When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Polymyalgia rheumatica

Last reviewed: 1 Nov 2024
Last updated: 17 Nov 2023

Summary

Definition

History and exam

Key diagnostic factors

  • shoulder/hip girdle stiffness
  • shoulder/hip girdle pain
  • rapid response to corticosteroids
Full details

Other diagnostic factors

  • acute onset
  • low-grade fever
  • anorexia
  • weight loss
  • malaise
  • depression
  • asthenia
  • oligoarticular arthritis
Full details

Risk factors

  • age ≥50 years
  • giant cell arteritis (GCA)
  • female sex
Full details

Diagnostic tests

1st tests to order

  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • CBC
Full details

Tests to consider

  • TSH
  • ultrasound
  • MRI
  • serum protein electrophoresis
  • serum creatine phosphokinase
  • rheumatoid factor
  • anti-cyclic citrullinated peptide antibodies
Full details

Emerging tests

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

Treatment algorithm

ACUTE

initial presentation

ONGOING

treatment-resistant or relapse or disease exacerbation

Contributors

Authors

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

CA

Disclosures

AW declares that he has no competing interests.

Acknowledgements

Dr Ari Weinreb would like to gratefully acknowledge Dr Lynell Newmarch, a previous contributor to this topic.

Disclosures

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

Cleveland

OH

Disclosures

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

Romford

UK

Disclosures

KC declares that he has no competing interests.

  • Differentials

    • Giant cell arteritis (GCA)
    • Early rheumatoid arthritis (RA)
    • Hypothyroidism
    More Differentials
  • Guidelines

    • 2022 guideline for the prevention and treatment of glucocorticoid induced osteoporosis
    • 2022 guideline for vaccinations in patients with rheumatic and musculoskeletal disease
    More Guidelines
  • Patient information

    Polymyalgia rheumatica

    More Patient information
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer