Polymyalgia Rheumatica and Giant Cell Arteritis

What Are the Most Recognizable Symptoms of Polymyalgia Rheumatica?

Polymyalgia rheumatica, commonly called PMR, is an inflammatory condition that occurs almost exclusively after age 50. Its characteristic pattern is aching and stiffness around both shoulders, often accompanied by symptoms in the neck or hip girdle. Stiffness is generally most pronounced after waking or resting, and routine activities such as dressing, raising the arms or getting out of a chair may become difficult.

PMR does not have a single definitive diagnostic test. Clinicians evaluate the symptom pattern, physical examination and inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate while excluding rheumatoid arthritis, infection, cancer, thyroid disease and medication-related muscle symptoms. Improvement after glucocorticoid treatment may support the assessment, but treatment response alone should not replace a careful differential diagnosis.

When Could PMR Symptoms Indicate Giant Cell Arteritis?

PMR and giant cell arteritis are related inflammatory diseases and can occur together. Giant cell arteritis affects medium and large arteries, including vessels supplying the eyes. Warning symptoms include a new or unusual headache, scalp tenderness, jaw or tongue discomfort during chewing, double vision, temporary visual loss and persistent constitutional symptoms such as fever or unexplained weight loss.

Suspected giant cell arteritis is a medical emergency because interrupted blood flow can cause permanent vision loss. Treatment should not be delayed while waiting for every diagnostic result when clinical suspicion is high. Depending on local expertise, evaluation may include vascular ultrasound, temporal artery biopsy or other imaging, alongside blood tests and specialist assessment.

How Is Polymyalgia Rheumatica Treated Safely?

International recommendations support oral glucocorticoids as initial PMR treatment. The 2015 European League Against Rheumatism and American College of Rheumatology recommendations describe an initial prednisone-equivalent range of 12.5 to 25 mg daily, with the precise dose determined by symptom severity, relapse risk and vulnerability to adverse effects. Patients should not start, change or stop glucocorticoids without clinical supervision.

Follow-up is essential because symptoms can recur during dose reduction and prolonged glucocorticoid exposure can contribute to osteoporosis, infection, high blood pressure, cataracts and elevated blood glucose. Monitoring should assess disease activity and treatment toxicity. Clinicians may also consider bone-protection measures and steroid-sparing therapy for selected patients with repeated relapses or substantial glucocorticoid risk.