Polymyalgia rheumatica — PMR for short, literally “pain in many muscles” — is an inflammatory rheumatic condition that mainly affects the bursae, tendon sheaths and joint capsules around the shoulders and hips. Despite the name, it is not the muscles themselves that are inflamed: the symptoms arise in the surrounding soft tissue.¹
What is characteristic is the onset. Many people can name the day it started: overnight, getting up becomes a struggle, putting on a jacket impossible, rising out of an armchair something you manage only with your arms. That sheer force of onset is what sets PMR apart from slowly creeping osteoarthritis.
Normal or abnormal? Being stiff for a few minutes in the morning is an everyday experience. Stiffness that lasts longer than about 45 minutes, affects both sides and comes with night pain, on the other hand, needs assessing — particularly beyond the age of 50.
The good news: PMR usually responds impressively to steroids within a few days. The less good news: treatment runs for months to years, and the way out is more demanding than the way in.
2. The dangerous sibling: giant cell arteritis
PMR and giant cell arteritis (formerly “temporal arteritis”) belong to the same disease spectrum. In giant cell arteritis, medium-sized arteries are inflamed — above all in the head. Some people with PMR go on to develop such a vessel inflammation as well, and the other way round.¹,²
These signs are an emergency. New, unfamiliar headache around the temples, pain when chewing, a temporal artery that is tender or hardened, and above all visual disturbances or sudden loss of vision in one eye. Giant cell arteritis may lie behind this, and left untreated it can lead to blindness. This is not a situation for waiting — see your practice or an emergency department the same day, and immediately if you lose vision.
That is why asking about these warning signs is part of every PMR review — at every appointment, not just at the start.
3. Symptoms and consequences
The typical symptoms
Pain in both shoulders — the first symptom for most people; it often radiates into the upper arms. The article on shoulder pain helps with telling the causes apart.
Pelvic girdle and thigh pain — climbing stairs and getting up from a chair turn into hurdles.
Pronounced morning stiffness — typically well beyond 45 minutes, often one to two hours.
Night pain — turning over in bed wakes you; the result is disturbed sleep.
General symptoms — feeling run down, fatigue, a slight fever, weight loss, low mood.
Possible consequences
Left untreated, PMR restricts independence severely — dressing, combing your hair, driving. On top of that comes muscle loss from inactivity, which makes the symptoms worse again. Some of the consequences, though, arise not from the condition but from the treatment: months of steroid therapy raise the risk of osteoporosis, of raised blood sugar and of infections, among other things. That is precisely why dose and duration have to be steered so carefully.
4. Causes and risk factors
Why the immune system suddenly turns on the tissue around the large joints is, according to current knowledge, not understood. An interplay of genetic predisposition, ageing of the immune system and possibly preceding infections is under discussion. So far, only two factors are firmly established:
Age — before the age of 50 the diagnosis is a rarity; that is a key distinguishing feature.
Sex — women are affected more often than men.
Medicines as a source of confusion. Muscle pain and weakness can also be caused by medicines — this is well documented for statins such as simvastatin or atorvastatin. An underactive thyroid produces similar complaints too. So bring a complete list of your medicines to the appointment — it saves detours.
5. Diagnosis: why there is no single test
There is no laboratory test that proves PMR. The diagnosis emerges from the overall picture — and from the fact that other causes have been ruled out.
History: how it started, which sides are affected, how long the morning stiffness lasts, night pain, general symptoms — and specifically the warning signs of giant cell arteritis.
Examination: mobility of the shoulders and hips, tenderness, ruling out joint swelling that would point more towards rheumatoid arthritis.
Inflammatory markers: ESR and CRP are usually clearly raised — in rare cases they are normal, which does not rule the diagnosis out. Context in the guide Understanding blood values.
Further laboratory tests: among others full blood count, kidney and liver values, muscle enzymes, thyroid values and rheumatoid factors — above all to rule out other causes.
Imaging: ultrasound of the shoulders and hips shows typical signs of inflammation; where vessel involvement is suspected, targeted imaging of the arteries is added.
One detail matters a great deal in practice: a rapid response to steroids counts as an important clue. If symptoms do not improve markedly within a few days, the diagnosis is usually reconsidered — other conditions then come into play, such as fibromyalgia or a thyroid disorder.
6. Treatment: steroids at a low dose
PMR is treated with glucocorticoids — and at considerably lower doses than many people fear. The aim is the lowest dose that keeps the symptoms under control, for the shortest possible time. The specific dose is always set by your treating practice.²
First lineSteroids — getting symptoms under control quickly
Prednisolone (or an equivalent glucocorticoid)
Started at a low dose, according to guideline recommendations in the range of a few milligrams up to a maximum of around 25 mg a day. The effect usually sets in within days. It is normally taken in the morning, because that matches the body's own cortisol rhythm.
Movement and physiotherapy
As soon as the pain eases: work deliberately against muscle loss. This is not an optional extra — muscle mass protects against falls and stabilises the joints.
Second lineWhen the dose will not come down
Methotrexate as a steroid sparer
Comes into consideration where there are repeated relapses, where tapering does not succeed, or where there is a high risk of steroid side effects — for instance with diabetes or osteoporosis. It is usually taken once a week, accompanied by folic acid.
Further options
In difficult cases, targeted therapies may be an option at specialist centres. That decision belongs in rheumatological hands.
Important for context. Non-steroidal painkillers such as ibuprofen are, according to current knowledge, considerably less effective than steroids in PMR and are no long-term solution — not least because in older people they put a strain on the stomach, the kidneys and blood pressure.
7. Medicines and the protection that goes with them
With PMR it is especially true that treatment involves more than the one medicine. Because steroids are taken over months, what else they do in the body is thought through from the outset.
The main medicine
Prednisolone is the glucocorticoid used most often. The basics on how it works, its side effects and living with it day to day are set out in our cortisone guide.
The protection that goes alongside
Bones: calcium and vitamin D are usually part of the package; where risk is raised, a bisphosphonate such as alendronic acid is added. A bone density scan is often arranged.
Stomach: an acid blocker such as pantoprazole is added above all when painkillers are needed as well or other risk factors are present.
Blood sugar: steroids push blood sugar up. Where diabetes already exists, monitoring becomes closer — see Measuring blood sugar correctly.
Blood pressure and weight: both often rise during longer steroid treatment and are therefore tracked as well.
Eyes: with long-term treatment, eye checks are recommended, among other reasons because of cataract and glaucoma.
The steroid emergency card. Anyone taking steroids over a longer period should be able to prove it in an emergency. With a fever, an accident or an operation the body temporarily needs more steroid, because its own production is suppressed. Ask actively about a steroid card — and keep your medication list current, as described under Keeping a medication list.
Six products, one plan
Steroids, bone protection, stomach protection — brite keeps the times and doses together.
Starting steroid treatment is unspectacular — it works quickly and it works well. The art lies in coming off it. As a rule that stretches over many months to more than a year, and it frequently fails when the dose is brought down too quickly.
Stabilise first. Reduction usually only begins once symptoms have been under control for several weeks.
Come down in small steps. The lower the dose, the smaller the steps and the longer the intervals between them. The last few milligrams are the hardest.
Write your symptoms down. After each reduction, pay deliberate attention for a few days: is the morning stiffness coming back? The night pain?
Plan for relapses. A flare-up is common and is not a failure. As a rule the dose then goes back briefly to the one that worked before, and reduction starts again more slowly.
Never stop abruptly. After longer use, the adrenal cortex needs time to bring its own production back up.
Never stop steroids on your own. A sudden stop after longer use can trigger a life-threatening adrenal crisis — with weakness, nausea, a drop in blood pressure and confusion. What safe tapering looks like is described in the guide Stopping cortisone; the general principles are covered under Stopping medications. If an adrenal crisis is suspected, call 112 (emergency services in Germany) immediately.
One thing that has proved its worth in practice is putting the tapering plan in writing: which dose from which date, when the next review is due, and how you would recognise a relapse. That is where things most often come unstuck in everyday life — not at the medical concept, but at carrying it through over twelve months.
9. Everyday life with polymyalgia rheumatica
Allow time in the morning — the stiffness is at its worst early on. A warm shower before breakfast often makes the start of the day easier.
Hold on to your muscles — light strength training and walks work against the loss caused by steroids and inactivity. Pointers in the guide Medications and exercise.
Defuse the trip hazards — loose rugs, poor lighting, missing grab rails. On steroids, every fall you prevent counts double.
Take infections seriously — steroids dampen the immune system and can mask a fever. If you feel unwell for any length of time, better to ring once too early.
Prepare for appointments — note down your dose history, your symptoms and your questions. The guide Prepare for a doctor's appointment gives you a structure.
Because several medicines often come together in this age group anyway, it is also worth a look at Polypharmacy and Medications in old age — interactions with painkillers and blood pressure tablets in particular are easily overlooked.
A relapse or a normal fluctuation?
A documented course answers exactly that question at your appointment.
FAQ: Common questions about polymyalgia rheumatica
As a rule for many months, often one to two years. The dose is brought down step by step rather than stopped suddenly. How quickly it can be reduced depends on how the condition behaves and is decided by your treating practice.
In many people the condition burns itself out after one to two years and the steroids can be stopped completely. In others it lasts longer or comes back. A permanent cure cannot be guaranteed, but good control of the symptoms can usually be achieved.
That is typical. The inflammation in polymyalgia rheumatica responds far less well to ordinary painkillers than it does to steroids. This very difference is in fact a diagnostic clue — high doses of painkillers over the long term are not the answer here.
Usually the old symptoms return: pain in both shoulders or hips and, above all, the long morning stiffness, often a few days to weeks after a dose reduction. Report this to your practice rather than putting the dose back up yourself.
With treatment lasting several months, basic cover with calcium and vitamin D is usually recommended, often together with a bone density scan. Whether a bisphosphonate makes sense in addition depends on your individual risk.
Polymyalgia rheumatica and giant cell arteritis belong to the same disease spectrum, and some people develop both. New headache around the temples, pain when chewing or visual disturbances therefore have to be assessed immediately — untreated, there is a risk of blindness.
Yes, and it is expressly encouraged as soon as the pain eases. Moderate strength and endurance training counteracts the muscle loss caused by steroids and inactivity. Start gently and build up slowly, ideally with guidance from a physiotherapist.
Weight gain and increased appetite are among the known effects, but they depend on the dose and are often moderate at the low doses used in PMR. Regular movement and mindful eating make a noticeable difference. Do raise any marked weight gain at your practice.
NHS: Polymyalgia rheumatica and giant cell arteritis. Accessed 2026. nhs.uk
German guideline on the management of polymyalgia rheumatica (German Society for Rheumatology) together with the joint EULAR/ACR recommendations. awmf.org
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. Never stop steroids on your own and do not change the dose yourself — after longer use, an abrupt stop can trigger a life-threatening adrenal crisis. New headache around the temples, pain when chewing or visual disturbances require immediate medical assessment, because untreated giant cell arteritis can lead to blindness. The choice of medicine and the dose are always determined individually by your treating practice. Last updated: August 2026.
