ConditionBones, joints & muscles
Polymyalgia Rheumatica (PMR)
Polymyalgia rheumatica (PMR) is an inflammatory condition causing pain and stiffness in the shoulders, neck, upper arms, hips and thighs, almost always in people over 50. Stiffness is worst in the morning, often lasting more than 45 minutes, and can make it hard to get out of bed or raise the arms. Blood tests usually show raised inflammation. It responds dramatically to low-dose steroids, often within days. About 1 in 5 people also develop giant cell arteritis, which can threaten vision.
Also called: PMR, polymyalgia
At a glance
- What it is
- Inflammation causing pain and stiffness around the shoulders and hips.
- Who gets it
- People over 50, most often over 70; more common in women and people of northern European descent.
- Key symptom
- Morning stiffness lasting 45 minutes or more, on both sides.
- Tests
- Raised ESR and CRP; ultrasound may show bursitis.
- Treatment
- Low-dose prednisone tapered over 1 to 2 years; steroid-sparing drugs in some.
- Watch for
- Giant cell arteritis symptoms, which need urgent treatment.
When to get help
Call 911 or go to the ER
- Sudden loss of vision, double vision or a curtain over vision, especially with headache: go to the ER immediately
See a doctor within a day or two
- New headache, scalp tenderness, jaw pain when chewing, or visual disturbance in someone with PMR (possible giant cell arteritis)
- Fever, night sweats or weight loss that is getting worse
- Muscle weakness (rather than pain and stiffness)
Book a routine appointment
- Shoulder and hip pain and stiffness lasting more than 2 weeks in someone over 50, worst in the morning
- Symptoms returning as the steroid dose is reduced
- Steroid side effects such as high blood sugar, mood changes or weight gain
What polymyalgia rheumatica is
PMR is an immune-mediated inflammation of the tissues around the shoulders and hips, particularly the bursae and tendon sheaths, rather than the muscles themselves. The name means "pain in many muscles," but muscle strength is normal. The cause is unknown; age, genetics and possibly infections play a role.
Symptoms
- pain and stiffness in both shoulders, often the first symptom, spreading to the neck and upper arms
- pain and stiffness in the hips, buttocks and thighs
- morning stiffness lasting at least 45 minutes, and stiffness after rest
- difficulty getting out of bed or a chair, dressing, combing hair or reaching overhead
- pain at night
- fatigue, low mood, mild fever, loss of appetite and weight loss
- sometimes swelling of the hands and wrists
Symptoms often start over days to weeks.
PMR and giant cell arteritis
Giant cell arteritis (GCA) is inflammation of large arteries, especially in the head. About 15 to 20% of people with PMR develop GCA, and about half of people with GCA have PMR symptoms. GCA warning signs:
- new headache, often at the temples
- tender scalp
- pain in the jaw or tongue when chewing
- visual changes: blurring, double vision or sudden loss
GCA can cause permanent blindness and needs high-dose steroids the same day.
Conditions that can mimic PMR
| Condition | How it differs |
|---|---|
| Rheumatoid arthritis in older adults | Swollen small joints, positive antibodies |
| Shoulder problems (rotator cuff, frozen shoulder) | Usually one side, specific movements |
| Hypothyroidism | Fatigue and aches with abnormal thyroid tests |
| Myositis | True muscle weakness and raised CK |
| Fibromyalgia | Widespread pain, normal inflammatory markers, often younger |
| Cancer or infection | Weight loss, fever, other findings |
| Statin muscle side effects | Linked to medicine, CK may be raised |
Diagnosis
There is no single test. Diagnosis is based on:
- age over 50 and typical symptoms
- raised ESR and/or CRP
- tests to exclude other conditions: blood count, kidney and liver function, calcium, thyroid, CK, rheumatoid factor and anti-CCP, protein electrophoresis
- ultrasound showing bursitis of the shoulders or hips can support the diagnosis
- a rapid response to low-dose steroids, which also supports it
Treatment
Steroids
- Prednisone at a low starting dose, as prescribed. Most people feel dramatically better within days to a week.
- The dose is gradually tapered over months, usually aiming for treatment of 1 to 2 years. Some people need longer.
- Do not stop steroids suddenly, as this can cause adrenal insufficiency and relapse.
Protecting against steroid side effects
- bone protection: calcium, vitamin D and often a bisphosphonate
- monitoring blood sugar, blood pressure, weight and eyes (cataracts, glaucoma)
- staying active
Steroid-sparing treatment
For relapses or high risk of steroid side effects: methotrexate, or sarilumab (an IL-6 blocker approved for PMR), or tocilizumab in some cases.
Physical activity
Gentle exercise and physical therapy help maintain strength and mobility.
Outlook
Most people recover fully, though relapses during tapering are common. Treatment usually lasts 1 to 2 years, sometimes longer. Staying alert to GCA symptoms throughout is important.
Frequently asked questions
What are the first signs of polymyalgia rheumatica?
The first signs are usually pain and stiffness in both shoulders and the neck, often spreading to the hips and thighs, with marked stiffness in the morning lasting more than 45 minutes. Fatigue, mild fever and weight loss are common.
How is polymyalgia rheumatica diagnosed?
Doctors diagnose it from typical symptoms in someone over 50, raised inflammation markers (ESR or CRP), tests that rule out other causes, and often a rapid response to low-dose steroids. Ultrasound of the shoulders can help.
How long does polymyalgia rheumatica last?
Most people need treatment for 1 to 2 years, with steroids slowly reduced over that time. Some have relapses and need longer. Eventually most people can stop treatment.
Is polymyalgia rheumatica serious?
PMR itself is not life-threatening and responds well to treatment. The main concerns are its link with giant cell arteritis, which can cause blindness, and the side effects of long-term steroids.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Rheumatology/EULAR: 2015 Recommendations for the management of polymyalgia rheumatica; 2012 classification criteria
- British Society for Rheumatology: Guideline for the management of polymyalgia rheumatica (2024)
- American College of Rheumatology: Polymyalgia rheumatica patient fact sheet
- MedlinePlus: Polymyalgia rheumatica
- NHS: Polymyalgia rheumatica