to be some research work being quoted, which is brilliant.
thanks for all your work, along with Eileen and Mrs o and others many of us would be seriously, mentally lost and broken without the help and information you all offer. Regards, christina
Why do you ask? Christian Mallen, Rod Hughes and Sarah Mackie are part of an OMERACT working group that I'm involved in but Dasgupta isn't to my knowledge. Not really sure what else Christian mallen does though.
How very intriguing...
Like misdiagnose I had a history of what was probably ME - I had the typical "herald illness" when I was in my mid-20s. It resolved fairly well after about 8 or 9 months although the fatigue took much longer - it must have been over 4 years before I could walk upstairs without feeling I wanted to go to bed and sleep! Then in my 30s I had episodes of fatigue and night sweats that were greatly improved with HRT - trialed by my gynaecologist thinking it might be early menopause (it wasn't, or it was the longest pre-menopause in medical history at 25 years!). It must have been just a couple of years after stopping the HRT after yet another major scare story that the PMR symptoms started.
Not only for Oregonjohn for all of you.
How I wish that everyone who has PMR and/or GCA would register with their GP that they would be willing to take part in any Research Trial taking place on these two illnesses.
If you every get the chance to participate - take it - the treatment is first class.
We will be putting an article about taking part in research on our updated website within the next two months.
Eileen, Dasgupta and Mallen are on the Eular/Arc for new guidelines.
Meant to add he works out of Keele, who are doing major research as you know and he is classed as a PMR Expert. You can see photos of him using your search engine.
Thanks for posting. Though I had very sudden onset of severe PMR pain in mid December, I have been pondering about poorly I had been functioning for several months prior to then. Much of the problem I am having coping now is because of the backlog of “routine maintenance” activity that had built up since last summer.
I have read in the past that people that have took HRT, like you and myself, go onto get PMR...makes you wonder. I have had ME since 1989, and last 12 years Fibro as well.......
Hi Eileen - got this from Keele:
I am involved in two large randomised controlled trials. The TATE study is investigating the use of TENS for people with tennis elbow, whilst the POST study is a large cluster randomised trial looking at the effects of screening older consulters with joint pain for anxiety and depression symptoms in the consultation.
I have active research collaborations with the University of Birmingham (Dr Karim Raza - early diagnosis of rheumatoid arthritis) and University of Essex (Professor Dasgupta - polymyalgia rheumatica) and am a member of the Brisbane Initiative.
My work is funded by Arthritis Research UK, the National Institute for Health research (Research for Patient Benefit, Programme Grant, National School for Primary Care Research) and the North Staffordshire Medical Institute.
I have been awarded three Fellowships by Arthritis Research UK, an RCGP Great Expectations Award and a prize for best patient involvement in research.
Thanks Christina, It's me being 'nosey' (like Mrs O !!) I like to know what going on and now I have the time to 'research' it's supprising what you find out. It was a locum I saw after my regular GP dis diagnosed, who suspected PMR and from that point on I really had one up on my GP!!
Hi Judy, My brain is still in a bit of fog (suspect the preds) but I'm taking the slow but hopefully safe route reducing preds. I will be glad when I can get more of my life back.
Do you think if enough people say this that the powers that be might research it?
I can understand why there is a majority of ladies with PMR! We men are very lucky not having to go thru' all the problems associated with the menopause.