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What Is Polymyalgia Rheumatica? Symptoms, Causes, Diagnosis, and Treatment

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Updated on February 20, 2024
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Polymyalgia rheumatica (PMR) is an inflammatory disease that causes pain and stiffness in major muscle groups of your body, often including your neck, shoulders, and hip area. It’s the most common inflammatory rheumatic disease affecting adults over 50, and it’s 2 to 3 times more common in women than in men.

It can be difficult to diagnose polymyalgia rheumatica, since there is no specific test for the disorder. Your doctor may suspect the condition based on your symptoms and other factors like your age and health history. Often, doctors prescribe a treatment for polymyalgia rheumatica as part of the diagnostic process — if your symptoms improve, that helps confirm the diagnosis.

Typically, polymyalgia rheumatica responds well to drug treatment, although many people experience a return of symptoms once they stop taking their treatment. Eventually, most people experience a full recovery from polymyalgia rheumatica, with no ongoing symptoms or need for treatment.

People with polymyalgia rheumatica may also have a condition called giant cell arteritis, which is a related inflammatory disorder that affects your arteries, including those leading to and in your head and scalp. If you have giant cell arteritis, you may experience symptoms such as headache, jaw pain, or vision problems.

Signs and Symptoms of Polymyalgia Rheumatica

Symptoms of polymyalgia rheumatica are caused by inflammation of your joints and surrounding tissues. The most common problems are pain and stiffness, which may occur in the following areas:

  • Upper arms and shoulders
  • Neck
  • Hip area
  • Buttocks
  • Upper thighs

Stiffness due to polymyalgia rheumatica is usually worse in the morning and after periods of inactivity. If you avoid certain activities or change how you use your body due to pain and stiffness, you may develop muscle weakness as a result of the condition. It’s common to have trouble raising your arms above your shoulders.

Episodes of pain and stiffness typically last an hour or longer.

 You may experience difficulty with activities like getting out of bed, getting dressed, personal care routines, standing up from a chair, or getting in and out of a car. Some people also have sleep disturbances due to pain and stiffness.

Some people with polymyalgia rheumatica may develop the following symptoms:

  • Fatigue
  • Fever
  • Reduced appetite
  • Weight loss
  • Swelling in your wrists or hands
Symptoms of polymyalgia rheumatica may initially develop over the course of a few days or weeks, or even overnight. Both sides of your body are equally affected.

Without treatment, polymyalgia rheumatica symptoms usually do not go away on their own. In some cases, they may get better on their own within one to five years. With treatment, symptoms can start to improve within a few days. Long-term treatment can make the symptoms go away entirely for some people, but others may have relapses or flare-ups even after treatment, according to the Cleveland Clinic.

In rare cases, polymyalgia rheumatica can cause inflammation in the aorta, the body’s largest artery. This could cause an aortic aneurysm, an abnormal bulging of the aorta that’s life-threatening if it ruptures.

 In its early stages, an aortic aneurysm generally has no symptoms. As it gets larger, an aortic aneurysm located in the chest may cause hoarseness and difficulty swallowing, while an aortic aneurysm located in the abdomen may cause pain in the abdomen, back, and groin.
How Polymyalgia Rheumatica Affects the Body: Glutes, low back, shoulders, neck, upper arms, hips, thighs
Polymyalgia rheumatica causes pain and stiffness in large muscle groups throughout the body, particularly in the hips and shoulder girdle.Everyday Health

Causes and Risk Factors of Polymyalgia Rheumatica

The cause of polymyalgia rheumatica — why inflammation develops in certain areas — is unknown.

 While the sudden onset of symptoms in some people may suggest an infection, there has been no confirmed link to any specific bacteria or virus. Researchers have also confirmed that polymyalgia rheumatica is not a side effect of any medication.
It’s possible that polymyalgia rheumatica is an autoimmune disease — meaning that your body’s immune system mistakenly attacks healthy tissue, leading to inflammation.

 Genetic and environmental factors, including infections, may play a role in the onset of autoimmune diseases. It’s also likely that the aging process affects the development of polymyalgia rheumatica, since the condition is seen almost exclusively in older adults.
The pain that people with polymyalgia rheumatica experience may be felt in areas other than where inflammation occurs, known as referred pain. For example, pain in your upper arms may be due to inflammation in your shoulder joints, or pain in your thighs may be due to inflammation in your hip joints.

You’re more likely to develop polymyalgia rheumatica if you have any of the following risk factors:

  • Older age, especially if you’re 70 to 80 years old
  • Being a woman
  • Northern European ancestry
A clearly higher risk for polymyalgia rheumatica begins in your late sixties, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and most people with the condition are age 70 to 75.

Higher rates of the condition may be seen in areas where most people are of northern European descent, and lower rates are seen in areas where fewer people have this background.

The United States and northern Europe have higher rates of polymyalgia rheumatica than other areas of the world,

 and people of northern European ancestry are more likely to develop the condition than other groups in the United States. This link to ethnicity suggests a genetic component in a person’s risk of developing polymyalgia rheumatica.

How Is Polymyalgia Rheumatica Diagnosed?

Diagnosing polymyalgia rheumatica may be a complicated process, since there is no definitive test for the condition. The first step involves your doctor evaluating your symptoms and medical history.

 Key signs that you may have polymyalgia rheumatica include pain and stiffness in your shoulders or hip area that is worse in the morning and gets better with activity.

If your doctor suspects that you have polymyalgia rheumatica, you’ll undergo a physical exam in which your doctor looks for common signs of the condition. Your doctor may also order blood tests that can help support a polymyalgia rheumatica diagnosis or point to a different health condition.

One blood test result that may point to polymyalgia rheumatica is a high erythrocyte sedimentation rate (ESR).

 Many, but not all, people with the condition have this test result, which indicates the presence of inflammation.
Other blood tests that your doctor may order include the following:

Some of these tests — like C-reactive protein — may help support a diagnosis of polymyalgia rheumatica by showing inflammation, while others may help your doctor detect a condition that’s causing symptoms similar to those of polymyalgia rheumatica, such as rheumatoid arthritis or lupus.

Other potential signs of polymyalgia rheumatica seen in blood test results may include abnormal levels of protein in your blood, abnormal levels of white blood cells, or anemia (inadequate red blood cells).

Since people with polymyalgia rheumatica don’t tend to have any physical abnormalities in their muscle tissue, it’s generally not necessary to take a tissue sample (biopsy) unless your doctor suspects a different health condition.

X-ray imaging typically doesn’t help with a diagnosis of polymyalgia rheumatica.

 But in situations in which it’s difficult to arrive at a diagnosis, your doctor may recommend an ultrasound or MRI of your shoulder to look for joint inflammation or bursitis (inflammation of the small fluid-filled sacs located near your joints).

Duration and Prognosis of Polymyalgia Rheumatica

Polymyalgia rheumatica typically responds well to treatment. Once you start on an effective therapy, you can expect your symptoms to lessen or go away within a few days.

 Without treatment, your symptoms are likely to remain for at least a year and up to five years or longer.
If your polymyalgia rheumatica is treated, it’s likely to go away entirely after one to two years.

 You may be able to stop taking your medication entirely at this point, but some people experience a return of their symptoms as a result. If this happens, you may need to start on a different treatment for the condition.
If you develop the related condition of giant cell arteritis in addition to polymyalgia rheumatica, symptoms of giant cell arteritis may start around the same time as those of polymyalgia rheumatica — or they may develop later. It’s important to let your doctor know if you develop any new symptoms, especially fever, headache, jaw pain, or vision changes.

Treatment and Medication Options for Polymyalgia Rheumatica

The goal of treatment for polymyalgia rheumatica is to relieve your symptoms, especially pain and stiffness. The standard treatment is a group of drugs called corticosteroids (also known simply as steroids), but there are other treatment options if your condition doesn’t respond well to steroids or you experience intolerable side effects.

Medications

Polymyalgia rheumatica typically responds well to treatment with corticosteroids, a group of anti-inflammatory medications. These drugs are taken by mouth at the lowest possible dose to help reduce the risk for side effects. Current recommendations are for a starting dose of prednisolone between 12.5 and 25 milligrams daily.

 Once your polymyalgia rheumatica symptoms are under control, it’s common for your doctor to gradually reduce your dose of corticosteroids until you reach a very low maintenance dose that you may take for a year or longer.

Potential side effects of corticosteroids include increased appetite, weight gain, type 2 diabetes, and osteoporosis (weak and brittle bones).

Weight gain most often happens in people who take higher doses or longer courses of corticosteroids. If you gain weight while on corticosteroids, you’ll likely find it easier to lose the weight 6 to 12 months after you stop taking them.

While taking corticosteroids, strategies like exercising and eating a nutritious diet rich in fruits, vegetables, fiber-rich carbohydrates, and proteins can help minimize weight gain as much as possible. It may also help to eat six small meals throughout the day instead of three large ones, especially if your appetite has increased while on corticosteroids.

It’s important for your doctor to measure your glucose level when you start corticosteroids and monitor it while you’re taking them so you can start on insulin or oral drugs to lower your glucose level if it goes and stays too high. Your doctor may also teach you how to self-monitor your glucose level each day.

If you’re considered at risk for osteoporosis, your doctor may prescribe a medication to help protect your bones along with corticosteroids. It’s common for doctors to recommend taking a daily calcium and vitamin D supplement to help reduce the risk for bone loss.

If you experience unpleasant side effects from corticosteroids, or if your symptoms aren’t adequately controlled by this treatment, your doctor may consider prescribing the following drugs:

  • Disease-Modifying Anti-Rheumatic Drugs (DMARDs) This group of medications includes drugs approved for other conditions that help reduce inflammation at the cellular level, such as the immune-suppressing drug methotrexate. Your doctor may prescribe DMARDs along with corticosteroids to help reduce your corticosteroid dose or to address episodes of worsening polymyalgia rheumatica symptoms, according to NIAMS.

  • Sarilumab (Kevzara) This biologic medication was approved in 2023 in the United States to treat polymyalgia rheumatica in people who don’t respond adequately to corticosteroids or who can’t tolerate long-term corticosteroid use. Sarilumab is given as an injection every two weeks for as long as needed.
Some people with mild polymyalgia rheumatica and only those who don’t have any symptoms of giant cell arteritis such as headache, jaw pain, or vision loss may respond well to over-the-counter nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, or naproxen.

 These drugs typically have fewer undesirable side effects than corticosteroids, but they’re not effective for many people.

Physical Therapy

Most people with polymyalgia rheumatica can return to their regular daily activities once they start taking a corticosteroid or another effective treatment. But if your movement has been limited for a long time, you may benefit from physical therapy; talk to your doctor about this option.

Complementary and Alternative Treatments

Along with taking medications as prescribed, it’s important to pay attention to both exercise and rest as part of your polymyalgia rheumatica treatment. Regular exercise helps maintain joint flexibility and muscle strength, both of which can help reduce the burden of polymyalgia rheumatica symptoms. Potentially helpful forms of exercise include:

Getting enough rest and sleep can help make sure that your body recovers from exercise and daily activities, which may help limit inflammation.

Following a healthy diet can also help reduce inflammation and potentially help reduce side effects of corticosteroids. Eat plenty of fruits, vegetables, whole grains, and lean sources of protein and dairy. If you’re taking a corticosteroid, limiting sodium (including salt) in your diet can help prevent fluid buildup and high blood pressure.

Related Conditions: Giant Cell Arteritis

Polymyalgia rheumatica is closely related to — and sometimes occurs along with — a condition called giant cell arteritis, in which inflammation affects large and medium-sized arteries in your body. Affected arteries include those in your head and scalp, which can lead to symptoms like headache, scalp tenderness, and jaw pain. If the arteries leading to your eyes are affected, you may experience vision problems or vision loss.

It’s especially important to get treatment for giant cell arteritis right away if you have vision problems, since leaving the condition untreated may result in permanent vision loss. You may develop giant cell arteritis at the same time that you develop polymyalgia rheumatica or later on.

Giant cell arteritis is diagnosed in a similar way to polymyalgia rheumatica — your doctor will consider your symptoms and medical history, and may examine your temporal arteries (on each side of your head). Your doctor may also order blood tests and possibly a biopsy of your temporal artery, in which a small tissue sample is examined for signs of inflammation.

Treatment for giant cell arteritis usually involves taking corticosteroids at a higher dose than is typical for polymyalgia rheumatica. As with polymyalgia rheumatica, your doctor will most likely recommend gradually reducing your dose once your symptoms are under control.

About 15 percent of people with polymyalgia rheumatica also develop giant cell arteritis.

Additional reporting by Christina Vogt.

Common Questions & Answers

What does polymyalgia rheumatica feel like?
Polymyalgia rheumatica causes pain and stiffness in the shoulders, upper arms, neck, hips, upper thighs, and buttocks.
Polymyalgia can cause pain in certain parts of the legs, including the hips, buttocks, and upper thighs.
There’s no single cause for polymyalgia rheumatica. It sometimes occurs following an infection, but the disease has no known link to any bacteria or virus, nor is it a side effect of any medication.
Rarely, polymyalgia rheumatica can cause inflammation of the aorta, the body’s largest artery. This could cause an aortic aneurysm, or a bulge in the aorta that’s life-threatening if it ruptures.
With standard treatment, polymyalgia rheumatica usually clears up in a year or two. Without treatment, polymyalgia rheumatica symptoms may continue for one to five years or longer.
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Alexa Meara, MD

Medical Reviewer

Alexa Meara, MD, is an assistant professor of immunology and rheumatology at The Ohio State University. She maintains a multidisciplinary vasculitis clinic and supervises a longitudinal registry of lupus nephritis and vasculitis patients. Her clinical research is in improving patient–physician communication. She is involved in the medical school and the Lead-Serve-Inspire (LSI) curriculum and serves on the medical school admissions committee; she also teaches multiple aspects of the Part One curriculum. Her interests in medical-education research include remediation and work with struggling learners.

Dr. Meara received her medical degree from Georgetown University School of Medicine in Washington, DC.  She completed her internal medicine training at East Carolina University (ECU) at Vidant Medical Center in Greenville, North Carolina, then spent two more years at ECU, first as chief resident in internal medicine, then as the associate training program director for internal medicine. She pursued further training in rheumatology at The Ohio State University in Columbus, completing a four-year clinical and research fellowship there in 2015. 

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A freelance health writer and editor based in Wisconsin, Quinn Phillips has a degree in government from Harvard University. He writes on a variety of topics, but is especially interested in the intersection of health and public policy. Phillips has written for various publications and websites, such as Diabetes Self-Management, Practical Diabetology, and Gluten-Free Living, among others.

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Resources
  1. Lundberg IE et al. An Update on Polymyalgia Rheumatica. Journal of Internal Medicine. November 2022.
  2. Polymyalgia Rheumatica. Arthritis Foundation.
  3. Polymyalgia Rheumatica and Giant Cell Arteritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. February 2022.
  4. Polymyalgia Rheumatica. American College of Rheumatology. February 2023.
  5. Polymyalgia Rheumatica. Cleveland Clinic. August 29, 2023.
  6. Polymyalgia Rheumatica. Vasculitis Foundation.
  7. Polymyalgia Rheumatica: Symptoms & Causes. Mayo Clinic. June 16, 2022.
  8. Polymyalgia Rheumatica. National Organization for Rare Disorders. August 7, 2007.
  9. Polymyalgia Rheumatica. Mount Sinai.
  10. Dejaco C et al. 2015 Recommendations for the Management of Polymyalgia Rheumatica: A European League Against Rheumatism/American College of Rheumatology Collaborative Initiative. Annals of the Rheumatic Diseases. October 2015.
  11. Understanding Steroid-Related Weight Gain. University Hospitals. May 12, 2023.
  12. Tamez-Pérez HE et al. Steroid Hyperglycemia: Prevalence, Early Detection and Therapeutic Recommendations: A Narrative Review. World Journal of Diabetes. July 2025.
  13. Polymyalgia Rheumatica: Diagnosis & Treatment. Mayo Clinic. June 16, 2022.