Polymyalgia rheumatica (PMR) | Mate uaua mārō

Polymyalgia rheumatica (PMR) is a condition that causes inflammation, pain and stiffness in your shoulders, neck and hips. This pain and stiffness is often accompanied by a feeling of being unwell and tired. 

We don't know what causes PMR, but it mainly affects people over 60. Some people with PMR develop a more serious condition called giant cell arteritis (GCA).

Image credit: canva

The symptoms of PMR vary from person to person, but generally include:

• pain, aching and tenderness in your neck, shoulders, hips, buttocks, and thighs
• stiffness in the morning that improves after moving around for 30–40 minutes
• pain when moving your joints
• sometimes, other more general symptoms such as tiredness, weight loss, fever, and loss of appetite.

If your symptoms include a sudden headache, tenderness around your scalp, pain in your jaw when chewing or changes in your eyesight, see your GP as soon as possible. These are signs of giant cell arteritis (GCA).

Your doctor will ask you about your symptoms and how long you've had them. They'll want to make sure you don't have GCA, and will want to rule out other health conditions, such as fibromyalgia and osteoarthritis.

There's no single test to diagnose PMR, but your doctor will want you to have blood tests to look for inflammation in your body. They'll usually make a diagnosis based on your symptoms combined with your blood test results. If your doctor is unsure about a diagnosis, especially if you're younger than 50, they may refer you to see a rheumatologist for more tests.

If your doctor diagnoses you with PMR, they'll start you on a steroid medication called prednisone straight away. The medication works by reducing your inflammation, and you should see an improvement within a few days. Your doctor will monitor your progress to check if your symptoms are improving, and will adjust the dose if necessary.

You usually start taking 15–20 mg of prednisone daily and stay at this dose for at least a month. When your symptoms improve, your doctor will gradually reduce the dosage. Often people need to keep taking a low dose of prednisone for several years to stop the PMR from coming back.

As steroids can reduce your bone density and may cause osteoporosis, your doctor will usually give you advice about trying to prevent this.

Clinical resources

Investigating myalgia in patients taking statins(external link) BPAC, NZ, 2014
Polymyalgia rheumatica – look before you leap(external link) BPAC, NZ, 2013
Polymyalgia rheumatica (PMR)(external link) 3D Regional HealthPathways, NZ 

Continuing professional development

Video: Dr Daniel Boulos – understanding and managing polymyalgia rheumatica

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(Musculoskeletal Australia, 2020)

For more videos of the same series, view PHARMAC video series(external link).