Understanding Polymyalgia Rheumatica (PMR)

Polymyalgia rheumatica (PMR) is a common inflammatory condition that causes joint and muscle pain and stiffness in the body. Most people who get PMR are over the age of 50. It affects women more often than it affects men. It is also more common in white people.^1-3

Many people with PMR may also have a condition called giant cell arteritis (GCA). They are closely linked because they both involve the same type of body-wide inflammation. They often happen at the same time or one after the other.^1,2

While PMR causes muscle stiffness, GCA causes inflammation in your blood vessels (arteries), usually in the head and temples.^1,2

What are the symptoms of PMR?

The hallmark symptoms of PMR are pain and stiffness, especially in the morning. People with PMR often feel this stiffness in their shoulders, upper arms, and neck. It is also common in the hips or pelvic girdle.^1-4

With PMR, symptoms often start relatively quickly. For example, many people feel fine when they go to bed but wake up the next morning with aches, pain, and stiffness on both sides of the body. This is known as an "overnight" onset. This feeling is usually worse in the morning, but gets better as the day goes on. Or, you may feel stiff after sitting or resting for a period of time (like on a long car ride).^1-4

It may be hard to raise your arms to brush your hair. You might struggle to stand up from a chair. This sudden change can be unsettling for patients and caregivers. Talk with your doctor if you or someone you love is experiencing these symptoms.^1-4

How does PMR differ from rheumatoid arthritis?

PMR and rheumatoid arthritis (RA) are both immune-mediated diseases. However, while RA is a classic autoimmune disease where the body produces specific antibodies to attack itself, PMR is often categorized as an autoinflammatory disease. This means the innate immune system – the body's first line of defense – becomes overactive and causes body-wide inflammation, even without specific autoantibodies present.⁴

RA usually targets the joints themselves, whereas PMR targets the tissue around the joints. RA can cause permanent joint damage. PMR does not usually damage the joints in this way. The cause of pain in PMR is also unique. RA causes inflammation in the lining of the joints.⁴

How is PMR diagnosed?

Doctors look at your symptoms and your age when diagnosing PMR. They will likely perform a physical exam to check your range of motion. They may also use blood tests or imaging tests to look for inflammation in the joints and soft tissue.^1-3,5

One of the best ways to confirm the diagnosis is the "prednisone litmus test." Prednisone is a low-dose corticosteroid drug. It helps to lower inflammation in the body.^1-3,5

If you have PMR, you will likely feel much better after taking a low dose of this drug. This relief usually happens within 1 to 3 days. This rapid response acts as a tool for the doctor. It helps them know that the diagnosis is correct. If the drug does not help quickly, the doctor may look for another cause of your pain.⁵

What does treatment for PMR realistically look like?

After taking low-dose steroids, you may feel better very quickly. However, PMR does not go away as fast as it starts. The inflammation still "smolders" in the body for a long time. You cannot stop taking the drug right away. You must slowly lower the dose over many months. This process is called a taper.^3-5

People with PMR may need to take steroids for 12 to 24 months. Some people may need them for longer. Lowering the dose too quickly can cause a relapse. A relapse is when the pain and stiffness return.^3-5

A slow taper helps to prevent these flare-ups. Your doctor will watch you closely during this time. They will check your blood and ask how you feel.^3,5

Other things to know about managing PMR

PMR is a condition that appears quickly but requires a slow management plan. The rapid response to low-dose steroids is a key part of finding the disease. Staying in contact with your healthcare team is the best way to ensure you are managing PMR safely.^1-3