Polymyalgia rheumatica is an inflammatory condition that causes pain and stiffness in the shoulders, neck, hips, and upper arms. The word “polymyalgia” means pain in many muscles, and “rheumatica” refers to joint and soft tissue inflammation. It is most common in adults over age 50 and affects women more often than men. The stiffness is typically worst in the morning and after periods of inactivity.
PMR, as it is often called, is not a form of arthritis in the usual sense, though it is related to inflammation in and around the joints. It is also closely linked to a condition called giant cell arteritis, which affects blood vessels. Understanding what PMR is, how it differs from other conditions, and what treatment typically involves can help people recognize it and seek appropriate care.
What Is Polymyalgia Rheumatica and What Causes It?
PMR is an inflammatory disorder driven by the immune system. Something triggers the body’s immune response to attack its own tissues, particularly the bursae (fluid-filled sacs that cushion joints) and tendons around the shoulders and hips.
The exact cause remains unknown. Researchers have not identified a single trigger. What is known is that the immune system plays a central role. Inflammatory markers in the blood, such as erythrocyte sedimentation rate and C-reactive protein, are typically elevated in people with PMR. These markers indicate that inflammation is present, though they do not reveal the cause.
Genetics appear to play a role. PMR is more common in people of Northern European descent, and certain genetic markers are associated with the condition. However, having those markers does not mean someone will develop PMR.
PMR is not caused by overuse, injury, or poor posture. It is not a wear-and-tear condition like osteoarthritis. The pain comes from inflammation, not from mechanical damage to the joints.
What Are the Symptoms of Polymyalgia Rheumatica?
The hallmark symptoms are pain and stiffness in specific areas: the shoulders, neck, upper arms, hips, and sometimes the lower back or thighs. The stiffness is usually worse in the morning and can last for an hour or more. It may also worsen after sitting still for a long time.
People with PMR often describe difficulty getting out of bed, rising from a chair, or lifting their arms above their head. The pain is typically on both sides of the body, though one side may be more affected than the other.
Other symptoms can include:
- Fatigue and a general sense of feeling unwell
- Low-grade fever
- Unexplained weight loss
- Mild swelling or pain in the wrists, knees, or other joints
- Anemia (low red blood cell count)
What PMR does not typically cause is muscle weakness. The muscles themselves are not damaged. People may feel weak because moving hurts, but true muscle weakness suggests something else may be going on.
Symptoms usually develop over a few weeks, though they can come on more suddenly. The intensity can vary from day to day, but the condition does not go away on its own without treatment.
How Is Polymyalgia Rheumatica Diagnosed?
There is no single test that confirms PMR. Diagnosis is based on a combination of symptoms, physical examination, and blood test results. Doctors look for the characteristic pattern of pain and stiffness in people over 50, along with elevated inflammatory markers.
Blood tests commonly ordered include:
- Erythrocyte sedimentation rate (ESR): A measure of how quickly red blood cells settle at the bottom of a test tube. A high rate suggests inflammation.
- C-reactive protein (CRP): A protein produced by the liver in response to inflammation.
- Complete blood count: To check for anemia or other abnormalities.
Imaging tests such as ultrasound or MRI may be used in some cases, particularly to look for inflammation in the shoulder or hip bursae. These are not routine for all patients but can help when the diagnosis is unclear.
One important step is ruling out other conditions that can cause similar symptoms. These include rheumatoid arthritis, polymyositis, dermatomyositis, and hypothyroidism. Your doctor may order additional tests to check for these possibilities.
The response to treatment is sometimes used as a diagnostic clue. If symptoms improve quickly with a low dose of corticosteroids, that supports a PMR diagnosis. However, this is not a definitive test, and other conditions can also respond to steroids.
What Is the Connection Between PMR and Giant Cell Arteritis?
PMR and giant cell arteritis (GCA) are closely related. GCA is an inflammation of blood vessels, most often the arteries in the head and neck. About 15 to 20 percent of people with PMR also have GCA, according to some estimates, though the exact percentage varies across studies.
GCA is a serious condition because it can lead to vision loss if not treated promptly. Symptoms of GCA include:
- New, persistent headaches
- Jaw pain when chewing
- Scalp tenderness
- Vision changes, including double vision or temporary vision loss
- Pain in the temples
Anyone with PMR who develops these symptoms should seek medical care immediately. Vision loss from GCA can be permanent if treatment is delayed. High-dose corticosteroids are typically started right away when GCA is suspected.
Not everyone with PMR develops GCA, and not everyone with GCA has PMR. But because the two conditions are linked, doctors often ask about GCA symptoms when diagnosing PMR.
How Is Polymyalgia Rheumatica Treated?
Corticosteroids, usually prednisone, are the standard treatment for PMR. Most people experience significant relief of symptoms within days of starting treatment. The starting dose is typically low, often in the range of 10 to 20 milligrams per day, though the exact dose is determined by a doctor based on individual factors.
Treatment usually continues for one to two years or longer. The dose is gradually reduced over time as symptoms improve and inflammatory markers normalize. Some people can taper off completely; others need a low maintenance dose for a longer period.
Because long-term steroid use carries risks, doctors aim to use the lowest effective dose for the shortest time possible. Potential side effects of corticosteroids include:
- Weight gain, particularly in the abdomen and face
- Increased blood sugar, which can worsen diabetes
- Bone loss (osteoporosis)
- High blood pressure
- Increased risk of infection
- Mood changes or difficulty sleeping
To reduce these risks, doctors may recommend calcium and vitamin D supplements, bone density monitoring, and regular check-ups. In some cases, other medications such as methotrexate may be added to help reduce the steroid dose. The evidence for methotrexate in PMR is mixed; some studies suggest it may help some people reduce steroid use, but it is not effective for everyone.
More recently, researchers have studied biologic drugs that target specific parts of the immune system. Some evidence suggests that certain biologics may help reduce steroid needs in people with PMR, but these are not yet considered standard first-line treatment. The evidence is still developing.
What Is the Outlook for People with Polymyalgia Rheumatica?
Most people with PMR respond well to treatment. Symptoms typically improve within days to weeks of starting corticosteroids. Many people are able to reduce their medication over time and eventually stop treatment.
However, the course of PMR varies. Some people have symptoms that resolve within a year or two. Others experience a more prolonged course, with symptoms that persist or flare when the steroid dose is reduced. Relapses are common, especially during the tapering phase.
PMR itself does not appear to shorten life expectancy. The main concern is the side effects of long-term steroid treatment, which is why doctors work to minimize the dose and duration.
Regular follow-up with a doctor is important. Blood tests can help monitor inflammation, and adjustments to treatment can be made as needed. Physical activity, as tolerated, may help maintain strength and mobility, though there is no strong evidence that exercise changes the course of the disease itself.
It is also worth noting that PMR is not the same as fibromyalgia, despite some overlapping symptoms. Fibromyalgia does not cause elevated inflammatory markers, and it does not respond to corticosteroids. Distinguishing between the two is important for getting the right treatment.
When Should You See a Doctor?
If you are over 50 and experience new, persistent pain and stiffness in your shoulders, neck, or hips, especially if it is worse in the morning, see a doctor. Early diagnosis and treatment can help relieve symptoms and reduce the risk of complications.
Seek immediate medical care if you have symptoms that could suggest giant cell arteritis, such as a new headache, jaw pain when chewing, or any vision changes. These symptoms require urgent evaluation and treatment.
PMR is a manageable condition for most people, but it requires medical care. It is not something to treat on your own with over-the-counter pain relievers, which are generally not effective for the inflammation involved.
Frequently Asked Questions
What is the main symptom of polymyalgia rheumatica?
The main symptom is pain and stiffness in the shoulders, neck, and hips that is usually worse in the morning. The stiffness often lasts an hour or more and can make it hard to get out of bed or lift your arms.
Is polymyalgia rheumatica the same as arthritis?
No, PMR is not the same as osteoarthritis or rheumatoid arthritis, though it involves inflammation around the joints. It is an inflammatory condition that affects the bursae and tendons, not the joints themselves in the way arthritis does.
Can polymyalgia rheumatica go away on its own?
PMR does not typically resolve without treatment. Most people need corticosteroids to control symptoms, though the condition can eventually go into remission for many people after one to two years of treatment or longer.
What happens if polymyalgia rheumatica is left untreated?
Untreated PMR can lead to ongoing pain and stiffness that interferes with daily activities and quality of life. It also raises the risk of complications if giant cell arteritis is present but not treated, which can cause vision loss.
