Polymyalgia Rheumatica: Understanding Morning Muscle Pain in Adults

Waking up with unexplained stiffness and aching muscles, especially in the shoulders, neck, and hips, can be more than just a sign of aging or overexertion. For some adults, particularly those over the age of 50, these symptoms may signal a condition called polymyalgia rheumatica (PMR). Often mistaken for common arthritis or fibromyalgia, PMR is a distinct inflammatory disorder that deserves attention and proper diagnosis.

In this article, we’ll explore what polymyalgia rheumatica is, its symptoms, possible causes, and how it’s treated.

What Is Polymyalgia Rheumatica?

Polymyalgia rheumatica is an inflammatory condition that causes severe muscle pain and stiffness, primarily affecting the shoulders, neck, and hips. The term “polymyalgia” comes from Greek, meaning “much muscle pain,” and it typically develops quickly — sometimes overnight.

PMR most commonly affects people over 50, with the average age of onset being around 70. It is rare in younger adults. Women are about two to three times more likely to develop PMR than men.

Common Symptoms

The hallmark of polymyalgia rheumatica is morning stiffness that lasts more than 30 minutes — often persisting for several hours. Other symptoms include:

• Pain and stiffness in both shoulders, upper arms, hips, and thighs
• Limited range of motion in affected areas
• Fatigue and general malaise
• Low-grade fever
• Weight loss
• Depression or irritability

Notably, symptoms usually appear on both sides of the body (bilateral) and worsen with inactivity, especially in the morning or after sitting for a long time.

Possible Causes and Triggers

The exact cause of polymyalgia rheumatica remains unknown. However, researchers believe it involves a combination of genetic predisposition and environmental triggers, possibly including viral infections. The condition is linked to an overactive immune system, which mistakenly attacks healthy tissues, leading to inflammation in the joints and surrounding areas.

Interestingly, PMR is closely associated with another serious condition called giant cell arteritis (also known as temporal arteritis), which involves inflammation of the arteries, particularly those in the head. About 10–20% of people with PMR also develop giant cell arteritis, and up to 50% of those with giant cell arteritis have PMR symptoms. Because of this link, early diagnosis is crucial to prevent complications like vision loss.

Diagnosis: How Is PMR Identified?

Diagnosing polymyalgia rheumatica can be challenging because its symptoms mimic other conditions like rheumatoid arthritis, lupus, or even infections. There is no single definitive test for PMR. Instead, doctors rely on:

• A thorough medical history and physical exam
• Blood tests to detect inflammation markers (such as ESR and CRP)
• Imaging tests, like ultrasound or MRI, to assess inflammation in joints and bursae
• Ruling out other possible causes of muscle pain

If PMR is suspected, treatment may be started promptly due to the significant improvement patients often experience with appropriate therapy.

Treatment and Management

The primary treatment for polymyalgia rheumatica involves the use of corticosteroids, most commonly prednisone. Most patients experience dramatic relief within days of starting the medication.

• Corticosteroids: Usually prescribed at a low to moderate dose and gradually tapered over months or even years to prevent relapse.
• Monitoring: Regular follow-up appointments are essential to adjust dosages and monitor for side effects such as osteoporosis, high blood pressure, or elevated blood sugar.
• Lifestyle Support: Physical therapy, gentle exercise (like walking or swimming), and a balanced diet can help maintain mobility and reduce stiffness.

While symptoms may resolve within 1–2 years, some patients require treatment for several years. Approximately 25% of patients experience relapse when tapering medication, so close medical supervision is vital.

When to See a Doctor

If you or a loved one over age 50 experiences persistent morning stiffness, muscle pain in the shoulders or hips, or unexplained fatigue and weight loss, don’t dismiss it as normal aging. Prompt medical evaluation can lead to an early diagnosis and prevent complications — especially the risk of vision loss from undiagnosed giant cell arteritis.

Seek urgent care if you experience:

• Headaches, especially around the temples
• Jaw pain when chewing
• Vision changes or double vision

These could be signs of giant cell arteritis, a medical emergency.

Final Thoughts

Polymyalgia rheumatica may not be widely known, but it significantly impacts the quality of life for many older adults. The good news? With early diagnosis and proper treatment, most people can regain mobility, reduce pain, and return to their daily activities.

If morning stiffness is interfering with your life, talk to your doctor. You’re not alone — and help is available.

Disclaimer: This article is for informational purposes only and does not replace professional medical advice. Always consult a healthcare provider for diagnosis and treatment.