Polymyalgia Rheumatica (PMR)

What is it?

This is an inflammatory condition which usually affects people who are 65 or older. It can occur earlier, but it is not common in younger people (between 50-65). 

Occasionally, people start off with symptoms of PMR and these then develop into a related condition called GCA or Giant Cell Arteritis (sometimes called Temporal Arteritis). This can occur in 10-20% of people with PMR.

What are the symptoms?

Most people describe severe pain and stiffness most prominent in the early morning across their upper/back and shoulders (both sides) and their low back, buttock and thigh muscles (both sides).  Often it is difficult to get out of bed or out of a chair because of this.

People usually feel very tired / exhausted and the pain and stiffness can wake them.

These symptoms generally improve as the day goes on (often after 1-2  hours in the morning) but can get worse again if you sit down for long periods.

In most cases, a hot shower or bath helps the stiffness to some extent.

Occasionally, people have a low level temperature and can lose some weight unintentionally.

Warning signs of GCA (Seek Medical Attention Immediately):**

• New or severe headaches (usually around one temple)
• Scalp tenderness (too painful to out your head on the pillow or comb your hair)
• Jaw pain while chewing (and ache in the muscles of your jaw)
• Blurred or double vision
• Sudden vision loss

How is PMR diagnosed?

It is diagnosed usually by a rheumatologist or a GP using the combination of listening to the symptoms you have experienced, what is found when you are examined, your blood tests (especially CRP level) and your rapid response to low dose prednisolone (usually within 48 hours).

Other conditions will need to be ruled out e.g. Rheumatoid Arthritis, infection, malignancy

How is it treated?

Prednisolone (a steroid) is the standard treatment for PMR. The doses used are quite low, generally starting at 15mg daily, and there are standards ways of slowly reducing the dose over a 6-12 month period.

Symptoms are usually 80% better within 48 hours. If they are not your doctor will need to reconsider the diagnosis.

It is very important to follow the steroid tapering regime to avoid long term side effects.

Occasionally, some people with more severe PMR do not respond fully to the low dose Prednisolone reducing regime and need to have a ‘steroid sparing agent’ added e.g. Methotrexate, Leflunomide or Mycophenolate Motifil.

Regular follow up is required to make sure you are responding as expected to the Prednisolone.

Bone Protection

Because long-term steroids can weaken bones, your doctor may also recommend:

• Calcium and vitamin D supplements or Vitamin D3 alone
• Bisphosphonates to prevent osteoporosis (e.g. Alendronic Acid 70mg weekly)

Living with PMR

• Take medication as prescribed and attend regular follow-up appointments
• Gentle physical activity can help maintain mobility and strength
• Monitor for signs of relapse or GCA
• Inform your healthcare provider if symptoms return or worsen

Final Thoughts

Polymyalgia Rheumatica can be painful and disruptive, but with early diagnosis and appropriate treatment, most people respond very well. Recognising the symptoms and starting treatment early is key to managing this condition successfully.

*Sources: NICE NG73 (2018), BMJ Best Practice, Versus Arthritis*