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Study procedures and the baseline sample have been described in detail elsewhere. We consider whether the presentation of a patient at the time of diagnosis is different in those who go on to have different symptom trajectories. In this article we use latent class growth models in data from the PMR Cohort Study to derive clinically recognizable groups of patients with differing patterns of pain and stiffness over 2 years. This may identify subgroups of patients who do not respond to glucocorticoids as expected or who are otherwise suitable for early interventions.
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A key aim of this cohort, supported by patient groups, is to better understand the prognosis of the condition. To our knowledge, this inception cohort of patients with PMR, recruited in England at the time of diagnosis, is the only prospective large-scale study of incident PMR in a primary care setting. In order to provide an evidence base to understand the wider epidemiology of PMR, the PMR Cohort Study was established in 2012. We therefore have little knowledge of the course of PMR in relation to its symptoms or treatment in the setting in which it is most frequently diagnosed and managed. study samples including patients with atypical presentation and/or more severe/difficult to treat disease). To date, the majority of PMR research has been conducted in secondary care settings, which given the guidance on indications for referral for specialist review, potentially induces spectrum bias (i.e. Guidelines suggest a gradual tapering of glucocorticoid treatment over 18–24 months, although recent evidence suggests that treatment is often required for longer, which may increase the likelihood of experiencing potentially serious treatment-related adverse effects. The mainstay of treatment is with oral glucocorticoids, which typically, although not always, bring about rapid relief of symptoms and improve physical function. ESR, CRP), but it can present atypically or with non-specific symptoms, especially in the early stages. PMR causes disabling pain and stiffness in the shoulder and hip girdles, often accompanied by elevated inflammatory markers (e.g. PMR, a relatively common inflammatory rheumatological condition, is underresearched, especially in primary care, where the majority of patients are exclusively diagnosed and managed. In people with polymyalgia rheumatica, there are distinct groups with different symptom experiences over time.įuture research into polymyalgia rheumatica should aim to identify those at risk of poor recovery.
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Pain and stiffness in polymyalgia rheumatica may be more variable across individuals than previously thought.