Polymyalgia Rheumatica — Symptoms & Treatments

Things to remember

Polymyalgia rheumatica causes pain and stiffness in older adults
Symptoms include muscle aches and stiffness, unexplained weight loss and fatigue
Polymyalgia rheumatica can be treated effectively with medication and lifestyle changes.

Polymyalgia rheumatica is a condition that causes pain and stiffness in older adults. Typical symptoms include moderate-to-severe muscle pain and stiffness, particularly affecting the neck, shoulders and hips.

People aged 50 years and over are most commonly affected by polymyalgia rheumatica. It’s a common condition and very treatable.

Polymyalgia rheumatica should not be confused with fibromyalgia – a condition that also causes pain and muscle stiffness, but doesn’t cause inflammation.

Cause

Polymyalgia rheumatica produces inflammation and swelling in the larger joints of your body, such as your shoulders and hips, and in the tissues around these joints.

The inflammation is due to your immune system attacking the membranes lining your joints, but the reason for this is unknown. Your genetics and environmental factors (e.g. infections) are believed to play a role.

Symptoms

The symptoms of polymyalgia rheumatica usually develop over a short period of time (days/weeks) and may include:

muscle pain and stiffness, particularly in your neck, shoulders, hips, thighs and upper arms
fatigue (or tiredness)
increased pain and stiffness after you’ve been resting or inactive
difficulty sleeping (due to pain)
difficulty raising arms above shoulder height
weight loss
slight fever.

Not everyone will experience all of these symptoms. Each person with polymyalgia rheumatica will have their own unique set of symptoms.

Risk factors

Risk factors for polymyalgia rheumatica include:

advancing age – it’s more common in people aged 50 years and over.
gender – women are more likely to develop the condition than men
race – Caucasian (white) people are most susceptible.

Diagnosis

No single test can diagnose polymyalgia rheumatica, so your doctor will make a diagnosis based on several factors. These include your medical history, a physical examination, tests that measure the levels of inflammation markers in your blood, and tests (e.g. scans) to rule out other possible causes.

Polymyalgia rheumatica and giant cell arteritis

Some people with polymyalgia rheumatica experience giant cell arteritis (also known as temporal arteritis). Giant cell arteritis involves painful inflammation of the blood vessels (arteries) of your skull. Your temples are tender to touch and chewing may cause some pain in the side of your face.

Symptoms include:

severe headache
blurred or double vision
pain in the side of your jaw or face when chewing
temples are tender to touch
scalp tenderness.

If not treated promptly, giant cell arteritis can cause damage to the arteries of the eye, which can lead to blindness. Seek urgent medical attention if you experience any of the above symptoms.

Treatment

Most people with polymyalgia rheumatica will be treated with oral corticosteroid medication. The amount prescribed will depend on your specific situation. A higher dose will be prescribed in more severe conditions and when giant cell arteritis is present.

The aim of treatment for polymyalgia rheumatica is to relieve your symptoms and slowly reduce the medication dose to the lowest possible amount without the return of symptoms.

You may also need to take other medications from time to time to help manage your pain. Pain-relieving medications (analgesics) and non-steroidal anti-inflammatory drugs (NSAIDs) can provide temporary relief of pain and stiffness.

Creams and ointments can be rubbed into the skin over a painful area to relieve pain.

Complications of oral corticosteroids

Long-term use of oral corticosteroids can cause unwanted side effects, so it’s important you see your doctor regularly while taking these medications. If you have any concerns about the side effects of corticosteroids, you should discuss them with your doctor.

Self-management

You can do many things to help yourself including:

Learn more about polymyalgia rheumatica – knowing as much as possible about your condition means that you can make informed decisions about your healthcare and play an active role in the management of your condition.

Get active – low-impact activities such as swimming or walking can help reduce muscle pain and stiffness. A physiotherapist or exercise physiologist can help design an individual program for you.

Learn new ways to manage pain – there are many things you can do to manage pain – and different strategies will work for different situations. For example, heat packs can help ease muscle pain, cold packs can help with inflammation, gentle exercise can help relieve muscle tension. Try different techniques until you find the things that work best for you.

Eat well – eating a balanced diet can help provide you with better energy levels, help to maintain your weight, and give you a greater sense of wellbeing.

Ask your doctor to check your calcium and vitamin D levels – steroid tablets reduce the amount of calcium your body absorbs, while vitamin D is important in helping your body absorb and process calcium. With this in mind, it’s a good idea to check your calcium and vitamin D levels with your doctor and discuss the need for any supplements.

Don’t smoke –smoking cigarettes is not only bad for your general health but it can also worsen your polymyalgia rheumatica symptoms and make it harder to treat.

Pace yourself – plan and organise your activities so you make the most of your energy.

Stay at work – it’s good for your health and wellbeing. Talk to your doctor or allied healthcare professional about ways to help you to get back to or to stay at work.

Join a peer support group – dealing with a chronic condition can be isolating. Being able to speak with others who understand your condition can be a great relief.

Where to get help

Your doctor
Rheumatologist
Musculoskeletal Australia
National Arthritis and Back Pain+ Help Line 1800 263 265

How we can help

Call our Help Line and speak to our nurses. Phone 1800 263 265 or email helpline@msk.org.au.

We can help you find out more about:

polymyalgia rheumatica and other musculoskeletal conditions
ways to live well with these conditions
managing your pain
- read our A-Z guide to managing pain
- watch our excellent videos on pain, your brain and how you can retrain your pain system.
  - Pain, the brain and your amazing protectometer – Lorimer Moseley
  - Treating pain using the brain – David Butler
upcoming webinars, seminars and other events.

More to explore

Download this information sheet (PDF).

Watch the recording of our webinar

Understanding and managing polymyalgia rheumatica (PMR), presented by Dr Daniel Boulos.
This webinar provided information on what we know about the causes of PMR, how it’s diagnosed, the important complications not to be missed, and what you and your treating doctor can do to help manage your condition.
Recorded on 25 June 2020.
We would like to thank Dr Daniel Boulos for kindly re-recording the webinar after a technical problem caused the original recording to be lost.

The whole or part of this material is copyright to the State of Victoria and the Better Health Channel. Reproduced with permission of the Victorian Minister for Health. Users are permitted to print copies for research, study or educational purposes.

Information has been produced in consultation with and approved by: Musculoskeletal Australia.