Polymyalgia rheumatica

What it is

Polymyalgia rheumatica is inflammation of the tissues around the shoulder and hip girdles, producing severe pain and stiffness that is worst in the morning and can be genuinely disabling. It almost exclusively affects people over fifty, and the response to corticosteroids is so rapid and complete that it is part of the diagnosis.

The relief comes at a cost. Treatment typically runs one to two years of tapering prednisolone, and steroids over that period cause substantial muscle wasting and bone loss. That collateral damage, plus the stiffness that develops during the weeks when moving hurt, is where exercise has its role - not in treating the inflammation itself.

What it feels like

• Sudden onset of severe aching and stiffness in both shoulders and often both hips
• Morning stiffness lasting an hour or more, sometimes making dressing impossible
• Difficulty raising the arms and getting out of a chair
• Fatigue, low mood, and sometimes fever and weight loss
• Dramatic improvement within days of starting steroids

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Inflammation of the shoulder and hip girdle tissues

The bursae, tendon sheaths and joint linings around the girdles become inflamed. It is a genuine inflammatory disease with raised blood markers, not a muscular problem despite the name.

Age

It essentially does not occur under fifty and becomes more common with each decade after. Age is the strongest single risk factor.

Steroid-induced muscle wasting

One to two years of prednisolone causes proximal muscle wasting in the thighs and shoulders - precisely the areas the disease affected. Much of the residual weakness is from the treatment rather than the disease.

Steroid-induced bone loss

Bone density falls rapidly on corticosteroids, fastest in the first months. Bone protection should be considered from the start of treatment rather than after a fracture.

Stiffening during the painful phase

Weeks of severe pain before diagnosis and treatment means weeks of not moving the shoulders and hips. The resulting stiffness persists after the inflammation has been treated.

Giant cell arteritis

A closely related condition affecting the arteries of the head, occurring in a proportion of people with polymyalgia. New headache, scalp tenderness, jaw pain on chewing or any visual change is an emergency because it can cause permanent blindness.

Genetics and ethnicity

More common in people of Northern European descent, and there is a familial tendency.

Relapse on tapering

Symptoms commonly return as the steroid dose is reduced, prolonging treatment and extending the exposure to the side effects.

Nobody addressing the muscle and bone

The disease is treated well and the collateral damage frequently is not. Resistance training and bone protection alongside the steroids is the gap.

Who tends to get it

• Adults over fifty, with risk rising with each decade
• People of Northern European descent
• Women, in whom it is around twice as common
• Anyone on long-term steroids for it, for the muscle and bone consequences
• Anyone with polymyalgia who develops headache or visual symptoms, which is an emergency

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineInflammatory Arthritis (RA, PsA & Axial SpA)

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

New headache, scalp tenderness, jaw pain on chewing or any change in vision - possible giant cell arteritis, same-day medical care; pain that does not improve within a week of starting steroids - the diagnosis may be wrong

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

The inflammatory disease responds dramatically to steroids and usually resolves over one to two years, with a proportion needing longer. What determines how someone comes out of it is largely what happened to their muscle and bone during that time - which is why starting resistance training alongside the steroids is worth arguing for. New headache, scalp tenderness, jaw pain on chewing, or any change in vision is giant cell arteritis until proven otherwise and needs the same day.

Prevalence basis: StatPearls; British Society for Rheumatology guideline scope

Others the same routine covers

These share the Inflammatory Arthritis (RA, PsA & Axial SpA) routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.