Subjective sleep disturbances at the time of diagnosis in patients with polymyalgia rheumatica and in patients with seronegative elderly-onset rheumatoid arthritis. A pilot study

Abstract

Objectives: To investigate subjective sleep disturbances in patients with recent-onset polymyalgia rheumatica (PMR) and in patients with recent-onset seronegative elderly-onset rheumatoid arthritis (SEORA). Material and methods: The study involved patients consecutively referred to two outpatient clinics from January to June 2018, with a diagnosis of PMR according to 2012 European League Against Rheumatism and American College of Rheumatology provisional criteria, and patients with a diagnosis of SEORA according to 1987 American Rheumatism Association criteria + age + absence of rheumatoid factor and anti-citrullinated peptide antibodies. All patients were naive to glucocorticoid (GC) therapy. After informed consent, we asked the patients to fill out a questionnaire including the Medical Outcomes Study-Sleep Scale (MOS-SS), pain Visual Analogic Scale (VAS), Cumulative Illness Rating Scale (CIRS), Neuropsychiatric Inventory (NPI), and how many minutes their morning stiffness (MS) lasted, at baseline and after 1 (T1) and 12 (T2) months. Differences between groups were calculated with the t-test; all p-values were two-sided and p < 0.05 was used to determine statistical significance. The study was approved by the local ethics committee and carried out in accordance with the Helsinki Declaration. Results: The MOS-SS scores and MS duration were the only variables to show at T0 a significant difference between the two groups. In particular, MOS-SS scores were 47.6 ±8.4 (PMR) and 28.26 ±12.4 (SEORA), with p-values = 0.000. The MS duration was 90 ±9.9 minutes and 45 ±5.5 minutes, with p-value = 0.000. At T1 and T2, MOS-SS scores and MS duration decreased in the two groups, and no significant differences were found. Conclusions: The study suggests that the assessment of subjective sleep disturbances can be useful in the differential diagnosis between recent-onset PMR and SEORA.

Differentiating between Seronegative Elderly-Onset Rheumatoid Arthritis and Polymyalgia Rheumatica: A Qualitative Synthesis of Narrative Reviews

“…The duration of follow-up varied depending on the review [8,[17][18][19][20]. The clinical courses of seronegative EORA and PMR are acute and affect the activities of daily living in older patients [27,28]. Steroids can be initiated to mitigate the acute symptoms of seronegative EORA and PMR after ruling out other diseases such as bacteremia, sepsis, and other systemic inflammations [29].…”

Absence of Long-Lasting Morning Stiffness at the Time of Diagnosis as Paraneoplastic Warning in Patients with Polymyalgia Rheumatica (PMR): Data from Italian Single-Center Study

“…We hope that our inclusion and exclusion criteria reduced most of the potential bias. In particular, we systematically asked all the patients with suspicion of PMR attending our rheumatologic outpatient clinic whether they had MS [ 19 , 20 , 21 ]. Therefore, we had no bias in the collection of these data.…”

Feasibility and usefulness of a fast-track clinic for patients suspected of polymyalgia rheumatica: notes for a work schedule through a narrative review of published literature

“…If misdiagnosed or inadequately treated, PMR can exert a profound burden on the patient’s quality of life (QoL) [ 17 ]. This derives from the impairment due to the inflammatory pain and stiffness, from secondary depressive symptoms and sleep disorders, and chronically from the potential adverse events (AEs) of medium to high dosages of GCs [ 18 – 22 ].…”