Polymyalgia rheumatica (PMR) is an inflammatory rheumatologic syndrome. Affected patients describe difficulty rising from seated or prone positions, significant shoulder and hip girdle stiffness, varying degrees of muscle tenderness, shoulder/hip bursitis, and/or oligoarthritis.
More common in women.
About 15% to 20% of patients with PMR have giant cell arteritis (GCA); 40% to 60% of GCA patients have PMR.
Diagnosis is made via history and with supportive laboratory tests indicating an elevated ESR or CRP.
Rapid improvement often occurs within 24 to 72 hours with low-dose prednisolone.
Polymyalgia rheumatica (PMR) is an inflammatory rheumatological syndrome that manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than age 50 years. Peripheral musculoskeletal involvement may also be present. PMR occurs either as an isolated condition or associated with giant cell arteritis.
History and exam
Key diagnostic factors
- presence of risk factors
- shoulder/hip girdle stiffness
- shoulder/hip girdle pain
- rapid response to corticosteroids
Other diagnostic factors
- acute onset
- low-grade fever
- weight loss
- oligoarticular arthritis
- age ≥50 years
- giant cell arteritis (GCA)
- female sex
1st investigations to order
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
Investigations to consider
- serum protein electrophoresis
- rheumatoid factor
- anti-cyclic citrullinated peptide antibodies
- interleukin (IL)-6
- fluorodeoxyglucose F-18 PET scan
treatment-resistant or relapse or disease exacerbation
Ari Weinreb, MD, PhD
Associate Chief of Rheumatology
VA Greater Los Angeles Healthcare System
Associate Clinical Professor of Medicine
David Geffen School of Medicine at UCLA
AW declares that he has no competing interests.
Dr Ari Weinreb would like to gratefully acknowledge Dr Lynell Newmarch, a previous contributor to this topic. LN declares that she has no competing interests.
Brian F. Mandell, MD, PhD, FACR
Vice Chairman of Medicine for Education
Professor of Medicine
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
Editor in Chief
Cleveland Clinic Journal of Medicine
BFM declares that he has no competing interests.
Kuntal Chakravarty, FRCP (London), FRCP (Glasgow), FRCP (Ireland), FACP (USA), FACR (USA)
BHRT University Hospital
KC declares that he has no competing interests.
- Giant cell arteritis (GCA)
- Early rheumatoid arthritis (RA)
- 2015 recommendations for the management of polymyalgia rheumatica
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