Polymyalgia Rheumatica (PMR) is an inflammatory condition that causes pain and stiffness in the muscles of the shoulders, neck, upper arms, hips, and thighs. The name comes from the Greek for "pain in many muscles." It almost exclusively affects people over 50 and is one of the most common inflammatory conditions in older adults.
PMR is closely associated with giant cell arteritis (GCA) – an inflammatory condition affecting the large arteries of the head and neck.
Up to 20% of people with PMR develop GCA, which can cause serious complications including sudden vision loss and requires urgent treatment.
How common is Polymyalgia Rheumatica?
PMR is estimated to affect approximately 20,000 Australians. It is the most common inflammatory rheumatic condition in people over 50 in Australia. Women are affected approximately twice as often as men.
PMR is rare before the age of 50 and becomes increasingly common with age, with the average age of diagnosis around 70 years. It is more prevalent in people of Northern European descent.
Symptoms typically develop relatively quickly – over days to weeks – and are often most severe in the morning:
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- Aching and stiffness in the shoulders, upper arms, neck, hips, and thighs – usually affecting both sides of the body
- Morning stiffness lasting more than 45 minutes
- Difficulty raising the arms above shoulder height, getting up from a chair, or climbing stairs
- Fatigue and general feeling of being unwell
- Mild fever and unintended weight loss in some people
- Disturbed sleep due to pain
PMR does not typically cause joint swelling or damage, which helps distinguish it from rheumatoid arthritis.
If symptoms of GCA are present – such as new headache, scalp tenderness, jaw pain when eating, or sudden vision changes – urgent medical attention is required.
The exact cause is not fully understood.
PMR results from abnormal immune system activity causing inflammation around the joints and tendons of the affected areas (bursae and synovial sheaths), rather than within the joints themselves.
Contributing factors include:
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- Age – PMR is almost exclusively a condition of older adults; the ageing immune system is thought to play a role
- Genetics – certain genetic variants are associated with increased risk
- Environmental triggers – seasonal variation in PMR incidence suggests that infections, particularly certain viral infections, may trigger the condition in susceptible individuals
There is no single diagnostic test for PMR.
Diagnosis is based on:
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- Clinical presentation – bilateral shoulder and/or hip girdle pain and stiffness, age over 50, and duration of more than two weeks
- Blood tests – elevated inflammatory markers (ESR and CRP) are almost always present in active PMR; full blood count and other tests to exclude alternative diagnoses
- Ultrasound or MRI – can show characteristic inflammation of the bursae and tendon sheaths around the shoulder and hip
- Response to corticosteroids – a rapid and dramatic response to low-dose prednisolone (typically within days) strongly supports a PMR diagnosis
Referral to a rheumatologist is recommended, particularly to exclude other causes of similar symptoms such as rheumatoid arthritis, inflammatory myopathy, or malignancy, and to assess for giant cell arteritis.
PMR responds well to corticosteroids, which are the cornerstone of treatment.
The goal is to relieve symptoms, gradually taper the steroid dose to the minimum effective amount, and prevent relapse – treatment typically continues for one to two years.
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- Corticosteroids: Prednisolone at a low starting dose (typically 12.5–25 mg/day) produces rapid and dramatic relief in most people. The dose is gradually reduced over many months. Relapses are common during tapering and may require temporary dose increases.
Steroid-sparing therapy
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- Tocilizumab (Actemra) is an IL-6 inhibitor used in PMR to reduce reliance on corticosteroids and lower relapse rates. It is particularly useful for people who experience frequent relapses or corticosteroid-related complications.
- Methotrexate and leflunomide are sometimes used as steroid-sparing agents in people who cannot tolerate long-term corticosteroids
Bone protection with calcium, vitamin D, and sometimes bisphosphonates is important for people on long-term corticosteroids.
The following specialty medications are available at Ace, a specialty pharmacy for Polymyalgia Rheumatica.
Note: Prednisolone (corticosteroids) is the primary treatment for PMR but is a general medication not listed here as a specialty medication.
With Ace, you’ll benefit from:
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- Expert Support — Our dedicated team of health concierges is always available to answer your questions, provide guidance, and help you navigate your condition with confidence.
- Specialty Medication — We offer a wide range of specialty medications and support services, designed specifically for those living with chronic illnesses. Whether you’re looking for help managing a specific condition, or simply need access to the medications you need, we’ve got you covered.
- A Wide Range of Conditions — From diabetes to heart disease, and everything in between, we help manage a variety of special condition
Take control of your health and well-being, and start your journey to better health with Ace today.
