If my experience is indicative, fatigue might indeed mark the earliest stages of PMR.

While on a vacation trip to Hawaii with family, one January, I became overwhelmed by fatigue and spent most of each day in bed sleeping and resting while the family were at the beach. By February I felt acute pain in my hips and shoulders and had trouble putting on a shirt. In March/April I was diagnosed with PMR. I had never thought that the extraordinary fatigue I experienced in January might have been a precursor to PMR but now it seems possible, if not likely. Thank you for your excellent question.