Journal Article

Polymyalgia Rheumatica

Matteson, Eric L., Dejaco, Christian

2026

Overview

Polymyalgia rheumatica is an inflammatory condition that affects persons older than 50 years of age and is characterized by pain in both shoulders with or without hip or neck pain (or both) and with pronounced morning stiffness. The condition is typically diagnosed on the basis of these hallmark symptoms along with elevated inflammation markers (erythrocyte sedimentation rate and C-reactive protein level) and the ruling out of other conditions including giant-cell arteritis. Glucocorticoids are the primary treatment, which provide rapid symptom relief. The initial dose, usually 12.5 to 25 mg of prednisone equivalent daily, is gradually reduced, ideally over 12 months or less, although the disease course varies and polymyalgia rheumatica may persist for a longer duration. Relapses are common and sometimes warrant the use of interleukin-6 receptor inhibitors or methotrexate to minimize glucocorticoid exposure. This review summarizes the diagnosis and management of polymyalgia rheumatica in adults older than 50 years of age, emphasizing clinical diagnosis, glucocorticoids as first-line therapy, relapses, and glucocorticoid-sparing options.

• Publisher: Massachusetts Medical Society
• Subject: Age / Aged / Aged, 80 and over / Aging / Aging General / Allergy / Antibodies, Monoclonal, Humanized - administration & dosage / Arteritis / Arthritis, Rheumatoid - blood / Arthritis, Rheumatoid - diagnosis / Autoimmune Disease / Blood Sedimentation / C-reactive protein / C-Reactive Protein - analysis / Chondrocalcinosis / Chondrocalcinosis - blood / Chondrocalcinosis - diagnosis / Clinical Medicine / Clinical Medicine General / Diabetes / Diagnosis / Diagnosis, Differential / Disease / Dose-Response Relationship, Drug / Drug Tapering / Drug Therapy, Combination - methods / Edema / Erythrocyte sedimentation rate / Geriatrics / Giant Cell Arteritis - blood / Giant Cell Arteritis - diagnosis / Glucocorticoids / Glucocorticoids - administration & dosage / Hip / Humans / Immunology / Immunology General / Inflammatory Disease / Interleukin 6 / Medical diagnosis / Medical treatment / Methotrexate / Methotrexate - administration & dosage / Middle Aged / Myalgia - blood / Myalgia - diagnosis / Myalgia - drug therapy / Myalgia - immunology / Osteoarthritis / Outpatient-Based Clinical Medicine / Pain / Patients / Polymyalgia rheumatica / Polymyalgia Rheumatica - blood / Polymyalgia Rheumatica - diagnosis / Polymyalgia Rheumatica - drug therapy / Polymyalgia Rheumatica - immunology / Prednisone / Prednisone - administration & dosage / Prednisone - therapeutic use / Receptors, Interleukin-6 - antagonists & inhibitors / Recurrence / Remission (Medicine) / Rheumatoid arthritis / Rheumatology / Rheumatology General / T-Cells / Tomography / Treatment Outcome / Vasculitis