Polymyalgia rheumatica (PMR) is a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips.

Symptoms of polymyalgia rheumatica
The main symptom is muscle stiffness in the morning that lasts longer than 45 minutes.

Other symptoms may include:

extreme tiredness
loss of appetite
weight loss
depression
See a GP if you have pain and stiffness for more than a week. They'll try to find out what's causing it.

Diagnosing polymyalgia rheumatica can be difficult because the symptoms are similar to those of many other conditions, including rheumatoid arthritis.

These conditions will need to be ruled out before polymyalgia rheumatica is diagnosed.

Causes of polymyalgia rheumatica
The cause of polymyalgia rheumatica is unknown, but a combination of genetic and environmental factors is thought to be responsible.

Polymyalgia rheumatica is an age-related condition. Most people diagnosed with it are over 70, and it's very rare in people younger than 50. It's also more common in women than men.

It's estimated 1 in every 1,200 people in the UK develop the condition every year.

Treating polymyalgia rheumatica
A corticosteroid medicine called prednisolone is the main treatment for polymyalgia rheumatica. It's used to help relieve the symptoms.

To start with, you may be prescribed a moderate dose of prednisolone, which will be gradually reduced over time.

Most people with polymyalgia rheumatica will need a course of corticosteroid treatment that lasts for 18 months to 2 years to prevent their symptoms returning.

Temporal arteritis
Up to 1 in 5 people with polymyalgia rheumatica develop a more serious condition called temporal arteritis (also known as giant cell arteritis), where the arteries in the head and neck become inflamed.

Symptoms of temporal arteritis include:

a severe headache that develops suddenly (your scalp may also feel sore or tender)
pain in the jaw muscles when eating
problems with sight, such as double vision or loss of vision
If you have any of these symptoms, contact a GP immediately, go to 111.nhs.uk, call NHS 111 or go to your nearest urgent care service.

Unlike polymyalgia rheumatica, temporal arteritis requires immediate medical attention. This is because it can cause permanent sight loss if not treated promptly.

The most common symptom of polymyalgia rheumatica (PMR) is pain and stiffness in the shoulder muscles, which develops quickly over a few days or weeks.

You may also have pain in your neck and hips. Both sides of the body are usually affected.

The stiffness is often worse first thing in the morning after you wake up. It starts to improve after about 45 minutes as you become more active.

Some people with polymyalgia rheumatica also:

feel very tired
lose their appetite
lose weight
have depression
When to get medical advice
See a GP if you have pain and stiffness that lasts longer than a week. They'll investigate the cause.

When to get immediate medical advice
Contact a GP immediately, use NHS 111 or go to your nearest urgent care service if you've been diagnosed with polymyalgia rheumatica (or it's suspected) and you suddenly have:

a severe headache that does not go away
pain or cramping in your jaw muscles that's worse when eating
pain in your tongue when chewing
vision loss or vision disturbances, such as double vision
These symptoms may indicate a more serious condition called temporal arteritis.

Diagnosing polymyalgia rheumatica (PMR) can often be quite a lengthy process involving several different tests.

This is because it shares many symptoms with more common health conditions such as rheumatoid arthritis, which need to be ruled out first.

Tests
There's no specific test for polymyalgia rheumatica, but it's likely that a series of blood tests will be done.

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are blood tests that can be used to check the levels of inflammation in your body.

If ESR and CRP are normal, it’s unlikely that polymyalgia rheumatica will be diagnosed.

Sometimes, ESR may be normal and CRP may be raised, which is more likely to indicate polymyalgia rheumatica. This is why both tests are usually done at the same time.

As inflammation is a feature of many conditions, high levels do not automatically mean you have polymyalgia rheumatica.

Further tests may be needed to help rule out other conditions that cause inflammation. For example, a test for rheumatoid factor and anti-CCP antibodies may be done to rule out rheumatoid arthritis.

Blood tests can also help determine:

whether you have a blood infection
how well your organs, such as your kidneys, are working
if you have an overactive thyroid gland or an underactive thyroid gland – both conditions can cause muscle pain
You may have a urine test to check how well your kidneys are functioning.

X-rays and ultrasound scans may also be used to look at the condition of your bones and joints.

Symptom checklist
After ruling out other possible causes of your symptoms, a checklist can be used to see if your symptoms match those most commonly associated with polymyalgia rheumatica.

Polymyalgia rheumatica can usually be confidently diagnosed if you meet all of the following criteria:

you're over 50 years of age
you have pain in your shoulders or hips
you have stiffness in the morning that lasts longer than 45 minutes
your symptoms have lasted for more than 2 weeks
blood tests show raised levels of inflammation in your body
your symptoms rapidly improve after treatment with corticosteroids

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