Polymyalgia Rheumatica (PR)
Polymyalgia Rheumatica (PMR)
Polymyalgia rheumatica (PR) is an inflammatory condition characterized by muscle pain and stiffness, primarily affecting the shoulders, hips, neck, and upper arms. It most commonly occurs in people over the age of 65 and rarely affects those under 50. Symptoms often develop quickly, over days to weeks, and are typically worse in the morning or after periods of inactivity.
Symptoms
- Bilateral aching and stiffness in the shoulders, neck, upper arms, hips, buttocks, and thighs
- Morning stiffness lasting longer than 45 minutes
- Reduced range of motion in affected areas
- Pain or stiffness may also affect wrists, elbows, and knees
- Systemic symptoms: mild fever, fatigue, malaise, loss of appetite, unintentional weight loss, and depression
- Difficulty performing daily activities such as dressing, brushing hair, or getting out of bed
- Symptoms often improve with movement during the day
Related Conditions
- Polymyalgia rheumatica is closely associated with giant cell arteritis (GCA) (also called temporal arteritis), an inflammatory disease of large blood vessels.
- Approximately 10-20% of PMR patients may develop GCA, and 40-60% of patients with GCA have PMR symptoms.
- GCA symptoms include headaches, scalp tenderness, jaw pain, and vision problems, requiring urgent medical attention.
Causes and Risk Factors
- The exact cause of PMR is unknown, but it is thought to involve a combination of genetic and environmental factors.
- It is an age-related condition, predominantly affecting those over 65.
- Women are slightly more affected than men.
- More common in Caucasians.
Diagnosis
- Based on clinical presentation and exclusion of other conditions such as rheumatoid arthritis.
- Blood tests often show elevated inflammatory markers (ESR, CRP).
- Imaging and biopsy may be used to rule out GCA or other diseases.
Treatment
- The main treatment is corticosteroids (usually prednisolone), which typically relieve symptoms rapidly.
- Treatment often starts with a moderate dose, gradually tapered over 12 to 24 months to prevent relapse.
- Regular monitoring is necessary to manage side effects and detect complications such as GCA.
Prognosis
- Most patients respond well to treatment and have symptom resolution.
- Some may experience relapses requiring adjustments in therapy.
- Severe disability or permanent impairment is uncommon.
Summary Table
| Aspect | Details |
|---|---|
| Definition | Inflammatory condition causing muscle pain and stiffness, mainly in shoulders and hips |
| Typical Age | Over 65 years old; rare under 50 |
| Symptoms | Bilateral shoulder/hip pain, morning stiffness, systemic symptoms (fatigue, fever, weight loss) |
| Associated Condition | Giant cell arteritis (temporal arteritis) |
| Diagnosis | Clinical assessment, elevated ESR/CRP, exclusion of other diseases |
| Treatment | Corticosteroids (prednisolone), gradual tapering over 1-2 years |
| Prognosis | Good response to treatment; relapses possible; serious complications rare |
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References
- Mayo Clinic. Polymyalgia Rheumatica – Symptoms & Causes. 2025.
https://doi.org/10.1093/ndt/gfaa156 Mayo Clinic - Cleveland Clinic. Polymyalgia Rheumatica: Symptoms & Treatment. 2025.
https://my.clevelandclinic.org/health/diseases/25215-polymyalgia-rheumatica - NHS. Polymyalgia Rheumatica. 2023.
https://www.nhs.uk/conditions/polymyalgia-rheumatica/ - American College of Rheumatology. Polymyalgia Rheumatica. 2025.
https://rheumatology.org/patients/polymyalgia-rheumatica - Arthritis Foundation. Polymyalgia Rheumatica. 2024.
https://www.arthritis.org/diseases/polymyalgia-rheumatica
Polymyalgia rheumatica is a treatable inflammatory disorder primarily affecting older adults, characterized by muscle pain and stiffness, with an important association with giant cell arteritis. Early diagnosis and corticosteroid treatment lead to rapid symptom relief and good outcomes.
