Polymyalgia rheumatica: causes, symptoms, diagnosis, and management

Typical features and clinical presentation

Key manifestations of PMR include:

• Symmetric aching and stiffness of shoulders, neck and hips.
• Marked morning stiffness that can last for 45 minutes or longer.
• Difficulty performing overhead activities, rising from a chair, or combing hair.
• Systemic symptoms such as fatigue, low-grade fever or malaise in some patients.

PMR is a clinical diagnosis; patients usually have raised inflammatory markers without major muscle damage. Muscle enzymes such as creatine kinase are typically normal, helping to distinguish PMR from primary myopathies.

Diagnosis and investigations

Diagnosis relies on the pattern of symptoms, physical examination and supportive laboratory tests. Common investigations include blood markers of inflammation — the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) — which are often elevated in PMR. The ESR test is widely used to detect inflammation and is one routine blood test performed in this condition. Imaging such as ultrasound or MRI can reveal bursitis or synovitis around the shoulders and hips in uncertain cases. Because PMR can overlap with or precede giant cell arteritis, clinicians assess for new headache, visual changes, jaw pain when chewing, or scalp tenderness; these symptoms prompt urgent evaluation, including possible temporal artery biopsy for suspected large-vessel involvement.

Treatment and prognosis

The mainstay of treatment is low-dose glucocorticoid therapy, which often produces a rapid and dramatic improvement in symptoms within days. If a patient does not respond as expected to an appropriate initial steroid trial, the diagnosis should be re-evaluated. Therapy is typically continued and tapered slowly over months to years to prevent relapse. Long-term steroid use requires monitoring and measures to reduce side effects, such as bone protection and cardiovascular risk management. In some patients with relapsing disease or when steroid side effects are problematic, additional medications (steroid-sparing agents) may be considered under specialist guidance.

Differential diagnosis and important distinctions

PMR must be distinguished from other causes of pain and stiffness in older adults, including late-onset rheumatoid arthritis, osteoarthritis, fibromyalgia and inflammatory myopathies. Unlike many myopathies, PMR causes pain and stiffness rather than true muscle weakness. Because of the potential coexistence with giant cell arteritis, clinicians maintain a low threshold for urgent assessment if vascular symptoms appear; roughly one in several patients with PMR may have or develop features of temporal arteritis.

Further information

People seeking more details about the condition, diagnostic tests or treatment options can consult general rheumatology resources and patient information services. See a clinical overview: PMR overview. For symptoms and daily management guidance: symptom guide. For information on joint and muscle involvement: joints and muscles and muscle symptoms. For details about the ESR blood test: ESR test. For commonly used medication information: prednisone and corticosteroids.