Polymyalgia rheumatica

Also called PMR

Sudden severe stiffness in the shoulders and hips in older people. It responds to steroids within days, and it travels with something that can blind you.

What it is

Polymyalgia rheumatica affects around 1 in 1,200 people over 50 each year, and almost never anybody younger.

It causes sudden, severe pain and stiffness in the shoulders, neck and hips. People describe waking one morning unable to lift their arms or get out of bed, having been fine the week before.

The response to steroids is dramatic and diagnostically useful: most people are substantially better within days of starting prednisolone. A poor response should make everybody reconsider the diagnosis.

The reason this entry matters more than its prevalence suggests: PMR is closely linked with giant cell arteritis, inflammation of the arteries in the head. Untreated, giant cell arteritis causes sudden permanent blindness, and it does so quickly.

Signs you might notice

Severe stiffness and aching in both shoulders, and often both hips, coming on over days.

Morning stiffness lasting more than 45 minutes, and often several hours.

Difficulty raising arms, getting out of a chair or bed, or turning over at night.

Fatigue, low-grade fever, weight loss, low mood.

Giant cell arteritis warning signs: a new headache, scalp tenderness particularly when combing hair, jaw pain when chewing, and any visual change. Those need treatment the same day.

How it can affect day-to-day life

Treatment is a long course of steroids, tapered over one to two years, and steroid side effects become the main day-to-day problem: bone loss, raised glucose, weight gain, thin skin, mood change and infection risk.

Bone protection should be started at the same time as the steroids and frequently is not. See osteoporosis.

Relapses during tapering are common and do not mean failure.

Never stop steroids abruptly; the adrenal glands need time to recover. See Addison's disease for why this matters.

Supporting someone well

Learn the giant cell arteritis warning signs and treat them as an emergency. New headache, jaw pain on chewing, scalp tenderness or visual change means same-day treatment, and treatment should start before the biopsy.

Start bone protection with the steroids, not later.

Carry a steroid card, and never stop steroids suddenly.

Monitor glucose and blood pressure during treatment.

Keep active; gentle exercise maintains muscle during long steroid courses.

Expect a slow taper and do not rush it. Relapse is common if reduced too quickly.

Where to get help

A GP can diagnose and treat PMR, and should refer to rheumatology if the response is atypical.

Any suspicion of giant cell arteritis needs same-day treatment and urgent referral. Visual loss is irreversible.

PMRGCAuk provide support and information.