Polymyalgia Rheumatica
2026/03/02
Polymyalgia Rheumatica (PMR) is a type of inflammatory arthritis that is characterised by severe stiffness and aches in the shoulders and hip. This condition usually occurs in people above 50 years old. PMR is closely linked to another autoimmune condition called Giant Cell Arteritis (GCA) which causes blood vessel inflammation (vasculitis) of the arteries in the head and neck.
The exact cause is not fully understood, but it is thought to result from an autoimmune response, where the body’s immune system mistakenly attacks itself. This can be contributed by several factors including genetics and certain environmental triggers.
Common symptoms may include:
• Joint pain and stiffness that is worse in the morning, often lasting several hours. The shoulders and hips are most commonly affected, but other joints can also be involved
• Fatigue
• Loss of appetite, loss of weight
Patients who develop Giant Cell Arteritis may have additional symptoms such as:
• Persistent fever
• Headache, often around the temples
• Scalp tenderness (e.g. pain when brushing hair)
• Jaw pain while chewing (jaw claudication)
• Sudden vision changes (e.g. blurred or double vision) or vision loss
The diagnosis of PMR usually involves a combination of:
• Detailed medical history and physical examination
• Blood tests including blood counts and inflammatory markers, such as the Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
• Imaging tests such as ultrasound or MRI scans of the shoulders/hips may be performed for certain patients to exclude other conditions that may appear similar to PMR
Additional tests may be required in patients with suspicion of GCA including further scans and biopsy of the artery near the temples.
PMR is a chronic condition that can be managed effectively with medications and lifestyle changes. Prompt treatment can reduce symptoms, prevent joint damage and other complications.
Steroids are immune suppression medications that work quickly to reduce inflammation. Patients with PMR usually have an excellent response to low-moderate dose of oral steroids. Higher doses may be required if there is suspicion of GCA as it is a medical emergency. Steroid doses will be gradually reduced over time.
Other immune suppressant medications may be given in addition to steroids to reduce the long-term need for steroids and control disease activity.
• Examples include methotrexate (a weekly medication given as oral tablets of subcutaneous injections in the thighs or abdomen), azathioprine and leflunomide (both of which are daily oral medications)
• Tocilizumab is a targeted biologic medication which is given intravenously (infusions given through the veins) every month or subcutaneously (given as injections under the skin in the thighs or abdomen) every week
Blood tests monitoring are usually required while on these medications
Physiotherapy and occupational therapy may be recommended in patients who have functional impairment and to relieve pain.
PMR is often associated with other medical conditions such as osteoporosis, high cholesterol, diabetes and high blood pressure. These conditions should be addressed as part of holistic care for PMR. Certain vaccinations are recommended to prevent common infections, such as influenza, pneumococcal, COVID-19, shingles and Respiratory Syncytial Virus (RSV). Your treatment plan will be coordinated by your rheumatologist and tailored to your symptoms and preferences.
Lifestyle changes are an important aspect of PMR management. Patients should be empowered to play an active role in their care.
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Avoid smoking
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Eat a balanced diet
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Stay active and exercise in moderation
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Lose weight if you are overweight
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Reach out for support – whether through friends, family, or support groups such as the
National Arthritis Foundation•
Take your medications as prescribed, even when you feel well, to avoid disease flares
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Inform your rheumatologist if you develop features of GCA such as headache around the temples, pain when you chew or when combing your hair. Seek immediate medical attention if you develop changes in your vision, as this could suggest inflammation of the blood vessels in your eyes, which can lead to permanent vision loss if not addressed in a timely manner.
Seek a doctor's advice early. You will be referred to a specialist (rheumatologist) who can confirm the diagnosis and start you on the appropriate treatment. Once diagnosed, it is important to start treatment early and follow your rheumatologist’s advice. This condition is managed by the
Division of Rheumatology and Allergy.
