MusculoskeletalICD-10: M35.3Relatively common in people over 50, especially women of northern European descent; rare under 50

Polymyalgia Rheumatica

Also known as: PMR

Polymyalgia rheumatica (PMR) is an inflammatory condition that causes aching and marked stiffness in the shoulders, neck and hips, typically worst in the morning and after rest. It almost always affects people over 50 and often comes on quite quickly, over days to a couple of weeks. Many people describe suddenly being unable to lift their arms to brush their hair or get out of a chair without difficulty. PMR responds dramatically to low-dose corticosteroids, which is one of the clues to the diagnosis. It is closely linked to giant cell arteritis, an inflammation of blood vessels in the head that can threaten vision, so new headaches, jaw pain or visual changes need urgent attention. Most people recover fully, but treatment usually continues for one to two years.

At a Glance

Common symptoms
Aching and stiffness in both shoulders, often spreading to the neck and upper arms, Aching and stiffness in the hips, buttocks and thighs, Morning stiffness lasting more than 45 minutes, and stiffness after sitting still
Main treatments
Low-dose oral corticosteroids (prednisolone), which usually relieve symptoms within days, A gradual, supervised taper of the steroid dose over 1 to 2 years, guided by symptoms and blood tests, Steroid-sparing medications such as methotrexate, or newer biologic agents, for people who relapse or cannot reduce the steroid dose
Category
Musculoskeletal · Relatively common in people over 50, especially women of northern European descent; rare under 50
See a doctor if
New aching and stiffness in both shoulders or hips lasting more than a week, especially if you are over 50

Symptoms

Aching and stiffness in both shoulders, often spreading to the neck and upper arms
Aching and stiffness in the hips, buttocks and thighs
Morning stiffness lasting more than 45 minutes, and stiffness after sitting still
Difficulty raising the arms above shoulder height, getting dressed or rising from a chair
Fatigue, low-grade fever, loss of appetite and unintended weight loss
Low mood
Occasionally mild swelling of the wrists or hands

Causes

  • The exact cause is unknown; it involves inflammation of the lining around joints, tendons and bursae of the shoulders and hips
  • Genetic susceptibility, with higher rates in people of northern European descent
  • Possible environmental triggers such as viral infections, given seasonal patterns of onset
  • Age-related changes in the immune system
  • Shared mechanisms with giant cell arteritis, which occurs in a minority of people with PMR

Risk Factors

  • Age over 50, with most cases occurring after 65
  • Being female
  • Northern European ancestry
  • A diagnosis of giant cell arteritis

Diagnosis

  • Characteristic history of bilateral shoulder and hip girdle pain with prolonged morning stiffness in a person over 50
  • Blood tests showing raised inflammatory markers (ESR and CRP)
  • Tests to exclude mimics such as rheumatoid arthritis, thyroid disease, infection and cancer
  • Ultrasound of the shoulders and hips, which can show characteristic inflammation
  • A rapid and marked improvement with a trial of low-dose prednisolone supports the diagnosis

Treatment

  • Low-dose oral corticosteroids (prednisolone), which usually relieve symptoms within days
  • A gradual, supervised taper of the steroid dose over 1 to 2 years, guided by symptoms and blood tests
  • Steroid-sparing medications such as methotrexate, or newer biologic agents, for people who relapse or cannot reduce the steroid dose
  • Protecting bone health during steroid treatment with calcium, vitamin D and often a bone-strengthening medication
  • Monitoring blood pressure, blood sugar and eye health while on steroids
  • Supportive: gentle regular exercise and physiotherapy to maintain shoulder and hip mobility and muscle strength
  • Supportive: a balanced diet and weight management to offset steroid side effects

Prevention

  • There is no known way to prevent PMR itself
  • Take corticosteroids exactly as prescribed and never stop them suddenly, as this can cause a flare and adrenal problems
  • Protect your bones with weight-bearing exercise, calcium and vitamin D while on steroids
  • Report any new headache, scalp tenderness, jaw pain when chewing or vision change immediately
  • Keep regular follow-up appointments so the dose can be tapered safely

When to See a Doctor

  • New aching and stiffness in both shoulders or hips lasting more than a week, especially if you are over 50
  • Sudden vision loss, double vision, severe new headache, scalp tenderness or jaw pain when chewing (seek emergency care; possible giant cell arteritis)
  • Symptoms returning while you are tapering steroids
  • Side effects of steroid treatment such as marked weight gain, high blood sugar, mood changes or easy bruising
  • Fever, weight loss or symptoms that do not improve quickly on steroids, which may indicate another diagnosis

Frequently Asked Questions

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