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Polymyalgia rheumatica
Pain and stiffness in both shoulders and hips, starting fairly suddenly after 50. Very treatable — and worth knowing its warning signs.
What is polymyalgia rheumatica?
Polymyalgia rheumatica (PMR) is an inflammatory condition of people over 50 that causes pain and marked stiffness in the shoulders, upper arms, neck, hips and thighs. It often starts over days to a couple of weeks. Many people describe suddenly feeling "old overnight" — struggling to get out of bed, lift their arms to comb their hair, or get up from a chair.
Symptoms to recognise
- Aching and stiffness in both shoulders and often both hips and thighs
- Morning stiffness lasting 45 minutes or more
- Difficulty raising the arms, turning over in bed, or standing up from a low seat
- Tiredness, low appetite, weight loss, low-grade fever
- Raised ESR or CRP on blood tests
The link with giant cell arteritis
Some people with PMR also develop giant cell arteritis, which can threaten sight. Seek same-day medical help for a new headache, scalp tenderness, jaw pain when chewing, or any change in vision. Read about giant cell arteritis.
How it is diagnosed
- Typical symptoms in someone over 50
- ESR and CRP — usually raised
- Tests to exclude look-alikes: rheumatoid arthritis (RF, anti-CCP), thyroid problems, low vitamin D, muscle disease (CK), infections and, in some, cancer screening
- Ultrasound of the shoulders and hips can show bursitis typical of PMR
How it is treated
- Low-dose prednisolone — symptoms usually improve dramatically within days; such a fast response itself supports the diagnosis
- The dose is then tapered slowly, usually over 1–2 years, to prevent relapse
- Methotrexate may be added to reduce the total steroid needed, especially if relapses occur
- Newer biologic treatments are an option in difficult cases
- Bone protection (calcium, vitamin D and often a bone medicine) during long steroid courses
Approach in line with the 2015 EULAR/ACR recommendations for polymyalgia rheumatica.
Common questions
How long does PMR last?+
Most people need treatment for 1 to 2 years, and some longer. Relapses during tapering are common and are managed by adjusting the dose.
Why did my pain go away within days of steroids?+
A rapid, dramatic response to low-dose prednisolone is typical of PMR. If there is little improvement, the diagnosis should be reconsidered.
Can PMR affect younger people?+
PMR is almost always diagnosed in people over 50. Similar symptoms in younger people usually have another cause.
Stiff shoulders and hips after 50?
PMR responds quickly to the right treatment — and needs careful follow-up. Walk-in, no appointment needed.
Clinic timings & location