Polymyalgia rheumatica Dr Rob Hicks PMR causes pain and stiffness of the muscles, especially in the shoulders and thighs.

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What is Polymyalgia rheumatica? Symptoms

Causes and risk factors Treatment and recovery

Polymyalgia rheumatica (PMR) is a debilitating condition in which the muscles supporting the neck, shoulders, hips and thighs become inflamed.

Symptoms often come on suddenly, with pain and stiffness in the muscles generally building up over a week or two making it difficult to function properly. Climbing stairs, walking, and getting in and out of the bath become uncomfortable and many previously active people find themselves housebound.

Sometimes lifting a fork or spoon becomes impossible. In severe cases, the pain may mean someone becomes bed-bound.

Symptoms are worse first thing in the morning, which means it's often hard to get out of bed. Pain and stiffness also tends to increase after sitting down for prolonged periods, making driving or travel difficult.

In addition to the pain and stiffness, many people experience extreme tiredness and feel feverish or very unwell. Some may lose weight, and many with PMR feel down or depressed.

There are also associated problems such as a painful inflammation of the arteries of the head known as temporal arteritis, which can damage the eye and needs urgent medical attention.

Nobody knows what causes the pain of PMR. However, it often develops quite suddenly after a flu-like viral infection.

The majority of people affected are over the age of 50. Women are more likely to get PMR than men.

Diagnosis can be difficult because no single test confirms the condition, and symptoms may be blamed on other problems such as osteoarthritis. Your doctor will want to take a careful history of how symptoms began, and then may do a blood test (usually one known as an ESR) to check for levels of inflammation in the body. Sometimes it is only the response to treatment which points to the diagnosis.

PMR can't be prevented but the symptoms are easily treated with medication.

Steroid medication in tablet form, usually prednisolone, reduces inflammation and brings rapid and dramatic improvement. The benefits are often felt within 48 hours. Because steroids have significant side effects, the dose is usually gradually reduced over a period of weeks to the minimum needed to control symptoms.

Regular monitoring with the ESR test is essential to measure the level of inflammation in the body. This, combined with a regular review of symptoms, gives an idea of how well the treatment is working and enables the doctor to adjust the dose as necessary.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also help. Physiotherapy can improve the function of the muscles once the pain and stiffness have subsided.

People often need to remain on medication for about two years, with the dose kept to the absolute minimum required. Being on oral steroid medication for a long time can thin the bones and lead to osteoporosis.

For this reason it's important to have plenty of calcium and vitamin D in the diet and, when able, to do weight-bearing exercises such as brisk walking. The doctor may also suggest taking a calcium and vitamin D supplement.

PMR eventually burns itself out and medication can be stopped. However, this should only be done under the supervision of the doctor.

This article was last medically reviewed by Dr Trisha Macnair in July 2009.