Medicines for Polymyalgia rheumatica

What it is

Polymyalgia rheumatica, usually shortened to PMR, is an inflammatory condition that almost always affects people over the age of fifty and becomes more common with age. Its hallmark is pain and pronounced stiffness on both sides of the body across the shoulder and hip girdles — the muscles around the upper arms, neck, shoulders, lower back, hips and thighs. The stiffness is typically worst first thing in the morning or after sitting still, and can make everyday actions such as getting out of bed, raising the arms or rising from a chair difficult. People often feel generally unwell, tired or low, and blood tests usually show raised inflammatory markers. PMR is closely linked to giant cell (temporal) arteritis, an inflammation of the arteries of the head and scalp, and the two conditions can occur together, so recognising the warning signs of arteritis is an essential part of looking after anyone with PMR.

How it is treated

The cornerstone of treatment is a corticosteroid (a steroid), which is the mainstay of care because PMR responds to it so quickly and completely — many people feel dramatically better within days, and this strong response helps confirm the diagnosis. Once symptoms are controlled, the steroid is not stopped suddenly but reduced very gradually, in small steps, often over a period of one to two years or sometimes longer, guided by how the person feels and by inflammatory markers. The aim is to use the smallest amount that keeps symptoms away while tapering as the condition settles. Because steroids taken over months carry their own risks, treatment is paired with measures to protect the bones and with monitoring of blood pressure, blood sugar and weight. It is important never to stop a steroid abruptly, as the body needs time to adjust. Throughout, clinicians stay alert for any features suggesting giant cell arteritis, which changes management urgently.