History and exam

Key diagnostic factors

common

shoulder/hip girdle stiffness

The typical presentation is morning stiffness for >1 hour in the shoulder girdle in 70% to 95% of patients and/or pelvic girdle pain in 50% to 70% of patients.​[5]​

shoulder/hip girdle pain

The typical presentation is inflammatory pain for >1 hour in the morning in the shoulder girdle in 70% to 95% of patients and/or pelvic girdle pain in 50% to 70% of patients.​[5]​

rapid response to corticosteroids

Response to a corticosteroid therapeutic trial is typically dramatic and rapid, usually occurring within 24 to 72 hours. This can be a helpful diagnostic finding (and is a criterion in one guideline[27]) that can distinguish PMR from other inflammatory conditions.[3][13][17]

Other diagnostic factors

common

acute onset

The onset is generally acute, but patients often delay several weeks in seeking treatment.[26]

low-grade fever

Part of constitutional symptoms present in one third of patients.[4][26]

anorexia

Constitutional symptoms such as loss of appetite are common and may occur in approximately one third of patients.[4][26]

weight loss

Up to one third of patients report weight loss as part of their presentation.[4][26]

malaise

Many patients report a feeling of general malaise.[4][26]

depression

Some patients report low mood or depression.[4][26]

asthenia

Patients may report unaccustomed physical weakness or lack of energy.[4][26]

oligoarticular arthritis

Most patients present with both oligoarticular and transitory manifestations at disease onset. The joints most frequently involved are the wrist, metacarpophalangeal, and knee joints.[18]

Risk factors

strong

age ≥50 years

PMR is uncommon in young patients.[9]

giant cell arteritis (GCA)

About 15% to 20% of patients with PMR have GCA, whereas 40% to 60% of those with GCA have PMR.[4]

weak

female sex

The incidence is higher in women. In one study, the incidence in women was 72.7/100,000 population aged ≥50 years, compared with 55.6/100,000 population aged ≥50 years in men.[2]

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