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Polymyalgia Rheumatica: Symptoms, Causes, and Treatment

Polymyalgia rheumatica (PMR) is an inflammatory disorder that causes widespread muscle pain and stiffness, primarily in older adults.

While it can significantly affect daily life, PMR is highly treatable—especially when diagnosed early.

This guide explains the signs and symptoms of PMR, who’s at risk, how it’s diagnosed, and what treatments are available in 2025.

What Is Polymyalgia Rheumatica?

Polymyalgia rheumatica is a chronic inflammatory condition that affects the muscles and joints, particularly around the shoulders, neck, and hips. Despite its name, PMR does not damage the muscles directly—instead, inflammation in the surrounding tissues causes stiffness and pain.

It primarily affects people over age 50, and is more common in women and individuals of Northern European descent.

Key Symptoms of Polymyalgia Rheumatica

Symptoms usually come on suddenly, sometimes overnight, and may include:

  • Morning stiffness lasting more than 45 minutes
  • Aching and stiffness in the shoulders, upper arms, neck, hips, or thighs
  • Difficulty getting out of bed, standing, or lifting arms
  • Fatigue
  • Low-grade fever
  • Loss of appetite and unintended weight loss
  • Depression or emotional changes due to chronic pain

Unlike arthritis, PMR does not usually cause joint swelling, though movement may be restricted due to stiffness and discomfort.

What Causes PMR?

The exact cause is unknown, but PMR is believed to result from a dysregulated immune response that leads to inflammation in the joints and soft tissues.

Potential contributing factors:

  • Genetic predisposition
  • Age-related immune system changes
  • Environmental triggers, such as infections

PMR is sometimes associated with a more serious condition called giant cell arteritis (GCA), which involves inflammation of the blood vessels and can lead to vision loss. About 10–20% of people with PMR may develop GCA.

How Is PMR Diagnosed?

There is no single test for PMR, so diagnosis is based on clinical evaluation, medical history, and bloodwork.

Common diagnostic steps:

  • Physical exam: Assess stiffness, pain, and range of motion
  • Blood tests: Look for elevated markers of inflammation such as
  • Erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • Imaging: Ultrasound or MRI to rule out other joint or muscle conditions
  • Response to corticosteroids: Rapid symptom improvement after a low dose of prednisone is often considered a diagnostic clue

Treatment for Polymyalgia Rheumatica

The standard treatment for PMR is low-dose corticosteroids, typically prednisone.

Treatment plan usually includes:

  • Initial dose: 10–20 mg of prednisone daily
  • Symptom relief: Often within 24–72 hours
  • Tapering: Gradual reduction in dose over 12–24 months under medical supervision

Other medications may include:

  • NSAIDs (e.g., ibuprofen) – For mild symptoms or as steroid-sparing agents
  • Methotrexate – Sometimes used in relapsing cases or to reduce steroid dependence
  • Bone protection therapy – Calcium, vitamin D, and bisphosphonates to prevent osteoporosis due to long-term steroid use

Living with PMR

While PMR is a chronic condition, most people respond well to treatment and can resume normal activities.

Tips for managing PMR:

  • Stay active: Light exercise and stretching can reduce stiffness
  • Eat anti-inflammatory foods: Focus on fruits, vegetables, omega-3s, and whole grains
  • Track symptoms: Journaling can help during steroid tapering
  • Follow up regularly: Adjust treatment based on symptom flares and side effects

When to See a Doctor

If you experience persistent morning stiffness, unexplained shoulder or hip pain, or symptoms that limit daily activities, it’s time to speak with a healthcare provider. Early treatment can prevent complications and improve long-term outcomes.

Also seek care if you have PMR and develop:

  • New headaches
  • Scalp tenderness
  • Jaw pain when chewing
  • Sudden vision changes

These could indicate giant cell arteritis, which requires urgent attention.

Final Thoughts: PMR Is Manageable with the Right Care

Polymyalgia rheumatica can feel overwhelming, especially when it impacts mobility and energy. But with timely diagnosis and appropriate steroid therapy, most people see significant symptom improvement and can lead active, fulfilling lives.

Understanding the signs—and working closely with a healthcare provider—can help you manage symptoms effectively and avoid complications.

Sources

  • Mayo Clinic – Polymyalgia Rheumatica Overview
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
  • Cleveland Clinic – PMR Diagnosis and Treatment
  • Arthritis Foundation