Introduction

Polymyalgia rheumatica (PMR) is a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips.

The main symptom is muscle stiffness in the morning that lasts longer than 45 minutes. It may also cause other symptoms, including:

  • high temperature (fever) and sweating
  • extreme tiredness (fatigue)
  • loss of appetite
  • weight loss
  • depression

If you have pain and stiffness that lasts longer than a week, you should see your GP so the cause can be investigated.

Diagnosing polymyalgia rheumatica can be difficult because the symptoms are similar to those of many other conditions, including rheumatoid arthritis. These conditions will need to be ruled out before polymyalgia rheumatica is diagnosed.

Read more about the symptoms of polymyalgia rheumatica and diagnosing polymyalgia rheumatica.

What causes polymyalgia rheumatica?

The cause of polymyalgia rheumatica is unknown, but a combination of genetic and environmental factors is thought to be responsible.

Polymyalgia rheumatica is relatively common in the UK. It's estimated that one in every 1,200 people develop the condition every year.

Polymyalgia rheumatica is age-related. Most people who are diagnosed with the condition are over 70. It's extremely rare in people younger than 50. It's also more common in women than men.

Treating polymyalgia rheumatica

The main treatment for polymyalgia rheumatica is a coritcosteroid medication called prednisolone, which is used to help relieve the symptoms.

You'll initially be prescribed a high dose of prednisolone, which will be reduced gradually over time.

Most people with polymyalgia rheumatica will need to take a long-term course of corticosteroid treatment (lasting 18 months to two years) to prevent their symptoms returning.

Read more about treating polymyalgia rheumatica.

Symptoms

The most common symptom of polymyalgia rheumatica (PMR) is pain and stiffness in the shoulder muscles, which develops quickly over a few days or weeks.

The muscles in the neck and hips are also often affected. Both sides of the body are usually affected.

The stiffness often feels worse first thing in the morning after you wake up and starts to improve after about 45 minutes as you become more active.

Some people with polymyalgia rheumatica have additional symptoms, including:

  • a mild high temperature (fever) of 37-38C (98.6-100.4F)
  • depression
  • fatigue (extreme tiredness)
  • loss of appetite
  • weight loss

When to seek medical advice

If you have symptoms of pain and stiffness that last longer than a week, you should make an appointment to see your GP so that the cause can be investigated.

When to seek immediate medical advice

You should seek immediate medical advice if you have been diagnosed with polymyalgia rheumatica (or the condition is suspected) and you suddenly develop:

  • a persistent and severe headache
  • jaw pain or cramping in your jaw muscles which is worse when you're eating
  • pain in the tongue when chewing 
  • vision loss or vision disturbances, such as double vision

These symptoms may indicate a more serious condition called giant cell arteritis (temporal arteritis).

Call your GP immediately for advice if you have any of the above symptoms. If this isn't possible, contact your local out of hours service or call the NHS 24 '111' service.

Diagnosis

Diagnosing polymyalgia rheumatica (PMR) can often be quite a lengthy process that involves several different tests.

This is because the condition shares many symptoms with more common health conditions, such as rheumatoid arthritis, which need to be ruled out first.

Tests

There's no specific test for polymyalgia rheumatica, but it's likely that a series of blood tests will be carried out.

Two blood tests – erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) – can be used to check the levels of inflammation in your body.

If the ESR and CRP test results are normal, it’s unlikely that polymyalgia rheumatica will be diagnosed because your doctor won’t want to prescribe a long-term course of steroids if the diagnosis is uncertain. Sometimes, the ESR may be normal and CRP may be raised, which would be more likely to indicate a positive diagnosis. This is why both tests are usually carried out at the same time.

As inflammation is a characteristic of many conditions, high levels don't automatically mean that you have polymyalgia rheumatica. Further tests may be needed to help rule out other conditions that cause inflammation. For example, a test for rheumatoid factor and anti-CCP antibodies, may be carried out to rule out rheumatoid arthritis.

Blood tests can also help determine:

You may also have a urine test to check how well your liver is functioning.

X-rays and ultrasound scans may also be used to look at the condition of your bones and joints.

Symptom checklist

After other possible causes of your symptoms have been ruled out, a checklist can be used to see whether your symptoms match those most commonly associated with polymyalgia rheumatica.

A confident diagnosis of polymyalgia rheumatica can usually be made if you meet all of the following criteria:

  • you're over 50 years of age 
  • you have pain in your shoulders or your hips
  • you have stiffness in the morning that lasts longer than 45 minutes
  • your symptoms have lasted longer than two weeks
  • blood tests show raised levels of inflammation in your body
  • your symptoms rapidly improve after treatment with corticosteroids

Read more about treating polymyalgia rheumatica.

Treatment

Steroid medication (corticosteroids) is the preferred treatment for polymyalgia rheumatica (PMR).

A type of corticosteroid called prednisolone is usually prescribed.

Prednisolone

Prednisolone works by blocking the effects of certain chemicals that cause inflammation inside your body. It doesn't cure polymyalgia rheumatica, but it can help relieve the symptoms.

When used to treat polymyalgia rheumatica, prednisolone is taken as a tablet. Most people will be prescribed several tablets to take once a day.

You'll be prescribed a high dose of prednisolone initially, and the dose will be gradually reduced every one to two months.

Although your symptoms should improve within a few days of starting treatment, you'll probably need to continue taking a low dose of prednisolone for about two years.

In many cases, polymyalgia rheumatica improves on its own after this time. However, there's a chance that the condition will return (relapse) once treatment stops.

Don't suddenly stop taking steroid medication unless a doctor in charge of your care tells you it's safe to do so. Suddenly stopping treatment with steroids can make you feel very ill.

Side effects of prednisolone

About one in 20 people who take prednisolone will experience changes in their mental state when they take the medication.

You may feel depressed and suicidal, anxious or confused. Some people also experience hallucinations (seeing or hearing things that aren't there). Contact your GP as soon as possible if you experience changes to your mental state. 

Other side effects of prednisolone include:

  • increased appetite that often leads to weight gain
  • increased blood pressure
  • mood changes, such as becoming aggressive or irritable with people
  • weakening of the bones (osteoporosis)
  • stomach ulcers 
  • increased risk of infection, particularly with the varicella-zoster virus (the virus that causes chickenpox and shingles

Seek immediate medical advice if you think you've been exposed to the varicella-zoster virus, or if a member of your household develops chickenpox or shingles.

The risk of these side effects should improve as your dose of prednisolone is decreased.

See side effects of corticosteroids for more information about how these side effects may affect you and how they're treated.

Other medications

Sometimes, other medicines may be combined with corticosteroids to help prevent relapses or to allow your dose of prednisolone to be reduced.

Some people are prescribed immunosuppressant medication, such as methotrexate. This is used to reduce or suppress the immune system (the body's defence against infection and illness). It may be helpful for people with polymyalgia rheumatica who have frequent relapses or don't respond to normal steroid treatment.

Your doctor may recommend painkillers, such as paracetamol, or non-steroidal anti-inflammatory drugs (NSAIDs), to help relieve pain and stiffness while your dose of prednisolone is reduced.

Follow-up

Your GP will ask you to attend regular follow-up appointments to check how well you're responding to treatment, whether your dose of prednisolone needs to be adjusted, and how well you're coping with the side effects of the medication.

During these appointments, you'll have blood tests to check the levels of inflammation inside your body.

Follow-up appointments are usually recommended every few weeks for the first three months and then at three- to six-monthly intervals after this time.

Contact your GP if your symptoms return during any part of your treatment. Your dosage may need to be adjusted.