Polymyalgia rheumatica

Overview

Polymyalgia rheumatica (PMR) is a condition that causes inflammation in the muscles, leading to pain and stiffness. It mainly affects the shoulders, neck, and hips. The symptoms often come on quickly, over days or weeks.

PMR is not extremely common, but it is the most common inflammatory condition affecting older adults. About 1 in 1,000 people over age 50 develop it each year.

PMR almost always occurs in people over the age of 50, and the average age of diagnosis is around 70. It is more common in women than men, and it tends to affect people of Northern European descent more than other ethnic groups.

Symptoms

Common symptoms

• Pain and stiffness in both shoulders, often making it hard to raise your arms.
• Pain and stiffness in the hips, thighs, or neck.
• Stiffness that is worse in the morning and lasts more than 45 minutes.
• Trouble getting out of bed, getting dressed, or combing your hair.
• Feeling very tired, weak, or generally unwell.
• Mild fever, loss of appetite, or weight loss.

Symptoms in children

• Polymyalgia rheumatica does not occur in children.

Symptoms in older adults

• Older adults may have more severe stiffness and find it hard to do daily tasks like bathing or cooking.
• They may also have more fatigue, weight loss, or low-grade fever.
• Depression or feeling low is common because of pain and reduced activity.

Causes

Main causes

• The exact cause of PMR is unknown.
• It is believed to be an autoimmune reaction, where the body's immune system mistakenly attacks healthy tissues, especially the lining of joints and muscles.
• It may be triggered by infections or other environmental factors in people who are genetically prone.

Risk factors

• Age over 50.
• Being female.
• Having a Northern European background.
• Having a family history of PMR or giant cell arteritis.

When to see a doctor

See a doctor urgently if:

• If you have new vision problems, severe headache, or jaw pain — these may be signs of giant cell arteritis and need same-day care.
• If you are unable to move your arms or legs due to stiffness or pain.

Book a routine appointment if:

• If you have new pain and stiffness in your shoulders, neck, or hips that lasts more than a few weeks.
• If morning stiffness lasts more than 30 minutes and does not get better with rest.
• If you feel unusually tired, have a low fever, or lose weight without trying.

Diagnosis

There is no single test for PMR. Doctors diagnose it based on your symptoms, a physical exam, and blood tests that show high levels of inflammation. They may also rule out other conditions like rheumatoid arthritis or infections.

Tests that may be done

• Blood tests for inflammation: ESR (sed rate) and CRP (C-reactive protein) are usually very high in PMR.
• Complete blood count (CBC) to check for anemia or other issues.
• Rheumatoid factor and anti-CCP antibodies to rule out rheumatoid arthritis.
• Sometimes imaging like ultrasound or MRI to look at the shoulder or hip joints.

What to expect at your appointment

Your doctor will ask about your symptoms, perform a physical exam, and order blood tests. The diagnosis often takes a few visits. If your symptoms and blood tests suggest PMR, your doctor may start a low dose of corticosteroids to see if your symptoms improve quickly — this is often a key clue.

Treatment

Treatment for PMR focuses on reducing inflammation and relieving pain. Most people need medication for 1 to 2 years, but the dose is gradually lowered over time.

Self-care at home

• Stay as active as possible, but pace yourself — rest when needed.
• Gentle stretching exercises can help maintain flexibility.
• Apply heat packs to stiff muscles in the morning.
• Eat a balanced diet rich in calcium and vitamin D to support bone health.
• Get enough sleep and manage stress.

Medical treatments

The main treatment is a type of medicine called corticosteroids (like prednisolone) that quickly reduce inflammation. Doctors start with a low to moderate dose and gradually taper it down over many months. Sometimes other medicines that affect the immune system are used to help lower the steroid dose. You will need regular blood tests and check-ups to monitor your response and adjust treatment.

Living with this condition

Living with PMR means learning to manage morning stiffness and fatigue. Plan your day so that mornings are less rushed — allow extra time to get moving. Gentle activity, like walking or stretching, can help ease stiffness. Keep a routine and listen to your body.

Lifestyle tips

• Exercise regularly — aim for gentle activities like walking, swimming, or tai chi.
• Eat a healthy diet to maintain strength and energy.
• Avoid smoking and limit alcohol.
• Use assistive tools if needed, like a long-handled brush or reacher.
• Join a support group or talk to others with PMR.

Diet and exercise

Aim for a well-balanced diet including fruits, vegetables, whole grains, lean protein, and healthy fats. Calcium and vitamin D are important because corticosteroids can weaken bones. Gentle exercise, especially stretching and low-impact aerobics, helps maintain muscle strength and joint flexibility. Always check with your doctor before starting a new exercise program.

Mental health and emotional wellbeing

Living with chronic pain and stiffness can be frustrating and tiring. Some people feel depressed or anxious. It is important to talk to your doctor or a mental health professional if you are struggling. Counseling or support groups can help you cope with the emotional side of the condition.

Prevention

There is no known way to prevent PMR. It cannot be predicted who will get it. The best approach is to stay healthy overall and seek medical advice early if symptoms develop.

Screening programmes

There is no routine screening for PMR. However, if you are over 50 and have new muscle pain and stiffness, see your doctor for evaluation.

Complications

If left untreated

• Persistent pain and stiffness that reduces quality of life.
• Muscle weakness and loss of function.
• Increased risk of developing giant cell arteritis, which can cause blindness or stroke.
• Depression and social isolation.

Long-term outlook

With proper treatment, most people with PMR improve quickly and can lead a full, active life. Treatment usually lasts one to two years, and many people eventually stop medication completely. The condition rarely causes permanent damage to muscles or joints. It is important to follow your doctor’s advice and attend regular check-ups to manage your health long-term.

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