Polymyalgia Rheumatica (PMR): Diagnosis and Treatment

Have you been experiencing extended morning stiffness and new, unexplained pain in your shoulders, upper arms, neck, or pelvic area that’s affecting your daily life? If you’re over 50, it’s essential to reach out to your health care provider for an evaluation. These symptoms could be a sign of polymyalgia rheumatica (PMR), the second most common type of inflammatory rheumatic disease, right after rheumatoid arthritis, among people over 50.

In this article, we’ll explain how doctors diagnose PMR, what you can expect during the evaluation process, and the available treatment options. Remember, getting a proper diagnosis is the first step in managing symptoms, improving functioning, and resuming the ability to continue doing the activities you enjoy.

Diagnosing PMR

If you or your loved one suspects PMR, your medical team, which may include your primary care doctor and a rheumatologist, will take a closer look at your symptoms. It’s important to give your doctor a detailed description of your symptoms, as your clinical presentation will be an important part of your diagnosis. Certain factors, such as bilateral pain (or on both sides), can help to eliminate other conditions.

Your doctor will also consider your medical history, as shoulder pain can also be the result of previous trauma or osteoarthritis.

Although there is not one specific blood test or diagnostic tool that can prove a diagnosis of PMR, the majority of patients will show an increase of inflammatory markers in the bloodwork, says Dr. Anisha Dua, MD, MPH, Associate Professor and Director of the Vasculitis Center in the Division of Rheumatology at Northwestern University. Polymyalgia will also show an initial dramatic improvement with low doses of prednisone.

As far as imaging, your doctor may perform an ultrasound to look for some features associated with PMR, but this is not usually part of the routine, says Dr. Dua.

How is PMR differentiated from other inflammatory diseases?

If PMR is suspected, some blood tests may be used to rule out other conditions like rheumatoid arthritis.

These tests may include:

• Anticyclic citrullinated peptide (anti-CCP)
• Antinuclear antibody (ANA)
• Complete blood count (CBC)
• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (ESR, also called sed rate)
• Rheumatoid factor (RF)

However, these tests can be inconclusive and time may be an important factor in getting the correct diagnosis.  

Treatment and Self-Care for PMR

In most cases, the symptoms of PMR can be well managed by medication and regular healthy lifestyle habits.

What is the first line of treatment for PMR?

Corticosteroids, such as prednisone, have been the standard treatment option for reducing stiffness, achiness, fatigue, and inflammation in PMR. The dosage is usually low and symptoms often improve quickly. As the inflammation improves, the dosage can be further adjusted.

Often patients have to be on steroids for long periods of time, according to Dr. Dua. Recently, she adds, sarilumab (Kevzara) — a biologic treatment that blocks the inflammatory protein called IL-6 — was approved for more stubborn cases of PMR.

Can you leave PMR untreated?

If polymyalgia rheumatica goes untreated, patients will continue to experience painful symptoms associated with the disease and suffer from chronic inflammation, says Dr. Dua. Muscle weakness can also develop if you are limiting movement because of untreated pain.

What are the long-term implications of PMR?

“In general, patients with PMR do very well,” says Dr. Michael George, MD, MSCE, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania. They do not develop joint damage and do not have an increased risk of mortality. There is typically an excellent response in controlling symptoms with prednisone at low to moderate doses. “Some people are able to stop treatment entirely after about a year and others may need small doses of prednisone to keep symptoms controlled,” he adds.

What is the best pain relief for polymyalgia?

In addition to corticosteroids, there are a few treatment options for reducing PMR pain. Nonprescription pain relievers such as acetaminophen can be used. Disease modifying anti-rheumatic drugs (DMARDs) are used sometimes, but only in a minority of cases, says Dr. George. Non-steroidal anti-inflammatory drugs (NSAIDS) are typically not effective.

Both exercise and rest can also play a role in helping you feel better. Low impact exercise such as walking or swimming may bring relief from pain and stiffness and help with joint flexibility.

Once treatment has started, physical therapy could be helpful if you have become deconditioned from inactivity.

Finding Support

If you have PMR, you are not alone. The important thing to remember is that the symptoms are manageable with the proper medication. There are also support groups that can offer you a place to share your struggles and get your questions answered.

The Mayo Clinic has a polymyalgia support group where you can find community support and practical advice for living with PMR and related inflammatory conditions such as giant cell arteritis. If you are experiencing signs of depression as a result of your condition, talk to your doctor or health care professional to get the help you need.

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This article was made possible with support from Sanofi.