What Is Polymyalgia Rheumatica?
PMR is an inflammatory condition causing aching, stiffness and pain in the shoulder, neck, upper arm, hip and thigh muscles, predominantly in people over 60. It is one of the most common inflammatory conditions in older adults and responds dramatically to low-dose corticosteroids.
Symptoms
- Bilateral shoulder pain and stiffness — typically worse in the morning (lasting >45 minutes)
- Aching in the hips and thighs
- Difficulty raising arms above the head or getting up from a chair
- Fatigue, loss of appetite, unintentional weight loss
- Low-grade fever
- Onset is often subacute over weeks
Blood Tests
| Test | Finding in PMR |
|---|---|
| ESR | Typically >50 mm/hr, often >80–100 mm/hr |
| CRP | Markedly elevated |
| Full Blood Count | Normochromic normocytic anaemia; raised platelets |
| Alkaline Phosphatase | Mildly elevated |
| Glucose (baseline) | Before starting steroids — steroids raise blood sugar |
Association with Giant Cell Arteritis (GCA)
GCA Warning Signs:15–30% of PMR patients also have giant cell arteritis (GCA). New headache, scalp tenderness, jaw claudication (pain on chewing) or visual disturbance in a PMR patient requires URGENT assessment — GCA can cause blindness.
Treatment
- Oral prednisolone — 15–25 mg/day for PMR; typically dramatic improvement within 48 hours
- Gradual dose reduction over 18–24 months
- Bone protection during steroid therapy: calcium, vitamin D, and bisphosphonate
- Tocilizumab (IL-6 inhibitor) — approved as a steroid-sparing agent
FAQs
How quickly do steroids work in PMR?
Typically within 24–48 hours — a dramatic response to 15mg prednisolone is itself diagnostic. If response is poor, alternative diagnoses should be reconsidered.
Can PMR recur?
Yes — about 25% relapse during or after steroid tapering. ESR/CRP monitoring guides dose adjustments.
How long is treatment needed?
Usually 18–24 months minimum. Some patients require several years. Very gradual dose reduction reduces relapse risk.
Medical Disclaimer: PMR requires long-term steroid management with monitoring for side effects and associated GCA. Manage with a GP or rheumatologist.