Green D J, Muller S, Mallen C D, Hider S L
Arthritis Research UK Primary Care Centre, Keele University , Staffordshire , UK.
Scand J Rheumatol. 2015 May;44(3):219-23. doi: 10.3109/03009742.2014.959047. Epub 2014 Nov 4.
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.
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.
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.
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.
风湿性多肌痛（PMR）是老年人最常见的炎性疾病。尽管疲劳并非最近公布的分类标准的一部分，但PMR患者经常抱怨疲劳。我们比较了患有和未患有PMR的个体在疲劳和睡眠问题方面的就诊情况。
在2000年至2009年期间，从9家全科诊所中接受了Read编码诊断为PMR的就诊者，按照年龄、性别、全科诊所和就诊年份，与4名未患PMR的患者进行匹配。使用Read编码定义疲劳和睡眠问题。采用Cox回归分析来确定PMR诊断与因疲劳/睡眠问题就诊之间的关联。
总共识别出549例PMR患者。他们的平均（标准差）年龄为73.9（8.6）岁，71%的参与者为女性。在索引日期之前，33例PMR患者和80例匹配的非PMR患者因疲劳就诊（每10000人年的就诊次数分别为0.43次和0.25次，p = 0.006）。在PMR诊断前的12个月内，PMR与明显更多的多次疲劳就诊相关[风险比（HR）1.95，95%置信区间（CI）1.23 - 3.08]；患有和未患有PMR的患者在睡眠问题就诊率方面没有显著差异。
PMR患者在被诊断为PMR之前明显更有可能有多次疲劳就诊经历。鉴于在PMR中观察到炎性细胞因子的过度产生，这种疲劳可能代表在出现更典型的肌肉骨骼症状之前的前驱期。这表明临床医生在诊治有疲劳症状的老年患者时应考虑PMR作为一种潜在诊断。
