Polymyalgia rheumatica

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.

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

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

Other symptoms include:

• Appetite loss, which leads to weight loss
• Depression
• Fever

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 (CRP).

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.

However, imaging tests such as x-rays of the shoulder or hips are not often helpful. These tests may reveal joint damage that is not related to recent symptoms. In difficult cases, ultrasound or MRI of the shoulder may be done. These imaging tests often show bursitis or low levels of joint inflammation.

Without treatment, PMR does not get better. However, low doses of corticosteroids (such as prednisone, 10 to 20 mg per day) can markedly ease symptoms, often within a day or two.

• The dose should 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 such as weight gain, development of diabetes or osteoporosis. You need to be watched closely if you are taking these medicines. If you are at risk for osteoporosis, your health care provider may recommend you take medicines to prevent this condition.

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 provider first.

For some people, symptoms return after they reduce or stop taking corticosteroids. In these cases, another medicine such as methotrexate or tocilizumab may be needed.

Giant cell arteritis may also be present or can develop later. If this is the case, the temporal artery would need to be evaluated and different treatment given.

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

Contact 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 new symptoms such as fever, headache, and pain with chewing or loss of vision. These symptoms may be from giant cell arteritis.

There is no known prevention.

PMR

Dejaco C, Singh YP, Perel P, et al. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheumatol. 2015;67(10):2569-2580. PMID: 2635874 pubmed.ncbi.nlm.nih.gov/26352874/.

Hellmann DB. Giant cell arteritis, polymyalgia rheumatica, and Takayasu's arteritis. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 93.

Salvarani C, Ciccia F, Pipitone N. Polymyalgia rheumatica and giant cell arteritis. In: Hochberg MC, Gravallese EM, Smolen JS, van der Hejjde D, Weinblatt ME, Weisman MH, eds. Rheumatology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 166.

Updated by: Neil J. Gonter, MD, Assistant Professor of Medicine, Columbia University, NY and private practice specializing in Rheumatology at Rheumatology Associates of North Jersey, Teaneck, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.