At a glance
What it is
A systemic inflammatory condition characterised by bilateral aching and stiffness in the shoulder and hip girdle muscles. Onset may be rapid — developing over days — or gradual. The cause is unknown; genetic susceptibility and environmental triggers (possibly viral) are implicated. Classified as a vasculitis-spectrum disease and closely related to giant cell arteritis (GCA), with which it overlaps in 15–20% of cases. ESR and CRP are markedly elevated.
Symptoms
Bilateral aching and stiffness in the shoulders, neck, upper arms, hips, and thighs — characteristically worst in the morning or after periods of inactivity, and improving with movement. Limited range of motion in affected joints. Systemic features: low-grade fever, fatigue, malaise, loss of appetite, and unintentional weight loss. Depression is common. Wrist, elbow, and knee pain may occur. Symptoms beginning overnight or over a few days are characteristic.
Approach
Low-dose oral prednisolone (15–20 mg/day) produces dramatic and rapid improvement — a dramatic response to steroids helps confirm the diagnosis. Slowly taper over 1–2 years guided by symptoms and inflammatory markers. Assess for giant cell arteritis: headache, scalp tenderness, jaw claudication, or visual symptoms require urgent higher-dose steroid and temporal artery biopsy. Add bone protection (calcium, vitamin D, bisphosphonate) for long-term steroid use. Pain and physiotherapy support during recovery.
What polymyalgia rheumatica is
Polymyalgia rheumatica (PMR) is one of the most common inflammatory conditions in adults over 50, with a peak incidence between 70–80 years. It is approximately twice as common in women as in men. The name describes its core features: *poly* (many) *myalgia* (muscle pain) *rheumatica* (rheumatic/inflammatory). However, the inflammation is primarily periarticular and vascular rather than truly myopathic — muscle enzymes (CK, aldolase) are normal.
**Relationship with giant cell arteritis (GCA)**
PMR and giant cell arteritis (temporal arteritis) share a biological relationship and frequently coexist. GCA is a large-vessel vasculitis affecting branches of the external carotid and occasionally the aorta. It is present in 15–20% of PMR patients; conversely, 40–50% of GCA patients have PMR symptoms.
GCA is the more serious diagnosis. Inflammation in the temporal and ophthalmic arteries can cause ischaemia to the optic nerve — sudden, painless, irreversible monocular visual loss (anterior ischaemic optic neuropathy) occurs in 15–20% of untreated cases. Stroke and aortic aneurysm are rarer but serious complications.
GCA symptoms to watch for alongside PMR: - New headache (typically temporal or occipital) - Scalp tenderness (painful to comb hair) - Jaw claudication (aching or fatigue in the jaw muscles on chewing) - Visual symptoms — blurring, diplopia, sudden visual loss - Tender, thickened, or nodular temporal artery
Any patient with PMR who develops these symptoms requires urgent evaluation and high-dose steroid treatment (40–60 mg prednisolone) while awaiting temporal artery biopsy or large-vessel imaging.
**Diagnosis**
No single diagnostic test is specific. Diagnostic criteria require: - Age ≥ 50 - Bilateral shoulder or hip girdle pain and stiffness - Morning stiffness lasting > 45 minutes - Elevated ESR and/or CRP - Dramatic response to prednisolone (≤ 20 mg/day) within 1–2 weeks
Conditions to exclude: rheumatoid arthritis (hands/feet involvement, positive RF/CCP), myositis (elevated CK), polymyositis, infection, malignancy.
**Treatment**
*Corticosteroids:* prednisolone 15–20 mg/day is the cornerstone. Response is typically dramatic within days — if the response is poor, the diagnosis should be reconsidered. Dose is tapered slowly over 12–24 months; relapse is common if tapering is too rapid. Total treatment duration is often 1–3 years.
*Steroid-sparing agents:* methotrexate or azathioprine may be added in relapsing or corticosteroid-dependent disease.
*Bone protection:* long-term corticosteroids cause osteoporosis; calcium + vitamin D + bisphosphonate should be prescribed from the outset.
*Symptom management:* physiotherapy, pain management interventions, and low-impact exercise support function during the recovery period.
Treatment options at Alimran Medical Center
Neuromodulation
Injection therapies
- Botox® injections
- Prolotherapy
- Ozone injection
- Trigger point injections
- Epidural steroid injections
Advanced therapies
Physiotherapy & rehabilitation
- Electrical stimulation
- Short and long wave therapy
- Laser therapy
- Ultrasound therapy
- Exercise and joint mobility rehabilitation
- SpineMED® system
- Sigma
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about polymyalgia rheumatica and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.