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Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory disorder. It involves pain and stiffness in the shoulders and often the hips.

Causes

Polymyalgia rheumatica most often occurs in people over 50 years old. The cause is unknown.

PMR may occur before or with giant cell arteritis (GCA; also called temporal arteritis). This is a condition in which blood vessels that supply blood to the head and eye become inflamed.

PMR can sometimes be hard to tell apart from rheumatoid arthritis (RA) in an older person. This occurs when tests for rheumatoid factor and anti-CCP antibody are negative.

Symptoms

The most common symptom is pain and stiffness in both shoulders and the neck. The pain and stiffness are worse in the morning. This pain most often progresses to the hips.

Fatigue is also present. People with this condition find it increasingly hard to get out of bed and to move around.

Other symptoms include:

Exams and Tests

Lab tests alone can't diagnose PMR. Most people with this condition have high markers of inflammation, such as the sedimentation rate (ESR) and C-reactive protein.

Other test results for this condition include:

  • Abnormal levels of proteins in the blood
  • Abnormal level of white blood cells
  • Anemia (low blood count)

These tests may also be used to monitor your condition.

Treatment

Without treatment, PMR does not get better. However, low doses of corticosteroids (such as prednisone) can ease symptoms within a day or two.

  • The dose can then be slowly reduced to a very low level.
  • Treatment needs to continue for 1 to 2 years. In some people, even longer treatment with low doses of prednisone is needed.

Corticosteroids can cause many side effects. You need to be watched closely if you are taking these medicines.

Outlook (Prognosis)

For most people, PMR goes away with treatment after 1 to 2 years. You might be able to stop taking medicines after this point, but check with your health care provider first.

More severe symptoms can make it harder for you to work or take care of yourself at home.

When to Contact a Medical Professional

Call your provider if you have weakness or stiffness in your shoulder and neck that does not go away. Also contact your provider if you have symptoms such as fever and headache.

Prevention

There is no known prevention.

Alternative Names

PMR

References

Hellmann DB. Giant cell arteritis, polymyalgia rheumatica, and Takayasu's arteritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 88.

Kermani TA, Warrington KJ. Advances and challenges in the diagnosis and treatment of polymyalgia rheumatica. Ther Adv Musculoskelet Dis. 2014;6(1):8-19. PMID: 24489611 www.ncbi.nlm.nih.gov/pubmed/24489611.

Spiera RF. Polymyalgia rheumatic and temporal arteritis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 271.

Review Date 2/8/2017

Updated by: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.