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 [1] . PMR is associated with temporal arteritis (also known as giant cell arteritis) - people with one of these conditions may also have the other.

In polymyalgia rheumatic the shoulders and upper arms, neck, and hips feel painful and stiff.Areas of the body affected by polymyalgia rheumatica. 

Temporal arteritis

A condition causing inflammation to the inside of some blood vessels, in particular the arteries of the head and neck.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

1. Salvarani, C., Cantini, F., Boiardi, L., et al. (2002). Polymyalgia Rheumatica and Giant-Cell Arteritis. New England Journal of Medicine 347: 261–271.

Causes

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 [2] . PMR might be an autoimmune condition, in which a person's immune system mistakenly reacts against their body's own tissues [3] .

Autoimmune condition

A medical condition in which the body's immune system abnormally targets substances that are normally found within the body.

Genetics

Related to genes, the body's units of inheritance or origin.

Immune system

The organs and cells involved in protecting the body against infection.

Infections

Entry into the body of microorganisms that can reproduce and cause disease.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

2. Kermani, T.A. & Warrington, K.J. (2013). Polymyalgia rheumatica. The Lancet 381: 63–72.

3. Salvarani, C., Cantini, F., Boiardi, L., et al. (2002). Polymyalgia Rheumatica and Giant-Cell Arteritis. The Lancet 372: 234–245.

Risk factors

Anyone can get PMR, but it is most often found in people over 50 years of age, typically in their 70s [1] . Women are at least twice as likely to have this condition as men [4] . People of Northern European descent are more likely than those of other ethnicities to develop PMR [4] .

1. Salvarani, C., Cantini, F., Boiardi, L., et al. (2002). Polymyalgia Rheumatica and Giant-Cell Arteritis. New England Journal of Medicine 347: 261–271.

4. Borg, F.A., Dasgupta, B. & Ghosh, P. (2010). Current understanding and management of giant cell arteritis and polymyalgia rheumatica. Expert Review of Clinical Immunology 6: 913+.

4. Borg, F.A., Dasgupta, B. & Ghosh, P. (2010). Current understanding and management of giant cell arteritis and polymyalgia rheumatica. Expert Review of Clinical Immunology 6: 913+.

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 [5] .

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 [2] . It can be accompanied by other symptoms including fever, weight loss, difficulty sleeping and fatigue.

Fatigue

A state of exhaustion and weakness.

Fever

An increase in body temperature above the normal temperature range. Fever is often caused by the body's immune reaction to infection.

5. Dasgupta, B., Borg, F.A., Hassan, N., et al. (2010). BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology 49: 186–190.

2. Kermani, T.A. & Warrington, K.J. (2013). Polymyalgia rheumatica. The Lancet 381: 63–72.

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 [4] , MRI [1] , PET or ultrasound) and rule out similar conditions (such as rheumatoid arthritis, fibromyalgia, or hypothyroidism).

Blood tests

During a blood test, blood can be drawn using a needle or by a finger prick. Your blood can then be analysed to help diagnose and monitor a wide range of health conditions.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

MRI

A type of imaging that uses a magnetic field and low-energy radio waves, instead of X-rays, to obtain images of organs.

PET

During positron emission tomography (PET) scan, an injection with a radioactive label is administered and then combined with a computerised tomography (CT) scan to produce functional images.

Ultrasound

A scan that uses high-frequency soundwaves to produce images of the body’s internal structures.

X-ray

A scan that uses ionising radiation beams to create an image of the body’s internal structures.

4. Borg, F.A., Dasgupta, B. & Ghosh, P. (2010). Current understanding and management of giant cell arteritis and polymyalgia rheumatica. Expert Review of Clinical Immunology 6: 913+.

1. Salvarani, C., Cantini, F., Boiardi, L., et al. (2002). Polymyalgia Rheumatica and Giant-Cell Arteritis. New England Journal of Medicine 347: 261–271.

Types of treatment

PMR is treated with low doses of corticosteroid medication [3] [6] . 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 [1] . 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.

Corticosteroid

A medication that resembles the cortisol hormone produced in the brain. It is used as an anti-inflammatory medication.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

3. Salvarani, C., Cantini, F., Boiardi, L., et al. (2002). Polymyalgia Rheumatica and Giant-Cell Arteritis. The Lancet 372: 234–245.

6. Murtagh, J. (2008). John Murtagh’s Patient Education (Australian edition.). North Ryde, N.S.W.: McGraw-Hill Book Company Australia.

1. Salvarani, C., Cantini, F., Boiardi, L., et al. (2002). Polymyalgia Rheumatica and Giant-Cell Arteritis. New England Journal of Medicine 347: 261–271.

Potential complications

Temporal arteritis (also known as giant cell arteritis) is an inflammation of the large and medium-sized arteries that supply blood to the head, neck and upper body.

PMR is associated with temporal arteritis [3] . Up to half of people with temporal arteritis develop PMR, and about 10-20% of people with PMR develop temporal arteritis [4] [6] . This suggests that they might be a single condition displaying two different sets of symptoms [6] .

Arteries

A blood vessel carrying blood saturated with oxygen from the heart to the body's tissues.

Temporal arteritis

A condition causing inflammation to the inside of some blood vessels, in particular the arteries of the head and neck.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

3. Salvarani, C., Cantini, F., Boiardi, L., et al. (2002). Polymyalgia Rheumatica and Giant-Cell Arteritis. The Lancet 372: 234–245.

4. Borg, F.A., Dasgupta, B. & Ghosh, P. (2010). Current understanding and management of giant cell arteritis and polymyalgia rheumatica. Expert Review of Clinical Immunology 6: 913+.

6. Murtagh, J. (2008). John Murtagh’s Patient Education (Australian edition.). North Ryde, N.S.W.: McGraw-Hill Book Company Australia.

6. Murtagh, J. (2008). John Murtagh’s Patient Education (Australian edition.). North Ryde, N.S.W.: McGraw-Hill Book Company Australia.

Prognosis

PMR normally goes away by itself after a few years. Many people can stop taking their PMR medication after six months to two years [7] . PMR can, however, return (relapse) in up to half of PMR cases [2] .

7. Pipitone, N. & Salvarani, C. (2013). Update on polymyalgia rheumatica. European Journal of Internal Medicine 24: 583–589.

2. Kermani, T.A. & Warrington, K.J. (2013). Polymyalgia rheumatica. The Lancet 381: 63–72.