Dr. Abhijeet Bhosikar
Inflammatory Arthritis

Polymyalgia Rheumatica — Treatment in Pune

Also known as: PMR

Sudden shoulder and hip stiffness after 50 that responds to steroids within days.

Book a consultationCall +91 70571 19999

What is Polymyalgia Rheumatica?

Polymyalgia rheumatica causes marked pain and stiffness of the shoulder and hip girdles, almost always in people over 50 and typically over 65. Onset is often strikingly abrupt — patients can name the week it began.

It closely overlaps with giant cell arteritis: roughly 15% of PMR patients develop GCA, and about half of GCA patients have PMR symptoms. Every PMR patient is therefore screened for headache and visual symptoms at every visit.

The response to low-dose steroids is usually dramatic, often within 72 hours. A poor response should trigger a serious rethink of the diagnosis rather than a dose increase.

Two older adults walking together along a garden pathIllustrative
150 minutes of low-impact activity a week protects both joints and heart.

Symptoms of Polymyalgia Rheumatica

Early signs

  • Aching and stiffness in both shoulders, upper arms, neck, hips and thighs
  • Severe morning stiffness lasting more than 45 minutes
  • Difficulty raising the arms to comb hair, or getting out of bed and low chairs
  • Fatigue, low-grade fever, poor appetite and weight loss
  • Markedly elevated ESR and CRP

If left untreated

  • Shoulder capsule inflammation with restricted movement
  • Peripheral joint swelling and carpal tunnel syndrome
  • Depression and disturbed sleep from unrelieved pain
  • Steroid complications when treatment is prolonged without monitoring
  • Development of giant cell arteritis features

Causes & risk factors

  • Age over 50, with incidence rising steeply with each decade
  • Genetic factors including HLA-DRB1*04 associations
  • Possible seasonal or infective triggers
  • Female sex — roughly twice as common in women
  • Underlying large-vessel inflammation demonstrable on PET in many patients

How Polymyalgia Rheumatica is diagnosed

No single test diagnoses a rheumatic disease. The diagnosis comes from combining the pattern of symptoms, the examination findings, and only the investigations that answer a specific question.

  1. Clinical pattern recognition

    Age over 50, bilateral shoulder or hip girdle pain, morning stiffness over 45 minutes and raised inflammatory markers form the core of the diagnosis.

  2. ESR and CRP

    Usually significantly elevated. A small subset has normal markers, which makes careful exclusion of alternatives even more important.

  3. Systematic exclusion of mimics

    Late-onset rheumatoid arthritis, hypothyroidism, statin myopathy, multiple myeloma, malignancy and infection are all actively ruled out — CPK, protein electrophoresis, thyroid function and imaging as needed.

  4. Shoulder and hip ultrasound

    Subacromial bursitis, biceps tenosynovitis and hip bursitis support the diagnosis objectively.

  5. Giant cell arteritis screening

    Direct questioning about headache, scalp tenderness, jaw claudication and visual symptoms at every single visit — this is what prevents avoidable blindness.

Treatment options

Low-dose prednisolone

Usually 12.5–25 mg daily. A rapid, near-complete response within a week is expected and is itself part of confirming the diagnosis.

Structured, slow taper

Reduction over 12–24 months guided by symptoms and CRP. Tapering too quickly is the commonest cause of relapse and of unnecessarily prolonged total treatment.

Methotrexate as a steroid-sparing agent

Added for relapsing disease, or where diabetes, osteoporosis or glaucoma make steroid exposure especially risky.

Tocilizumab

Considered in refractory PMR and established in GCA, allowing substantially lower cumulative steroid doses.

Mandatory bone and metabolic protection

Calcium, vitamin D, DEXA and a bisphosphonate where indicated, plus blood sugar, blood pressure and eye monitoring from day one of steroids.

Seek urgent medical attention if you have

  • New headache, scalp tenderness or jaw pain on chewing — possible giant cell arteritis
  • Any visual disturbance, even brief — treat as an emergency
  • Poor or absent response to an adequate steroid dose within a week
  • Weight loss, night sweats or bone pain suggesting malignancy
  • Progressive proximal weakness rather than pain-limited weakness (myositis)

Do not wait for a scheduled appointment for any of the above. Call the clinic on +91 70571 19999 or attend the nearest emergency department.

Frequently asked questions about Polymyalgia Rheumatica

How long will I need steroids?
Most patients need treatment for one to two years with a gradual taper. Some relapse and need longer. Attempting a fast taper to get off steroids quickly reliably backfires and usually extends total treatment time.
Is PMR the same as fibromyalgia?
No. PMR occurs after 50, is confined to the shoulder and hip girdles, raises inflammatory markers, and responds dramatically to steroids. Fibromyalgia is widespread, has normal inflammatory markers, and does not respond to steroids at all.
Why do I keep being asked about headaches?
Because giant cell arteritis develops in a meaningful minority of PMR patients and can cause permanent blindness within days. Asking at every visit is a deliberate safety net.

Get an expert opinion on Polymyalgia Rheumatica in Pune

Consultations at the Ravet clinic in Pimpri-Chinchwad. Bring your previous reports — a properly reviewed history usually saves repeating tests.

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Part of a wider group

Inflammatory ArthritisJoint swelling that is driven by the immune system, not by wear.

Related conditions

  • Vasculitis

    Inflammation of blood vessels — where days of delay can cost sight, kidneys or life.

  • Rheumatoid Arthritis

    Symmetric small-joint swelling that responds best when treated within the first 12 weeks.

  • Osteoporosis

    Silent until the first fracture — which is exactly why it should be screened for, not waited for.

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