We're using cookies to give you the best experience on our site. Cookies are files stored in your browser and are used by most websites to help personalise your web experience.

By continuing to use our website without changing the settings, you're agreeing to our use of cookies.

Find out more
For more information, go to

Summary and further reading

Back to Hip and shoulder pain in older adults – PMR

This module and the accompanying case studies demonstrate that an initial diagnosis of PMR should be kept under regular review:

  1. to monitor response to treatment
  2. to re-consider the diagnosis where appropriate
  3. to check for possible side-effects of treatment
  4. to remain vigilant for 'red flag' symptoms.

Key points:

  • Don't start treatment with glucocorticoids until you've done appropriate investigations to rule out other disorders.
  • Don't miss giant cell arteritis (GCA).
  • Most patients with PMR can be safely managed in primary care but you should have a low threshold for referral in cases of diagnostic uncertainty or inadequate response to treatment.
  • Patient education is essential and should include information on potential treatment side-effects and on the symptoms of GCA.
  • Assess for comorbidities and for potential treatment risks and side-effects during each patient review.


  • Smeeth L, Cook C, Hall AJ. Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990-2001. Ann Rheum Dis 2006 Aug;65(8):1093–98.
  • Crowson CS, Matteson EL, Myasoedova E, Michet CJ, Ernste FC, Warrington KJ, et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum 2011 Mar;63(3):633–39.
  • Helliwell T, Hider S, Mallen S. Polymyalgia rheumatica: Diagnosis, prescribing and monitoring in primary care. Br J General Prac 2013 May;63(610):e361–66.
  • Dasgupta B, Borg FA, Hassan N, Barraclough K, Bourke B, Fulcher J, et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford) 2010 Jan;49(1):186-90.
  • Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2012 Apr;71(4):484–92. 

Further reading and useful resources

  • Helliwell T, Hider S, Barraclough K, Dasgupta B, Mallen C. Diagnosis and management of polymyalgia rheumatica. Br J Gen Prac 2012 May;62(598):275–26.
  • Barraclough K, Mallen C, Helliwell T, Hider S, Dasgupta K. Diagnosis and management of giant cell arteritis. Br J Gen Prac 2012 Jun;62(599):329–30.
  • NICE Clinical Knowledge Summary!topicsummary
  • Concise Guideline (Royal College of General Practitioners)
  • Systematic Review Treatment of Polymyalgia Rheumatica. A Systematic Review. J Hernández-Rodríguez, M Cid, A López-Soto, G Espigol-Frigolé, X Bosch. Arch Intern Med 2009; 169: 1839–50.
  • Review Our approach to the diagnosis and treatment of polymyalgia rheumatica and giant cell (temporal) arteritis V Quick and J Kirwan J R Coll Physicians Edinb 2012; 42: 341–49.
  • Review of imaging Imaging of polymyalgia rheumatica: indications on its pathogenesis, diagnosis and prognosis. D Camellino, A Marco. Rheumatology 2012; 51; 77–86.
  • Review Advances and challenges in the diagnosis and treatment of polymyalgia rheumatica. TA Kermani and K Warrington. Ther Adv Musculoskel Dis 2014; 6: 8–19.
  • Case vignette Giant-Cell Arteritis and Polymyalgia Rheumatica CM Weyand and J Goronzy. N Engl J Med 2014; 371: 50–57.
  • CME Rheumatology. Polymyalgia rheumatica: pathogenesis and management. S Mackie. Clinical Medicine 2013; 13: 398–400.
  • PatientPlus (for Healthcare professionals)
  • NHS choices

Patient resources

Previous Next
Back to Hip and shoulder pain in older adults – PMR

We're now

Versus Arthritis.

You're being taken through to our new website in order to finish your donation.

Thank you for your generosity.

For more information, go to
Arthritis Research UK fund research into the cause, treatment and cure of arthritis. You can support Arthritis Research UK by volunteering, donating or visiting our shops.