PMR, or polymyalgia rheumatica, is an inflammatory condition that causes moderate to severe pain and stiffness in the shoulders, hips, and neck. It almost exclusively affects people over age 50, with the average age of diagnosis around 74. The stiffness is typically worst in the morning or after sitting still for a while, and it tends to affect both sides of the body at the same time.
How PMR Feels
The hallmark of PMR is bilateral pain, meaning it hits both shoulders or both hips rather than just one side. Most people notice aching in the shoulders first, often spreading to the upper arms, neck, buttocks, and thighs. The stiffness can be severe enough to make everyday tasks difficult: reaching overhead, getting out of a chair, or climbing stairs may suddenly feel like a struggle. Some people also develop pain in their wrists, elbows, or knees, though this is less common.
Symptoms can appear suddenly, sometimes within days, or build gradually over a few weeks. Morning stiffness is the defining feature. Many people describe feeling “locked up” when they wake, with the stiffness easing somewhat as the day goes on and they move around. Fatigue, low-grade fever, and a general sense of feeling unwell often accompany the joint and muscle symptoms.
What Causes the Inflammation
PMR is driven by an overactive immune response that targets the soft tissues around joints, particularly the fluid-filled sacs (bursae) that cushion the shoulders and hips. Immune cells flood these areas and release inflammatory signaling molecules, especially one called IL-6. This creates a feedback loop: IL-6 triggers more inflammation, which produces more IL-6, driving the pain and stiffness higher.
IL-6 doesn’t just cause joint symptoms. It also disrupts the body’s stress-response system and interferes with pain-processing pathways in the brain. This helps explain why PMR often comes with sleep problems, fatigue, mood changes, and a widespread feeling of pain that seems out of proportion to what’s happening in any single joint.
Who Gets PMR
PMR is one of the most common inflammatory conditions in older adults. The annual incidence is roughly 64 per 100,000 people aged 50 and older. About 64% of those diagnosed are women. It’s more prevalent in people of Northern European descent, though it occurs across all ethnic groups. The condition is virtually unheard of in people under 50, and most diagnoses happen in the early to mid-70s.
How It’s Diagnosed
There is no single blood test that confirms PMR. Diagnosis is based on the pattern of symptoms combined with blood markers showing elevated inflammation, particularly ESR (a measure of how quickly red blood cells settle in a tube) and CRP (a protein the liver produces during inflammation). Both are typically elevated in active PMR.
Ultrasound has become increasingly useful for supporting the diagnosis. In one large study, about 78% of PMR patients had inflammation of the biceps tendon sheath in the shoulder, roughly 59% had bursitis beneath the shoulder muscle, and around 58% had fluid or swelling in the shoulder joint itself. Hip bursitis appeared in about 26% of cases. These imaging findings help distinguish PMR from other conditions that cause similar symptoms.
One important distinction is between PMR and late-onset rheumatoid arthritis, which can look nearly identical in the early stages. Specific antibodies found in rheumatoid arthritis (RF and anti-CCP) are rarely present in PMR. If those antibodies show up positive, the diagnosis is more likely rheumatoid arthritis, which requires different treatment.
The Link to Giant Cell Arteritis
PMR and giant cell arteritis (GCA), a condition that inflames the blood vessels in the head and temples, are closely related. Roughly 23 to 29% of people newly diagnosed with PMR have subclinical GCA, meaning the blood vessel inflammation is present but hasn’t caused obvious symptoms yet. Watch for new headaches, scalp tenderness, jaw pain while chewing, or any changes in vision. These symptoms need urgent medical attention because untreated GCA can lead to permanent vision loss.
Treatment With Corticosteroids
Low-dose corticosteroids are the primary treatment, and the response is often dramatic. Most guidelines recommend starting at 15 to 20 mg of prednisone daily. In one study of PMR patients, the average time to clinical remission after starting treatment was about a week, with most people experiencing at least a 75% improvement in symptoms. Some people feel significantly better within just a day or two. This rapid, near-complete response to a low steroid dose is actually one of the ways doctors confirm the diagnosis. If the improvement is minimal, it raises questions about whether something else is going on.
Once symptoms are controlled, the dose is gradually tapered over months. Many people are able to stop prednisone after about one to two years, but the tapering process requires patience. Relapses are common, occurring in up to 67% of patients who try to discontinue steroids, and some estimates put the overall relapse rate as high as 76%. Flares usually mean temporarily increasing the dose and then tapering more slowly.
Side Effects of Long-Term Steroids
Because treatment often lasts a year or more, the side effects of corticosteroids become a real concern. Weight gain, thinning skin, elevated blood sugar, bone loss, and mood changes are all well-documented consequences. Up to 85% of patients on long-term steroids experience some degree of side effects. Your doctor will likely monitor your bone density and blood sugar throughout treatment.
Calcium and vitamin D supplementation is standard practice to protect bones during steroid use. Many people with PMR also find that staying physically active helps manage both the disease and the medication side effects. Walking regularly, even when stiffness makes it tempting to stay still, can help maintain muscle strength, manage weight, and support mood.
Diet and Lifestyle During Treatment
While no specific diet has been proven to treat PMR in clinical trials, many patients report meaningful benefits from reducing sugar, processed foods, and alcohol while on steroids. An anti-inflammatory eating pattern, heavy on vegetables, fruits, whole grains, fish, and olive oil, may help control inflammation and counteract some of the metabolic effects of prednisone like weight gain and blood sugar spikes.
Some people notice that specific foods seem to trigger flares. Nightshade vegetables (tomatoes, peppers, potatoes, eggplant) and gluten are commonly reported triggers, though responses vary widely from person to person. Vitamin D supplementation is particularly important, both for bone health during steroid use and because many older adults are already deficient. Regular moderate exercise, even daily walking, helps maintain mobility, supports a gradual taper, and offsets the muscle-weakening effects of both the disease and the medication.