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

We aimed 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.

Patients meeting the 2012 European Alliance of Associations for Rheumatology/American College of Rheumatology 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 Multidimensional Questionnaire and the 36-item Short Form Health Survey vitality scale. Sleep was quantified using the Pittsburgh Sleep Quality Index. Other data collected included PMR disease activity, depression, anxiety, and physical function status. All participants underwent body composition by dual-energy x-ray absorptiometry and physical function testing.

Thirty-six participants with PMR and 32 controls were included. PMR disease activity was low at both visits. Significantly, more patients with PMR than controls suffered severe fatigue (PMR: 36% and 35% at baseline and follow-up, respectively; controls: 3% at both timepoints). Poor sleep quality also affected more patients with PMR (77% and 84% at baseline and follow-up, respectively) than controls (56% 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.

Patients with PMR experience a disproportionate degree of fatigue and sleep disturbance, which persists almost 2 years after starting treatment. Features associated with fatigue include higher adiposity, psychological comorbidity, and PMR disease activity.