More Than Pain and Stiffness: Persistent Fatigue and Sleep Disturbance Characterise Polymyalgia Rheumatica.

Abstract

Objective: To examine fatigue and sleep disturbance in patients with recently diagnosed polymyalgia rheumatica (PMR) compared to age- and gender-matched controls, including associated characteristics and change over an 18-month follow-up period.

Methods: Patients meeting the 2012 EULAR/ACR Classification Criteria for PMR were prospectively recruited, together with matched controls. Assessments were undertaken 3 months after the commencement of glucocorticoids and again 18 months later. Fatigue was quantified using the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ) and the 36-Item Short Form Survey (SF-36) Vitality Scale. Sleep was quantified using the Pittsburgh Sleep Quality Index (PSQI). Other data collected included PMR disease activity, depression, anxiety and physical function status. All participants underwent body composition by DEXA and physical function testing.

Results: Thirty-six participants with PMR and 32 controls were included. PMR disease activity was low at both visits. Significantly more PMR patients than controls suffered severe fatigue (36% and 35% at baseline and follow-up respectively, versus 3% of controls at both timepoints). Poor quality sleep also impacted more PMR patients than controls (77% and 84% at baseline and follow-up respectively, versus 56% of controls at both timepoints). Higher BMI and fat mass index, anxiety, depression, PMR-Activity Score, inflammatory markers, pain, and stiffness were all associated with severe fatigue. There were no significant associations with poor sleep.

Conclusion: PMR patients experience a disproportionate degree of fatigue and sleep disturbance, which persists almost two years after starting treatment. Features associated with fatigue include higher adiposity, psychological comorbidity, and PMR disease activity.