Polymyalgia rheumatica (PMR) is an inflammatory condition affecting the shoulders, neck, and hips. Polymyalgia means “many muscle pains”. Rheumatica means “changing” or “influx”. The cause of polymyalgia rheumatica is currently unknown (1). The condition usually affects joints on both sides of the body at the same time. This can cause pain and stiffness in the affected joints and surrounding muscles (2).
Polymyalgia rheumatica has links with another condition called temporal arteritis (giant cell arteritis). This is a problem with the arteries supplying blood to the temple region of your skull (cranium) (5). This problem can be dangerous and you should seek medical advice if you have polymyalgia rheumatica and are getting severe headaches, scalp tenderness, jaw or facial soreness (especially with chewing), or vision changes/distorted vision that is caused by decreased blood flow to the eye.
Currently, the best treatment for polymyalgia rheumatica involves a combination of medication and physical activity. This involves taking oral steroids which can help to control the inflammatory process in joints and soft tissue structures. This, combined with exercises that aim to keep joints moving and increase strength in muscles surrounding joints, will benefit people with polymyalgia rheumatica (5).
Polymyalgia rheumatica symptoms usually develop quickly and cause aching in the muscles. Other symptoms include:
Approximately 15% of people with polymyalgia rheumatica will also have temporal arteritis and about half of the people with temporal arteritis also have polymyalgia rheumatica. Temporal arteritis causes inflammation that damages large and medium-sized arteries. The name of the condition stems from the fact that some of the affected arteries provide blood to the head, including the temples (1, 4). Symptoms of temporal arteritis include:
The cause of polymyalgia rheumatica is unknown. A combination of genetic and environmental factors is thought to be responsible. The disease has a very sudden onset and new cases occur in cycles which could suggest that infection is a cause. Inheritance of the disorder has been suggested due to patterns seen in family histories (4). However, there are no definitive studies that can confirm any of these factors are a direct cause of polymyalgia rheumatica.
This is not an exhaustive list. These factors could increase the likelihood of someone developing polymyalgia rheumatica. It does not mean everyone with these risk factors will develop symptoms (1).
Taking corticosteroid is the mainstay of treating polymyalgia rheumatica. However, there are side effects of long-term steroid use. These include:
It is estimated that 0.83% of people, or 1 in every 1,200, in the UK develop the condition every year. It carries a lifetime risk of 2.4% in females and 1.7% in males (1). The incidence of PMR was highest in women, older age groups and those living in the South of England (4).
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.
Diagnosing polymyalgia rheumatica can be a lengthy process as its symptoms are common in other inflammatory conditions. For example, rheumatoid arthritis shares many symptoms with polymyalgia rheumatica, so ruling out these types of conditions is important. There is no specific test for polymyalgia rheumatica. It is likely that a blood test will be done to check inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). If these are normal it is unlikely polymyalgia rheumatica will be diagnosed.
As inflammation is common in many conditions, above normal levels of inflammatory markers do not mean you have polymyalgia rheumatica. Further tests will be done to rule out other causes, e.g. a test for rheumatoid factor or anti-CCP antibodies to rule out rheumatoid arthritis.
Polymyalgia rheumatica can be confidently diagnosed if you meet all the following criteria:
With treatment, polymyalgia rheumatica symptoms usually lessen or go away within days. Without treatment, they may go away after a year but could take up to five years or more. Proper nutrition, activity, rest and following medication regimens are important for managing the condition. Once stiffness goes away, a person can return to daily activities, including exercise, as tolerated. Treatment includes anti-inflammatory medication and exercise (5, 6).
Polymyalgia rheumatica treatment focuses on reducing pain and inflammation, and easing stiffness, achiness, fatigue and fever.
A combination of exercise and education for polymyalgia rheumatica is recommended as this will reduce the risk of functional impairment and disability. Your physiotherapist will work with you to form a bespoke rehabilitation plan to help improve strength and mobility. This is vital for the long-term management of polymyalgia rheumatica in terms of managing pain and stiffness, and can help slow down, or in some cases help reverse some symptoms.
Exercise and keeping active are essential parts of this, but you may have to modify how you do things a little. Your musculoskeletal physiotherapist can instruct you on how this can be achieved by implementing a bespoke home exercise and self-management plan. In the meantime, the below exercise programme can provide a good starting point for this condition.
The exercises in this programme provide some basic exercises that can help to maintain function and reduce stiffness often associated with the condition. This should not exceed any more than 5/10 on your perceived pain scale.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and to establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
The typical medication for polymyalgia rheumatica is corticosteroid treatment, usually in the form of prednisolone. This works by blocking the effects of chemicals that cause inflammation; it is not a cure but helps to relieve symptoms. The corticosteroid is taken in tablet form and you will be started on a moderate dose to begin with; the dose will be gradually reduced every 1-2 months. Symptoms usually improve within a few days, but you will need to continue taking prednisolone for about 2 years. Do not suddenly stop taking your medication until your doctor says it is safe to do so. This is due to the potential side effects of stopping treatment abruptly. Polymyalgia rheumatica often resolves in time on its own, however, there is a chance of the symptoms returning; this is called a relapse.
Your doctor will prescribe daily doses of calcium and vitamin D supplements to help prevent bone loss because of corticosteroid treatment (5).
Treatment options include (5,6):
Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.
We have Pure Physiotherapy clinics across the country including Norwich, Great Yarmouth, Manchester, Stockport, Sheffield and Rotherham. Please view our clinics to find the closest physiotherapy clinic for you.
Common age-related changes to the structure of the hip joint may be associated with pain, stiffness and loss of function.
Thumb osteoarthritis (OA) is degeneration of the cartilage that covers the ends of the bones that form the joint, which creates pain and stiffness.
Age and activity related changes to the joints of the shoulder which can lead to pain and stiffness.
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