Polymyalgia Rheumatica

Painful stiffness across the shoulders, neck and hips that makes getting out of bed a struggle. It affects people over 50, mostly over 65. Steroid tablets usually work dramatically, within days.

Typical signs: pain and stiffness in both shoulders and upper arms, often the hips and thighs, worst in the morning and lasting more than 45 minutes. Tiredness, low appetite, weight loss and low mood are common. It usually comes on over days to weeks.

Why it happens: an inflammatory condition of the immune system. The cause isn’t known; genes and environment probably both play a part. It’s very rare under 50 and more common in women.

Diagnosis: there’s no single test. Your GP looks for the typical pattern, raised inflammation blood tests (ESR, CRP) and rules out look-alikes such as rheumatoid arthritis, thyroid problems, infections or cancer. A fast, clear response to steroids supports the diagnosis.

The PMR ladder

Steroids are the main treatment, usually for 1–2 years at a slowly falling dose. The other steps make that safer.

1. Step 1 · PrescriptionPrednisolone (steroid tablets)A moderate dose once a day, then reduced slowly, every month or two, as long as symptoms stay controlled.

   Works

   Symptoms usually improve within a few days, often dramatically

   Cost

   Under the $25 PBS co-payment

   How long

   Usually 1–2 years; don’t stop suddenly

   Watch for

   Mood or sleep changes (about 1 in 20 have mental side effects), raised blood sugar and blood pressure, weight gain, infections, thinner bones.

   Feeling 10 years younger in 3 days is the classic response. Don’t chase the dose down too fast.

2. Step 2 · PrescriptionBone, stomach and sugar protectionChecks and medicines to offset steroid side effects: calcium and vitamin D, often a bone-strengthening medicine, blood sugar and blood pressure checks.

   Works

   Long courses of steroids thin bones; protecting them lowers fracture risk

   Cost

   Mostly under the $25 PBS co-payment

   How long

   While on steroids

   Watch for

   Ask about a bone density scan and vaccines (flu, COVID-19, pneumococcal, shingles).

   Treat the PMR without trading it for a broken hip.

3. Step 3 · Self-careKeep movingWalking, gentle strength work and balance exercise.

   Works

   Helps protect muscles and bones from steroid effects; doesn’t treat the inflammation itself

   Cost

   Free

   How long

   Ongoing

   Watch for

   Falls risk if you’re stiff and weak: start gently.

   Steroids handle the inflammation. You handle the muscles.

4. Step 4 · PrescriptionMethotrexate (steroid-sparing)A weekly tablet added if flares keep happening as the steroid dose falls, or side effects are a problem.

   Works

   May modestly reduce relapses and total steroid needed

   Cost

   Under the $25 PBS co-payment

   How long

   Months to years, with regular blood tests

   Watch for

   Nausea, mouth ulcers, liver and blood count effects; avoid alcohol excess.

   A helper to get the steroid dose down.

5. Step 5 · SpecialistRheumatologist and newer injected medicinesFor relapsing or unusual PMR. Biologic medicines that block an immune signal (IL-6), such as tocilizumab or sarilumab, may be options where available.

   Works

   In a small trial, about 6 in 10 on tocilizumab were in remission off steroids at 16 weeks vs about 1 in 10 on placebo. Sarilumab: about 3 in 10 vs 1 in 10 in sustained remission at a year

   Cost

   Specialist fees vary; biologic access and subsidy depend on country and eligibility

   How long

   Months

   Watch for

   Infections; regular blood tests.

   Bigger guns for stubborn cases.

Costs are rough Australian prices in November 2026 and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.

Save your money

Popular, heavily marketed or often asked about, but the evidence is weak or says no.

• Anti-inflammatory tablets aloneMay take the edge off, but rarely control PMR, and carry stomach, kidney and heart risks in older people.
• Anti-inflammatory diets and supplementsNo evidence they replace or reduce steroids in PMR.
• Stopping steroids suddenly when you feel betterRisky: the body needs time to restart its own steroid production, and PMR is likely to flare.
• Starting steroids before blood testsUnless giant cell arteritis is suspected, tests come first: steroids can hide the results and muddy the diagnosis.

What you can do

• Take prednisolone in the morning with food, every day. Carry a steroid card or note.
• Never stop or drop the dose without talking to your GP.
• Keep a simple diary of stiffness and the dose. It makes tapering decisions easier.
• Know the giant cell arteritis warning signs (below) and act fast.
• Keep active, eat enough protein and calcium, and get vaccines up to date.
• See our osteoporosis fact sheet on protecting your bones.

See your GP if

• You’re over 50 with shoulder or hip pain and stiffness lasting more than a week or two
• Symptoms return as the steroid dose is lowered
• Mood changes, poor sleep or high blood sugar on steroids
• You don’t improve quickly on steroids: the diagnosis may need rethinking

Seek urgent same-day care for a new headache, scalp tenderness, jaw or tongue pain when chewing or talking, or any vision change (blurring, double vision, vision loss). Up to 1 in 5 people with PMR develop giant cell arteritis, which can cause blindness or stroke without fast treatment. Call 000 for sudden vision loss.

Helpful resources

• NHS: Polymyalgia rheumaticaClear overview including giant cell arteritis warning signs. Free, UK.
• NHS 111 Wales: Polymyalgia rheumaticaDetail on tests, steroid tapering and side effects. Free, UK.

Evidence and more information

• NHS: Polymyalgia rheumatica
• NHS 111 Wales: Polymyalgia rheumatica
• Bonelli et al, Ann Rheum Dis 2022: tocilizumab in new-onset PMR (PMR-SPARE), summary
• Spiera et al, NEJM 2023: sarilumab for relapsing PMR (SAPHYR), summary

Reviewed 1 November 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP, physio or pharmacist.

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