What Is Polymyalgia Rheumatica (PMR)?

TL;DR: Polymyalgia rheumatica (PMR) is an inflammation problem that causes deep aching pain and stiffness in the shoulders and hips, especially in the morning. It mainly affects adults over 50. Doctors diagnose it from your story, exam, blood tests for inflammation, and how you respond to treatment. Most people feel better quickly with the right plan.

What PMR feels like

• Both shoulders and the neck/upper arms feel sore and stiff.
• Both hips/thighs can ache, making it hard to get up from a chair.
• Morning stiffness often lasts 45 minutes or longer and eases as you move.
• You may feel tired, a bit “flu-ish,” and notice low appetite or mild fever.
  These are the hallmark features doctors look for.

Who gets PMR?

PMR almost always starts after age 50, is most common in the 70s, and happens more often in women than men (about 2–3 to 1). It’s seen worldwide, but is especially common in people with Northern European ancestry.

What causes PMR?

We don’t know the exact cause. PMR is driven by the immune system and certain inflammation signals, especially interleukin-6 (IL-6). IL-6 levels tend to be high when PMR is active and drop as it improves—one reason IL-6-blocking medicines are being used in hard-to-treat cases.

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How doctors diagnose PMR

There is no single test. Doctors put the pieces together:

1. History & exam – typical shoulder/hip stiffness pattern and daily impact.
2. Inflammation blood tests – ESR and CRP are often elevated.
3. Rule-outs – check for look-alikes like shoulder tendon tears, osteoarthritis, thyroid problems, inflammatory muscle disease, infection, or cancer.
4. Imaging (when helpful) – ultrasound of shoulders/hips can show bursitis or other signs of inflammation.
5. Response to therapy – improvement over days to weeks supports the diagnosis.

PMR vs. muscle “weakness”

Most people with PMR feel stiffness and pain, not true muscle weakness. If you can’t push, pull, or rise from a chair because the muscles are weak, your doctor will look for other causes. (In PMR, the movement is limited mainly by pain and stiffness, and improves as the day goes on.)

The link between PMR and Giant Cell Arteritis (GCA)

PMR and GCA are “sister” conditions. About 10–20% of people with PMR will also have GCA at some point, and 40–50% of people with GCA have PMR symptoms. GCA can threaten vision, so new headache, scalp tenderness, jaw pain with chewing, or any vision change needs same-day care.

Treatment (what usually happens)

Treatment is individualized, but most people start with low-to-moderate dose prednisone (a steroid) and then taper the dose slowly over months. The 2015 EULAR/ACR recommendations guide doctors on starting dose and tapering plans and suggest methotrexate as a helpful add-on for people with frequent relapses or higher risk from steroids.

Steroid-sparing options

• Sarilumab (Kevzara®), an IL-6 receptor blocker, was approved by the U.S. FDA in 2023 for adults with PMR who can’t taper steroids or don’t respond well. (Your doctor will check if it fits your situation.)
• Tocilizumab (IL-6 blocker) is used off-label in some cases and has supportive evidence, though it doesn’t have a PMR-specific FDA label.

Monitoring and safety

Because steroids can raise blood sugar, blood pressure, and affect bones and eyes, your plan usually includes:

• Regular checks of ESR/CRP and your symptoms
• Calcium + vitamin D, weight-bearing exercise, and sometimes a bone-protective medicine
• Blood pressure/glucose checks and eye care as needed
  Your clinician will personalize this to your health history.

When to call urgently

Call your clinician the same day (or seek urgent care) for:

• Vision changes, new severe headache, scalp tenderness, or jaw pain while chewing (possible GCA)
• Fever, chills, cough, or signs of infection—especially if you’re on higher-dose steroids or biologics.