Polymyalgia rheumatica


  • Chronic inflammatory condition
  • Primarily affects elderly
    • Almost exclusively in those over the age of 50, peak incidence occurs between ages 70-80[1]

Clinical Features

  • Onset abrupt or subacute (weeks-months)
  • Proximal myalgia primarily involving hips, shoulders, and neck
  • Morning stiffness
  • Giant cell arteritis develops in approximately 15% of patients with PMR[2]
  • +/- constitutional symptoms (fatigue/malaise, low-grade fever, anorexia)
  • +/- anemia
  • Rheumatoid arthritis-like symptoms (joint pain/swelling, degenerative changes) in 30% of patients[3]

Differential Diagnosis



  • Clinical diagnosis
  • Evaluate for alternate diagnoses


  • Low-dose Corticosteroids typically produce rapid response[4]
    • Example regimen:
      • Prednisone 15 mg PO QD for 2-4 weeks
      • Needs to start a year-long taper after the first month, so write enough for them to get in with PCP.
  • Avoid NSAIDs if history of or concern for GCA due to risk of renal injury


  • Discharge

See Also

External Links


  1. Salvarani C, Gabriel SE, O'Fallon WM, Hunder GG. Epidemiology of polymyalgia rheumatica in Olmsted County, Minnesota, 1970-1991. Arthritis Rheum. 1995 Mar;38(3):369-73. doi: 10.1002/art.1780380311. PMID: 7880191.
  2. Dejaco C, Duftner C, Buttgereit F, Matteson EL, Dasgupta B. The spectrum of giant cell arteritis and polymyalgia rheumatica: revisiting the concept of the disease. Rheumatology (Oxford). 2017 Apr 1. 56 (4):506-515
  3. https://rarediseases.org/rare-diseases/polymyalgia-rheumatica/
  4. https://emedicine.medscape.com/article/330815-overview