Polymyalgia rheumatica (sometimes referred to as PMR) is a common cause of widespread aching and stiffness that affects adults over the age of 50, especially Caucasians. Because polymyalgia rheumatica does not often cause swollen joints, it may be hard to recognize. It may occur with another health problem, giant cell arteritis.

The average age when symptoms start is 70, so people who have PMR may be in their 80s or even older. The disease affects women somewhat more often than men. It is more frequent in whites than nonwhites, but all races can get PMR.

 

What Is It?

Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders and hips. Symptoms tend to come on quickly, over a few days or weeks, and sometimes even overnight.

The signs and symptoms of polymyalgia rheumatica usually occur on both sides of the body and might include:

• Aches or pain in your shoulders

• Aches or pain in your neck, upper arms, buttocks, hips or thighs

• Stiffness in affected areas, particularly in the morning or after being inactive for a time

• Limited range of motion in affected areas

• Pain or stiffness in your wrists, elbows or knees

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You might also have more-general signs and symptoms, including:

• Mild fever

• Fatigue

• A general feeling of not being well (malaise)

• Loss of appetite

• Unintended weight loss

• Depression

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This condition is related to another inflammatory condition called giant cell arteritis. Giant cell arteritis can cause headaches, vision difficulties, jaw pain and scalp tenderness. It's possible to have both conditions together.

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What Causes Polymyalgia Rheumatica?

The cause of polymyalgia rheumatica (PMR) is unknown. PMR does not result from side effects of medications. The abrupt onset of symptoms suggests the possibility of an infection but, so far, none has been found. “Myalgia” comes from the Greek word for “muscle pain.” However, specific tests of the muscles, such as a blood test for muscle enzymes or a muscle biopsy (surgical removal of a small piece of muscle for inspection under a microscope), are all normal.

Recent research suggests that inflammation in PMR involves the shoulder and hip joints themselves, and the bursae (or sacs) around these joints. So, pains at the upper arms and thighs, in fact, start at the nearby shoulder and hip joints. This is what doctors call “referred pain.”

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PMR should not be confused with fibromyalgia, a different syndrome that unlike PMR does not elevate typical markers of inflammation.

 

Monitoring for giant cell arteritis:

Your doctor will monitor you for signs and symptoms that can indicate the onset of giant cell arteritis. Talk to your doctor immediately if you have any of the following:

• New, unusual or persistent headaches

• Jaw pain or tenderness

• Blurred or double vision or visual loss

• Scalp tenderness

 

How Is Polymyalgia Rheumatica Diagnosed?

Polymyalgia rheumatica may be hard to diagnose. Because rheumatologists are experts in diseases of the joints, muscles and bones, they can recognize the diagnosis of PMR and expertly manage its treatment.

In PMR, results of blood tests to detect inflammation are most often abnormally high. One such test is the erythrocyte sedimentation rate (ESR), also called “sed rate.” Another test is the C-reactive protein, or CRP. Both tests may be very elevated in PMR but, in some patients, these tests may have normal or only slightly high results. Your health care providers should rule out other similar health problems, such as rheumatoid arthritis.

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How Is Polymyalgia Rheumatica Treated?

• Corticosteroids: If your doctor strongly suspects PMR, you will receive a trial of low-dose corticosteroids. Often, the dose is 10–15 milligrams per day of prednisone. If PMR is present, the medicine quickly relieves stiffness. The response to corticosteroids can be dramatic. Sometimes patients are better after only one dose. Improvement can be slower, though. But, if symptoms do not go away after two or three weeks of treatment, the diagnosis of PMR is not likely, and your doctor will consider other causes of your illness.

 

Nonsteroidal anti-inflammatory drugs (commonly called NSAIDs), such as ibuprofen, (Advil, Motrin, etc.) and naproxen (Naprosyn, Aleve) are not effective in treating PMR.

When your symptoms are under control, your doctor will slowly decrease the dose of corticosteroid medicine. The goal is to find the lowest dose that keeps you comfortable. Some people can stop taking corticosteroids within a year. Others, though, will need a small amount of this medicine for 2–3 years, to keep aching and stiffness under control. Symptoms can recur and often do if medicine is decreased too quickly. Because the symptoms of PMR are sensitive to even small changes in the dose of corticosteroids, your doctor should direct the gradual decrease of this medicine.

 

• Calcium and vitamin D: Your doctor will likely prescribe daily doses of calcium and vitamin D supplements to help prevent bone loss as a result of corticosteroid treatment. The American College of Rheumatology recommends 1,000 to 1,200 milligrams of calcium supplements and 600 to 800 international units of vitamin D supplements for anyone taking corticosteroids for three months or more.

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•  Methotrexate: Joint guidelines from the American College of Rheumatology and the European League Against Rheumatism suggest using methotrexate (Trexall) with corticosteroids in some patients. This is an immune-suppressing medication that's taken by mouth. It might be useful early in the course of treatment or later, if you relapse or don't respond to corticosteroids.

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•  Kevzara has been used to treat rheumatoid arthritis. In 2023 it received a new FDA approved indication to treat PMR inpatients who do not respond to corticosteroids, cannot taper down Prednisone below 7.5 mg daily or can not tolerate corticosteroids.

 

Living with Polymyalgia Rheumatica

Once the stiffness has gone away, you can resume all normal activities, including exercise. Even low doses of corticosteroids can cause side effects. These include higher blood sugar, weight gain, sleeplessness, osteoporosis (bone loss), cataracts, thinning of the skin and bruising. Checking for these problems, including bone density testing, is an important part of follow-up visits with your doctor. Older patients may need medicine to prevent osteoporosis.

PMR can occur with a more serious closely related condition, giant cell arteritis. As such, you should see your doctor right away if you have PMR and you notice symptoms of headache, changes in vision, jaw pain, or fever.