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What is polymyalgia rheumatica?
Polymyalgia rheumatica (PMR) is an inflammation of the shoulders and the hips. It can cause pain and stiffness in the affected areas.
PMR mostly occurs in people over 50 years of age, affecting about one in every 133 people in this age group  . PMR is associated with temporal arteritis (also known as giant cell arteritis) - people with one of these conditions may also have the other.
The symptoms of PMR are caused by inflammation in the muscles of the affected areas. It is not clear why this inflammation occurs; both genetics and infections have been suggested as contributing factors  . PMR might be an autoimmune condition, in which a person's immune system mistakenly reacts against their body's own tissues  .
Anyone can get PMR, but it is most often found in people over 50 years of age, typically in their 70s  . Women are at least twice as likely to have this condition as men  . People of Northern European descent are more likely than those of other ethnicities to develop PMR  .
Signs and symptoms
The main symptom of PMR is pain and stiffness in the muscles of the shoulders and upper arms, neck and hips. The pain is felt on both sides of the body (for example, in both shoulders). The pain is often felt most strongly after sleep or rest - it can be worse in the early morning, but ease as the day progresses. Morning pain and stiffness that lasts at least 30-45 minutes and recurs for at least two weeks is a sign of PMR  .
The pain limits movement in the arms and/or hips, making it difficult to perform daily activities such as getting out of bed or dressing  . It can be accompanied by other symptoms including fever, weight loss, difficulty sleeping and fatigue.
Methods for diagnosis
Your doctor may suspect PMR based on your symptoms and risk factors. They will diagnose the condition based on blood tests that check for markers of inflammation in the blood, and imaging (such as a chest X-ray  , MRI  , PET or ultrasound) and rule out similar conditions (such as rheumatoid arthritis, fibromyalgia, or hypothyroidism).
Types of treatment
PMR is treated with low doses of corticosteroid medication   . Prednisone is the drug of choice. Azathioprine and methotrexate can sometimes be given to reduce the side effects of the corticosteroids.
These medications will not cure PMR, but should relieve your symptoms  . Your doctor will often be able to gradually lower the doses over time.
PMR does not respond to other medications that relieve muscle and joint pain and inflammation, such as aspirin or ibuprofen.
PMR is associated with temporal arteritis  . Up to half of people with temporal arteritis develop PMR, and about 10-20% of people with PMR develop temporal arteritis   . This suggests that they might be a single condition displaying two different sets of symptoms  .
PMR normally goes away by itself after a few years. Many people can stop taking their PMR medication after six months to two years  . PMR can, however, return (relapse) in up to half of PMR cases  .