How long does polymyalgia rheumatica last?

What is polymyalgia rheumatica?

Polymyalgia rheumatica, often shortened to PMR, is an inflammatory condition that causes pain and stiffness in the shoulders, neck, upper arms, hips and thighs. It occurs in people aged 50 and older and is more common in women 1.

A systematic review describes the diagnosis as based on clinical features such as new pain in both shoulders, muscle or joint stiffness and difficulty with daily tasks. Inflammatory markers in the blood are raised in more than 90 per cent of people with PMR or the related condition giant cell arteritis 1.

What are the typical symptoms?

Symptoms often start over days to weeks. Stiffness is typically worst in the morning and can last more than an hour, making it hard to get out of bed, dress, lift the arms to comb hair or rise from a chair. People may also feel tired, low in mood, have a mild fever or lose weight.

Ultrasound can show inflammation of the bursae in both shoulders, which was detected in 69 per cent of people with PMR in studies included in the review 1.

How is it treated?

Glucocorticoids, usually prednisolone, are the main treatment. Consensus-based recommendations suggest an initial dose of 12.5 to 25 mg of prednisone per day or equivalent, followed by an individualised, gradual reduction 12. Many people notice a marked improvement within days of starting treatment.

For people at high risk of relapse or side effects from steroids, methotrexate may be added. In the review, adjunctive methotrexate was associated with a 20 to 44 per cent reduction in the total steroid dose and a 36 to 54 per cent reduction in relapses in PMR and giant cell arteritis 1.

How long does treatment last?

The steroid dose is tapered slowly over many months to reduce the risk of symptoms returning. Treatment often continues for a year or more, and some people need low doses for longer.

Relapses are common as the dose is reduced. A return of shoulder and hip stiffness should be reported, as the dose may need adjusting. Regular blood tests help monitor inflammation.

Why does exercise matter?

Long-term steroids can weaken muscles and bones, raise blood sugar, increase weight and increase the risk of falls. The EULAR and American College of Rheumatology recommendations for PMR suggest considering an individualised exercise programme, especially for older people on long-term steroids, to maintain muscle mass and function and reduce the risk of falls 2.

Walking, gentle strengthening exercises for the thighs and shoulders, balance training and stretching help maintain independence. Bone protection, including calcium, vitamin D and sometimes osteoporosis medicines, is often recommended.

What is the link with giant cell arteritis?

Giant cell arteritis is inflammation of large arteries, often those in the head, and can occur together with PMR. Symptoms include a new headache, tenderness of the scalp or temples, jaw pain when chewing and visual disturbances 1.

Giant cell arteritis can cause permanent loss of vision and needs emergency assessment and treatment with higher doses of steroids.

How can steroid side effects be reduced?

Regular monitoring of blood pressure, blood sugar, weight and bone health helps detect side effects early. Eating a balanced diet, limiting salt and sugar, staying active and taking bone protection medicines if prescribed reduce risks.

People taking long-term steroids should carry a steroid card or information, as the body may need extra steroid during serious illness or surgery. Never stop steroids suddenly; any changes should be made with the doctor.

When should I seek urgent help?

Seek same-day emergency care for sudden vision loss, double vision, a new severe headache, scalp tenderness or jaw pain when chewing.

Contact your doctor if stiffness returns during steroid reduction, or if you develop symptoms such as excessive thirst, low mood, sleep problems or signs of infection while taking steroids.

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