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Polymyalgia rheumatica

Last reviewed: 4 Sep 2023
Last updated: 09 Mar 2023



History and exam

Key diagnostic factors

  • shoulder/hip girdle stiffness
  • shoulder/hip girdle pain
  • rapid response to corticosteroids
More key diagnostic factors

Other diagnostic factors

  • acute onset
  • low-grade fever
  • anorexia
  • weight loss
  • malaise
  • depression
  • asthenia
  • oligoarticular arthritis
Other diagnostic factors

Risk factors

  • age ≥50 years
  • giant cell arteritis (GCA)
  • female sex
More risk factors

Diagnostic investigations

1st investigations to order

  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • CBC
More 1st investigations to order

Investigations to consider

  • TSH
  • ultrasound
  • MRI
  • serum protein electrophoresis
  • serum creatine phosphokinase
  • rheumatoid factor
  • anti-cyclic citrullinated peptide antibodies
More investigations to consider

Emerging tests

  • interleukin (IL)-6
  • fluorodeoxyglucose F-18 PET scan

Treatment algorithm


initial presentation


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

Los Angeles



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.

Peer reviewers

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

Cleveland Clinic




BFM declares that he has no competing interests.

Kuntal Chakravarty, FRCP (London), FRCP (Glasgow), FRCP (Ireland), FACP (USA), FACR (USA)

Consultant Rheumatologist

BHRT University Hospital

Queen’s Hospital




KC declares that he has no competing interests.

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