Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized clinically by aching and morning stiffness in the shoulders, hip girdle, and neck . It can be associated with giant cell (temporal) arteritis (GCA), and the two disorders may represent different manifestations of a shared disease process.
PMR is two to three times more common than GCA. PMR occurs in about 50 percent of patients with GCA, while approximately 15 to 30 percent of patients with PMR eventually develop GCA [1,2]. Some patients have manifestations of both disorders occurring at different times.
The treatment of PMR will be reviewed here. Additional issues in PMR as well as the clinical manifestations, diagnosis, and treatment of GCA are discussed separately. (See "Clinical manifestations and diagnosis of polymyalgia rheumatica" and "Clinical manifestations of giant cell (temporal) arteritis" and "Diagnosis of giant cell (temporal) arteritis" and "Treatment of giant cell (temporal) arteritis".)
PMR is characterized by a prompt response to glucocorticoids, usually in low to moderate doses [1-3]. The initial dose of prednisone needed to alleviate musculoskeletal symptoms in PMR is lower than that required to control the vascular inflammation associated with GCA. (See "Treatment of giant cell (temporal) arteritis".)
General guidelines — We recommend treatment with glucocorticoids as initial therapy in patients diagnosed with PMR. The primary goal of therapy is the alleviation of symptoms. Therapy has not been shown to clearly improve prognosis or prevent progression to GCA. (See "Clinical manifestations and diagnosis of polymyalgia rheumatica".)