Musculoskeletal - Polymyalgia Rheumatica

In this episode, we review polymyalgia rheumatica (PMR), an inflammatory rheumatic condition that commonly affects adults over age 50 and presents with symmetrical pain and stiffness of the shoulders, neck, and hip girdle. We discuss the immune-mediated pathophysiology, including the role of IL-6–driven inflammation, and the strong association with giant cell arteritis (GCA). The episode highlights classic clinical features such as morning stiffness lasting more than 45 minutes, rapid onset of symptoms, and difficulty with everyday activities like rising from a chair or lifting the arms. We also review key diagnostic clues including elevated ESR and CRP with negative autoimmune serologies, supportive imaging findings, and the ACR/EULAR classification criteria. Finally, we cover treatment strategies—particularly glucocorticoids as first-line therapy, steroid tapering protocols, and monitoring for complications—along with high-yield clinical pearls for recognizing PMR in clinical practice and on board exams. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Lall M, Jackson CD. What Is Polymyalgia Rheumatica? JAMA. 2024; 332(6):514-. Acharya S, Musa R. Polymyalgia Rheumatica. [Updated 2025 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537274/ Milchert M, Brzosko M. Diagnosis of polymyalgia rheumatica usually means a favourable outcome for your patient . 2017; 145(5):593-600.