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Symptoms of PMR

Back to Hip and shoulder pain in older adults – PMR

Polymyalgia rheumatica (PMR) is characterised by bilateral pain and stiffness of the hips and shoulders and is often associated with profound disability.

For most patients, the onset of PMR is abrupt and may start with fevers or chills. Patients complain of pain in the shoulders and hips that's associated with stiffness, especially in the morning. They often report that they rapidly deteriorate over 1–2 weeks, becoming so disabled that they need help turning over in bed or getting up from a seated position.

Diagnosing PMR in primary care

The table shows when PMR can and cannot be safely diagnosed in primary care.

History, examination, investigations Trial of glucocorticoids: dose Response to treatment
A safe diagnosis of PMR can be made in the presence of all three of these Classical clinical features 15 mg prednisolone 'Magic', 'miracle', within 3 days
Consider other diagnoses if any of these are present (but can be atypical PMR) Atypical features Need for >15 mg prednisolone to relieve symptoms Incomplete or delayed response

Conditions that can mimic PMR

Other conditions can mimic PMR include:

Category Example
Inflammatory rheumatological disorders Rheumatoid arthritis
Giant cell arteritis
Crystal arthropathy
Non-inflammatory rheumatological disorders Osteoarthritis
Shoulder pathology (e.g. frozen shoulder, rotator cuff disease)
Infection Bacterial endocarditis, osteomyelitis, septic arthritis, tuberculosis and other infections
Malignancy Leukaemia, lymphoma, myeloma
Solid tumours (including prostate, renal, lung)
Endocrine Diabetes
Other disorders Drug-induced (e.g. statins)
Motor neurone disease
Parkinson's disease
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Back to Hip and shoulder pain in older adults – PMR

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