Longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the PMR Cohort study
Autor: | John Belcher, Toby Helliwell, Rebecca Whittle, Sara Muller, Samantha L. Hider, Sarah A Lawton, Chris Morton, Christian D Mallen, Emily Hughes |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
Male
musculoskeletal diseases medicine.medical_specialty Primary health care Pain polymyalgia rheumatica Polymyalgia rheumatica stiffness 03 medical and health sciences Postal questionnaire 0302 clinical medicine Rheumatology Rating scale Surveys and Questionnaires RC927 Humans Medicine Pharmacology (medical) clusters 030212 general & internal medicine AcademicSubjects/MED00360 Aged Aged 80 and over 030203 arthritis & rheumatology business.industry Middle Aged Clinical Science Prognosis medicine.disease Alternative treatment Physical therapy Female business Cohort study |
Zdroj: | Rheumatology (Oxford, England) |
ISSN: | 1462-0332 |
Popis: | Objectives To investigate potential subgroups of primary care–diagnosed patients with PMR based on self-reported pain and stiffness severity over time. Methods A total of 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 2 year period. A total of 446 people completed the 2 year follow-up. Pain and stiffness were reported on a 0–10 numerical rating scale. Latent class growth analysis was used to estimate the joint trajectories of pain and stiffness over time. A combination of statistical 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. Conclusion 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. |
Databáze: | OpenAIRE |
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