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

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 questio...

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Autores principales: Muller, Sara, Whittle, Rebecca, Hider, Samantha L, Belcher, John, Helliwell, Toby, Morton, Chris, Hughes, Emily, Lawton, Sarah A, Mallen, Christian D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382596/
https://www.ncbi.nlm.nih.gov/pubmed/31742642
http://dx.doi.org/10.1093/rheumatology/kez533
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author Muller, Sara
Whittle, Rebecca
Hider, Samantha L
Belcher, John
Helliwell, Toby
Morton, Chris
Hughes, Emily
Lawton, Sarah A
Mallen, Christian D
author_facet Muller, Sara
Whittle, Rebecca
Hider, Samantha L
Belcher, John
Helliwell, Toby
Morton, Chris
Hughes, Emily
Lawton, Sarah A
Mallen, Christian D
author_sort Muller, Sara
collection PubMed
description 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.
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spelling pubmed-73825962020-07-29 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 Rheumatology (Oxford) Clinical Science 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. Oxford University Press 2020-08 2019-11-19 /pmc/articles/PMC7382596/ /pubmed/31742642 http://dx.doi.org/10.1093/rheumatology/kez533 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Science
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
title Longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the PMR Cohort Study
title_full Longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the PMR Cohort Study
title_fullStr Longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the PMR Cohort Study
title_full_unstemmed Longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the PMR Cohort Study
title_short Longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the PMR Cohort Study
title_sort longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the pmr cohort study
topic Clinical Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382596/
https://www.ncbi.nlm.nih.gov/pubmed/31742642
http://dx.doi.org/10.1093/rheumatology/kez533
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