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Longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the PMR Cohort Study

Muller, Sara; Whittle, Rebecca; Hider, Samantha L; Belcher, John; Helliwell, Toby; Morton, Chris; Hughes, Emily; Lawton, Sarah A; Mallen, Christian D

Longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the PMR Cohort Study Thumbnail


Authors

Rebecca Whittle

Chris Morton

Emily Hughes



Abstract

Objectives. To investigate potential subgroups of primary care diagnosed patients with polymyalgia rheumatica (PMR) based on self-reported pain and stiffness severity over time.

Methods. 652 people with an incident PMR diagnosis were recruited from English general practices and completed a baseline postal questionnaire. They were followed-up with a further six questionnaires over a two-year period. 446 people completed 2-year follow-up. Pain and stiffness were reported on 0-10 numerical rating scales. Latent class growth analysis was used to estimate the joint trajectories of pain and stiffness overtime. A combination ofstatistical and clinical considerations was used to choose the number of clusters. Characteristics of the classes were described.

Results. Five clusters were identified. One cluster represented the profile of ‘classical’ PMR symptoms and one represented sustained symptoms that may not be PMR. The other three clusters displayed a partial recovery, a recovery followed by worsening and a slow, but sustained recovery. Those displaying classical PMR symptoms were in better overall health at diagnosis than the other groups.

Conclusions. PMR is a heterogeneous condition, with a number of phenotypes. The spectrum of presentation, as well as varying responses to treatment, may be related to underlying health status at diagnosis. Future research should seek to stratify patients at diagnosis to identify those likely to have a poor recovery and in need of an alternative treatment pathway. Clinicians should be aware of the different experiences of patients and monitor symptoms closely, even where there is initial improvement.

Journal Article Type Article
Acceptance Date Oct 6, 2019
Online Publication Date Nov 19, 2019
Publication Date 2020-08
Publicly Available Date Mar 29, 2024
Journal Rheumatology
Print ISSN 1462-0324
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 59
Issue 8
Pages 1906-1915
DOI https://doi.org/10.1093/rheumatology/kez533
Keywords polymyalgia rheumatica, pain, stiffness, clusters, prognosis
Publisher URL https://doi.org/10.1093/rheumatology/kez533

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