Polymyalgia Rheumatica
Dr. John Watterson, MD, FRCPC , Vancouver, BC
PMR symptoms often develop relatively quickly, over days to weeks, and may be worse after periods of inactivity.
A related condition, Giant Cell Arteritis, occurs in some people with PMR and requires urgent medical attention. Seek prompt medical care if symptoms include:
- New or severe headache
- Jaw pain while chewing
- Scalp tenderness
- Blurred vision, double vision, or vision loss
There is no single test that confirms PMR. Doctors typically use symptoms, physical examination, blood tests that show inflammation, and response to treatment to make the diagnosis.
If you’re asking because you or someone you know has symptoms, I can also explain how PMR is diagnosed and how it differs from arthritis, fibromyalgia, or normal aging-related stiffness.
Polymyalgia rheumatica (PMR) is an inflammatory disorder that most often affects adults over age 50. It causes pain and stiffness, especially in the shoulders and hips.
Common symptoms include:
- Pain and stiffness in both shoulders (the most common symptom)
- Hip, buttock, thigh, or neck pain and stiffness
- Morning stiffness lasting 30 minutes or more, often several hours
- Difficulty with everyday movements, such as:
- Getting out of bed
- Rising from a chair
- Lifting the arms above shoulder level
- Climbing stairs
- Fatigue
- Low-grade fever
- Loss of appetite
- Unintentional weight loss
- A general feeling of being unwell (malaise)
Polymyalgia rheumatica (PMR) Nutrition: MINDS MUSCLE MEALS
Dr. Maziar Badii, Rheumatologist, Vancouver, BC
Dr. Maziar Badii, Rheumatologist, Vancouver, BC
Featuring Dr. Stefanie Wade, Rheumatologist, Vancouver, BC
Featuring Dr. Stefanie Wade, Rheumatologist, Vancouver, BC
Dr. John Watterson, MD, FRCPC , Vancouver, BC
In fact, depression is recognized as a possible symptom or associated feature of PMR.
If you have PMR and are experiencing:
- Persistent sadness
- Loss of interest in activities
- Excessive worry
- Significant sleep problems
- Thoughts of self-harm
it’s important to discuss this with your healthcare provider, as mental health symptoms can often be treated alongside PMR.
These mental health effects can arise from several factors:
- Chronic pain and stiffness can make daily activities difficult and reduce quality of life.
- Poor sleep due to pain can worsen mood and concentration.
- Inflammation itself may contribute to depressive symptoms.
- Corticosteroid treatment (such as prednisone/prednisolone), commonly used for PMR, can sometimes cause mood changes, anxiety, agitation, insomnia, or depression in some people.
Arthritic Exercise: MINDS MUSCLE MEALS
Mr. Nick Pratap, Kinesiologist, Vancouver, BC
Mr. Nick Pratap, Kinesiologist, Vancouver, BC
Mr. Nick Pratap, Kinesiologist, Vancouver, BC
Mr. Bradley Vance, Physiotherapist, Surrey, BC
Polymyalgia rheumatica and exercise
With polymyalgia rheumatica (PMR), exercise can help maintain strength, flexibility, balance, and independence. However, PMR often causes significant pain and stiffness in the shoulders, hips, and neck, so activity should be gradual and adjusted to symptoms.
Good exercises
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Walking: Start with short, comfortable walks and gradually increase duration.
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Gentle range-of-motion exercises: Shoulder rolls, gentle arm movements, and hip movements can help maintain mobility.
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Strength training: Light resistance exercises can help prevent muscle weakness, particularly if you’re taking prednisone.
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Balance exercises: Simple balance work can help reduce fall risk.
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Water exercise: Swimming or exercising in a warm pool can be easier on painful joints.
- Low-Impact Activities:Walking, swimming, cycling, and water aerobics are generally recommended as low-impact options that are gentle on the joints.
- Range of Motion Exercises:These exercises focus on improving joint flexibility and mobility.
Strengthening Exercises:These exercises help build muscle strength to support and protect joints.
Aerobic Exercise:Activities like walking, swimming, and cycling can improve cardiovascular health and endurance
Dr. John Watterson, MD, FRCPC , Vancouver, BC
Chronic pain, inflammation, and stress from living with arthritis can directly worsen mental well-being, while mental health struggles can, in turn, exacerbate physical arthritis symptoms, creating a “chicken-and-egg” cycle. Managing both physical and mental health is crucial for individuals with arthritis, and strategies can include exercise, good sleep, social support, and seeking professional help
Dr. Grant Lum Sports Medicine ,Toronto.
During a flare
Don’t try to exercise through severe pain. Gentle movement is generally preferable to complete inactivity, but reduce intensity and duration if symptoms worsen. As inflammation improves with treatment, activity can gradually increase.
Important with PMR
PMR can occur with giant cell arteritis (GCA). If you develop a new severe headache, scalp tenderness, jaw pain while chewing, or visual changes, seek urgent medical attention because GCA can threaten vision.
A physiotherapist can create an exercise program appropriate for your age, fitness level, PMR symptoms, and prednisone treatment.
Potential benefits for PMR
People with PMR often experience pain, stiffness, and weakness in the shoulders, neck, hips, and thighs. Gentle isometric exercises may:
- Help preserve muscle strength during periods of reduced activity
- Improve stability and function
- Place less stress on painful joints than some dynamic exercises
- Support recovery alongside medical treatment
Important cautions
- PMR inflammation is usually treated with medications such as Prednisone. Exercise does not replace medical treatment.
- During periods of significant pain or active inflammation, even isometric contractions may worsen symptoms if performed too intensely.
- Long-term steroid treatment can contribute to muscle weakness and bone loss, so an individualized exercise program is often helpful.
- Avoid holding your breath during isometric exercises, as this can temporarily raise blood pressure.