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Polymyalgia Rheumatica (PMR) &
Giant Cell Arteritis (Temporal Arteritis)

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Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What is polymyalgia rheumatica?

Polymyalgia rheumatica (PMR) is a disorder of the muscles and joints characterized by pain and stiffness, affecting both sides of the body, and involving the shoulders, arms, neck, and buttock areas. Patients with polymyalgia rheumatica are typically over the age of 50 years.

What causes polymyalgia rheumatica?

The cause of polymyalgia rheumatica is not known. Recent research has indicated that genetic (inherited) factors play a role in who becomes afflicted with the illness. Theories have included viral stimulation of the immune system in genetically susceptible individuals. Rarely, polymyalgia rheumatica is associated with a cancer. In this setting, the cancer may be initiating an inflammatory immune response to cause the polymyalgia rheumatica symptoms.

What are symptoms of polymyalgia rheumatica?

The onset of the illness can be sudden. A patient may have a healthy history until awakening one morning with stiffness and pain of muscles and joints throughout the body. These symptoms persist and are often accompanied by an intense sensation of fatigue. Some patients notice a gradual loss of appetite, weight, and energy. Depression can occur.

How is polymyalgia rheumatica diagnosed?

The doctor frequently notes muscle tenderness and that the motion of the shoulders is limited by pain. The joints are usually not swollen. However, swelling of the small joints of the hands, wrists, and/or knees can occur. Blood testing for inflammation is generally abnormal, as indicated by a significant elevation in the erythrocyte sedimentation rate (ESR) and/or C-reactive protein. There are no specific tests, however, for polymyalgia rheumatica and X-rays are normal. The diagnosis is based on the characteristic history of persisting muscle and joint pain and stiffness associated with elevated blood tests for inflammation, such as the ESR. It is also not unusual for patients to have slight elevations of liver blood tests.