Polymyalgia Rheumatica
Also known as: PMR
An inflammatory condition causing severe stiffness and pain in the shoulders and hips, primarily in adults over 50. Responds dramatically to corticosteroids.
Key Facts
- Almost exclusively affects adults over 50, with peak onset at 70-80 years
- Women are affected 2-3 times more often than men
- Dramatic response to prednisone is so characteristic it helps confirm the diagnosis
- Associated with giant cell arteritis in 10-20% of patients
- Most patients can eventually taper off steroids, though it may take 1-2 years
What is polymyalgia rheumatica?
Polymyalgia rheumatica (PMR) is an inflammatory condition that causes severe stiffness and aching in the shoulders, neck, upper arms, hips, and thighs. It almost exclusively affects adults over 50 and is more common in women. PMR often comes on suddenly — patients frequently describe waking up one day barely able to get out of bed or lift their arms above their head.
PMR is associated with giant cell arteritis (GCA, or temporal arteritis) in a subset of patients, which requires urgent evaluation due to the risk of vision loss.
Symptoms
- Severe stiffness and pain in both shoulders and/or hips
- Symptoms typically worse in the morning
- Difficulty with daily activities — getting dressed, reaching overhead, getting out of a chair
- Sudden onset, sometimes over days
- Fatigue, low-grade fever, weight loss
- Symptoms are typically bilateral (both sides)
How we diagnose it
- Clinical presentation — Characteristic pattern of bilateral shoulder and hip stiffness in a patient over 50
- Blood work — Markedly elevated inflammatory markers (ESR and CRP); if these are normal, PMR is unlikely
- Musculoskeletal ultrasound — Can detect bursitis in the shoulders and hips that supports the diagnosis and helps distinguish PMR from other conditions
- Ruling out mimics — Rheumatoid arthritis, inflammatory myopathy, hypothyroidism, malignancy (particularly in atypical presentations)
- GCA screening — Assessment for headache, jaw claudication, visual symptoms, and temporal artery tenderness
How we treat it
- Prednisone — Typically started at a moderate dose (12.5–25 mg/day) with gradual taper over 12–24 months
- Monitoring — Regular inflammatory marker checks to guide taper speed; too-fast tapers lead to flares
- Steroid-sparing agents — Methotrexate may be added for patients who flare repeatedly during taper or who develop steroid side effects
- Bone protection — Calcium, vitamin D, and consideration of bisphosphonate therapy given prolonged steroid use
- GCA vigilance — Ongoing assessment for symptoms of giant cell arteritis throughout the treatment course
At Synergy Rheumatology
Ultrasound is helpful in confirming PMR — characteristic shoulder and hip bursitis on imaging supports the diagnosis and can distinguish it from inflammatory arthritis. We manage the prednisone taper closely, monitoring labs regularly to minimize both flares and steroid side effects.
Have questions about polymyalgia rheumatica?
Schedule an appointment to discuss your symptoms, diagnosis, or treatment options with Dr. Fellows.