Polymyalgia Rheumatica: Recognizing Symptoms

What Are the Symptoms of Polymyalgia Rheumatica?

Polymyalgia rheumatica, often abbreviated PMR, is an inflammatory condition that develops almost exclusively after age 50. Its hallmark is relatively sudden pain and stiffness affecting both shoulders, frequently accompanied by symptoms around the neck or hip girdles. Morning stiffness commonly lasts longer than 45 minutes, and everyday activities such as dressing, raising the arms, turning in bed, or rising from a chair may become difficult.

Some people also experience fatigue, reduced appetite, weight loss, low-grade fever, or a general feeling of illness. These features are not specific to PMR, however. Rheumatoid arthritis, thyroid disease, muscle disorders, infection, cancer, medication effects, and mechanical shoulder conditions can produce overlapping symptoms, making a structured medical evaluation essential.

How Is Polymyalgia Rheumatica Diagnosed?

Clinicians usually assess the distribution and duration of pain, the degree of morning stiffness, functional limitations, medication history, and signs of another inflammatory disease. Blood tests commonly include C-reactive protein and erythrocyte sedimentation rate, which are often elevated but cannot confirm PMR on their own. A normal result does not automatically exclude the condition, particularly when the clinical pattern is convincing.

Additional testing is selected according to the differential diagnosis and may include a full blood count, thyroid testing, muscle enzymes, rheumatoid arthritis antibodies, or imaging. Ultrasound can identify inflammation around the shoulders or hips and may support the diagnosis. Improvement after glucocorticoid treatment can provide useful evidence, but response alone should not replace a thorough assessment because several other conditions also improve temporarily with steroids.

How Is Polymyalgia Rheumatica Treated Safely?

Oral glucocorticoids are the standard initial treatment and often produce substantial symptom improvement. The dose should then be reduced gradually according to symptoms, inflammatory markers, adverse effects, and recurrence of disease activity. Treatment frequently continues for many months, and some patients require longer courses because relapse can occur during dose reduction.

Long-term glucocorticoid exposure can contribute to osteoporosis, infection, diabetes, high blood pressure, cataracts, and other complications. Clinicians should assess bone health and cardiovascular and metabolic risk while reviewing whether preventive measures are appropriate. Specialist input may be needed for an atypical presentation, repeated relapse, difficulty tapering treatment, or consideration of a steroid-sparing medicine such as methotrexate.