Quick answer. Polymyalgia rheumatica is an inflammatory condition in older adults that causes pain and stiffness in the shoulders and hips, typically worst in the morning. It usually responds quickly to low-dose steroids, but new severe headache, jaw pain on chewing or vision changes are an emergency, as they can signal a linked condition that threatens sight.
Polymyalgia rheumatica (often shortened to PMR) is an inflammatory condition that causes pain and stiffness, mainly in the shoulders, neck and hips. It almost always affects people over the age of 50 and becomes more common with age. The stiffness is typically worst in the morning or after rest, and can make everyday tasks like dressing or getting out of bed difficult. The reassuring news is that PMR usually responds well, and often dramatically, to low-dose steroid treatment.
This guide explains what polymyalgia rheumatica is, its symptoms, why it happens, how it is diagnosed and treated in Singapore, and the important warning signs of a closely linked condition called giant cell arteritis, which can threaten vision and needs urgent treatment. If you are an older adult with new shoulder and hip stiffness that is worse in the mornings, it is worth seeing a doctor for assessment.
At a glance
| Feature | Typical of PMR | Needs urgent attention |
|---|---|---|
| Main symptom | Pain and stiffness in shoulders, neck and hips | New severe headache or scalp tenderness |
| Timing | Stiffness worst in the morning or after rest | Sudden vision changes or loss of vision |
| Age group | Usually over 50, more common with age | Jaw pain or fatigue when chewing |
| Response to treatment | Often improves quickly on low-dose steroids | Symptoms of giant cell arteritis (see below) |
| General | May have tiredness or low-grade fever | Feeling very unwell with the above signs |
What is polymyalgia rheumatica?
Polymyalgia rheumatica is an inflammatory condition that causes pain and stiffness in the muscles around the shoulders, neck and hips. The word itself means ‘pain in many muscles’. It is caused by inflammation rather than by damage to the muscles, which is why it tends to respond so well to anti-inflammatory steroid treatment.
It almost exclusively affects older adults, typically those over 50, and is more common with increasing age and slightly more common in women. The cause is not fully understood, but it is thought to involve the immune system. PMR is closely linked to another condition called giant cell arteritis (also known as temporal arteritis), which involves inflammation of blood vessels and can affect vision – this connection is important and is covered in the final section.
Symptoms & signs
The main features of polymyalgia rheumatica are:
- Pain and stiffness in the shoulders, often on both sides, and frequently in the neck and hips
- Stiffness that is worst in the morning or after sitting still, often lasting more than 45 minutes to an hour
- Difficulty with everyday movements such as raising the arms, dressing, or getting up from a chair or bed
- The symptoms often come on fairly quickly, over days to a couple of weeks
- Tiredness, a general feeling of being unwell, mild fever, reduced appetite or low mood in some people
The pain is usually felt in the muscles rather than the joints themselves, although it can be hard to tell the difference. It typically affects both sides of the body.
Causes & risk factors
The exact cause of polymyalgia rheumatica is not known, but it is thought to result from the immune system causing inflammation. The main risk factors are:
- Age – it almost always affects people over 50, and the risk rises with age
- Sex – it is somewhat more common in women
- A possible role of genetic and environmental factors
It is not caused by anything you have done, and it is not a result of overuse or wear and tear. It is also separate from ordinary muscle aches and from arthritis, although a doctor will consider those when making the diagnosis. There is no way to prevent it, but it is very treatable.
How it's diagnosed
There is no single test that confirms polymyalgia rheumatica, so doctors diagnose it from the pattern of symptoms together with some tests. A doctor will ask about your symptoms – particularly the shoulder and hip stiffness that is worse in the mornings – and examine you.
- Blood tests for inflammation, such as the ESR and CRP, are usually raised in PMR and support the diagnosis
- Other blood tests help rule out conditions that can mimic PMR, such as other forms of arthritis or thyroid problems
- A good and rapid response to steroid treatment also helps confirm the diagnosis
Because the symptoms can overlap with other conditions, a careful assessment matters. The doctor will also ask about any headache, jaw or vision symptoms to check for giant cell arteritis.
Treatment options
Polymyalgia rheumatica is treated with steroids, usually a low dose of prednisolone. The response is often striking, with many people feeling much better within a few days of starting treatment. Key points about treatment include:
- The steroid dose is gradually reduced over many months, guided by your symptoms and blood tests; most people need treatment for one to two years or sometimes longer
- It is important not to stop steroids suddenly – they must be tapered under medical supervision
- Because long-term steroids can affect the bones and other systems, your doctor may recommend measures to protect bone health and monitor for side effects
- Simple measures such as gentle activity and pain relief can also help
With treatment, the outlook is generally good and many people make a full recovery, although it can take time and the dose needs careful adjustment. Follow your doctor’s instructions closely and attend follow-up appointments.
When to see a doctor & which specialist
See a doctor if you are over 50 and develop new pain and stiffness in your shoulders, neck or hips that is worse in the mornings, so it can be assessed and treated. Early treatment usually brings quick relief.
The most important warning is about giant cell arteritis, a condition closely linked to PMR. Seek urgent medical attention – the same day – if you develop a new, severe headache, tenderness of the scalp or temples, pain or fatigue in the jaw when chewing, or any change in your vision, including blurred vision, double vision or sudden loss of sight. These can be signs of giant cell arteritis, which is a sight-threatening emergency: untreated, it can cause permanent loss of vision, so it must be treated without delay. If you suddenly lose vision, go to A&E or call 995. For diagnosis and ongoing management of polymyalgia rheumatica, the specialist to see is a rheumatologist; you can find one through our directory of the best rheumatologists in Singapore.
Related guides
- Best Rheumatology Clinics in Singapore — our editorial shortlist
- rheumatology clinics directory
- Kidney cancer
- Roseola
- Baby reflux
- Scarlet fever
- Oral cancer
Sources
- NHS – Polymyalgia rheumatica
- Mayo Clinic – Polymyalgia rheumatica
- NHS – Giant cell arteritis (temporal arteritis)
- HealthHub Singapore – Diseases and conditions
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