The most common symptom of polymyalgia rheumatica (PMR) is pain and stiffness in the shoulder muscles, which develops quickly over a few days or weeks.

You may also have pain in your neck and hips. Both sides of the body are usually affected.

The stiffness is often worse first thing in the morning after you wake up. It starts to improve after about 45 minutes as you become more active.

Some people with polymyalgia rheumatica also:

• feel very tired
• lose their appetite
• lose weight
• have depression

When to get medical advice

See a GP if you have pain and stiffness that lasts longer than a week. They'll investigate the cause.

When to get immediate medical advice

Contact a GP immediately, use NHS 111 or go to your nearest urgent care service if you've been diagnosed with polymyalgia rheumatica (or it's suspected) and you suddenly have:

• a severe headache that does not go away
• pain or cramping in your jaw muscles that's worse when eating
• pain in your tongue when chewing 
• vision loss or vision disturbances, such as double vision

These symptoms may indicate a more serious condition called temporal arteritis.

Diagnosing polymyalgia rheumatica (PMR) can often be quite a lengthy process involving several different tests.

This is because it shares many symptoms with more common health conditions such as rheumatoid arthritis, which need to be ruled out first.

Tests

There's no specific test for polymyalgia rheumatica, but it's likely that a series of blood tests will be done.

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are blood tests that can be used to check the levels of inflammation in your body.

If ESR and CRP are normal, it’s unlikely that polymyalgia rheumatica will be diagnosed.

Sometimes, ESR may be normal and CRP may be raised, which is more likely to indicate polymyalgia rheumatica. This is why both tests are usually done at the same time.

As inflammation is a feature of many conditions, high levels do not automatically mean you have polymyalgia rheumatica.

Further tests may be needed to help rule out other conditions that cause inflammation. For example, a test for rheumatoid factor and anti-CCP antibodies may be done to rule out rheumatoid arthritis.

Blood tests can also help determine:

• whether you have a blood infection
• how well your organs, such as your kidneys, are working
• if you have an overactive thyroid gland or an underactive thyroid gland – both conditions can cause muscle pain

You may have a urine test to check how well your kidneys are functioning.

X-rays and ultrasound scans may also be used to look at the condition of your bones and joints.

Symptom checklist

After ruling out other possible causes of your symptoms, a checklist can be used to see if your symptoms match those most commonly associated with polymyalgia rheumatica.

Polymyalgia rheumatica can usually be confidently diagnosed if you meet all of the following criteria:

• you're over 50 years of age 
• you have pain in your shoulders or hips
• you have stiffness in the morning that lasts longer than 45 minutes
• your symptoms have lasted for more than 2 weeks
• blood tests show raised levels of inflammation in your body
• your symptoms rapidly improve after treatment with corticosteroids

Read more about treating polymyalgia rheumatica.

Steroid medicine is the main treatment for polymyalgia rheumatica (PMR).

A type of corticosteroid called prednisolone is usually prescribed.

Prednisolone

Prednisolone works by blocking the effects of certain chemicals that cause inflammation inside your body. It does not cure polymyalgia rheumatica, but it can help relieve the symptoms.

When used to treat polymyalgia rheumatica, prednisolone is taken as a tablet. Most people will be prescribed several tablets to take once a day.

To start with, you may be prescribed a moderate dose of prednisolone. The dose will gradually be reduced every 1 to 2 months.

Although your symptoms should improve within a few days of starting treatment, you'll probably need to continue taking a low dose of prednisolone for about 2 years.

Polymyalgia rheumatica often improves on its own after this time. However, there's a chance it will return after treatment stops. This is known as a relapse.

Do not suddenly stop taking steroid medicine unless your doctor tells you it's safe to stop. Suddenly stopping treatment with steroids can make you very unwell.

Side effects of prednisolone

About 1 in 20 people experience changes in their mental state when they take prednisolone.

You may feel depressed and suicidal, anxious or confused. Some people also have hallucinations, (seeing or hearing things that are not there).

Contact a GP as soon as possible if you experience changes to your mental state. 

Other side effects of prednisolone include:

• increased appetite, which often leads to weight gain
• high blood pressure 
• mood changes, such as becoming aggressive or irritable with people
• weakening of the bones (osteoporosis)
• stomach ulcers 
• increased risk of infection, particularly with the varicella-zoster virus, which is the virus that causes chickenpox and shingles 

Get immediate medical advice if you think you've been exposed to the varicella-zoster virus or if a member of your household develops chickenpox or shingles.

The risk of these side effects should improve as your dose of prednisolone is reduced.

Find out more about the side effects of steroid tablets.

Other medicines

Sometimes other medicines may be combined with corticosteroids to help prevent relapses or allow your dose of prednisolone to be reduced.

Some people are prescribed immunosuppressant medicine, such as methotrexate. It's used to suppress the immune system, the body's defence against infection and illness.

It may help people with polymyalgia rheumatica who have frequent relapses or do not respond to normal steroid treatment.

Your doctor may recommend painkillers, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), to help relieve your pain and stiffness while your dose of prednisolone is reduced.

Follow-up

You'll have regular follow-up appointments to check:

• how well you're responding to treatment
• if your dose of prednisolone needs to be adjusted
• how well you're coping with any side effects

During these appointments, you'll have blood tests to check the levels of inflammation inside your body.

Follow-up appointments are usually recommended every few weeks for the first 3 months, and then every 3 to 6 months after this time.

Contact a GP if your symptoms return during any part of your treatment. Your dosage may need to be adjusted.

Steroid card

If you need to take steroids for longer than 3 weeks, your GP or pharmacist should arrange for you to be given a steroid card.

The card explains that you're regularly taking steroids and your dose should not be stopped suddenly. Carry the card with you at all times.