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Polymyalgia Rheumatica (PMR) & Giant Cell Arteritis

Polymyalgia rheumatica (PMR) causes aching and stiffness in the shoulders, neck and hips, worst in the morning, mostly in people over 50. It is treated with steroid medicine and usually responds quickly. The key safety point: PMR can occur with giant cell arteritis, and a new headache, jaw pain when chewing or any vision change needs a doctor the same day.

Get a doctor the same day — and go to an emergency room if you cannot reach one — if you have PMR (or a suspicion of it) and notice any of these signs. They can mean giant cell arteritis (GCA), inflammation of the arteries in the head that can cause blindness or a stroke if it is not treated quickly (NHS).

Do not wait for a chiropractic, acupuncture or massage appointment, or try a home remedy first, if you have any of these signs. If you are already taking steroids, never stop them suddenly on your own — stopping can make you very unwell (NHS). The NHS advice quoted here is written for the UK; MBHA’s adaptation for readers in the US is to call your doctor right away and to go to an emergency room if you cannot reach one.

What is polymyalgia rheumatica?

Polymyalgia rheumatica (PMR) is an inflammatory condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips (NHS). The ACR adds that aching can also reach the upper arms, lower back and thighs, that it is usually worse in the morning, and that PMR does not cause joint swelling, so it can be hard to spot (ACR). Its cause is unknown; the NHS says a combination of genetic and environmental factors is thought to be responsible (NHS). The ACR says it is not caused by any medication, and that some research suggests the pain may be related to inflamed fluid sacs (bursae) in the shoulders or hips (ACR).

A 2023 Lancet review notes that PMR does not clearly shorten life or damage organs, but it can badly affect quality of life (Espigol-Frigole et al., 2023). The good news is that the inflammation responds quickly to treatment (ACR). This guide also covers giant cell arteritis, which is closely linked; an MBHA Vasculitis guide is planned.

Who gets it?

PMR is age-related. The NHS says most people diagnosed are over 65, it is very rare under 50, and it is more common in women than men (NHS). The ACR says it is more common after age 50, slightly more common in women and in Caucasians, but that anyone can get it (ACR).

What does it feel like?

  • Pain and stiffness in the shoulders, neck and hips, usually on both sides, that develops quickly over a few days or weeks. The stiffness is often worst first thing in the morning and usually starts to ease after about 45 minutes of moving about (NHS). The ACR says symptoms can even come on overnight (ACR).
  • Daily-life effects. It may be hard to raise your arms over your shoulders; hands and wrists may ache; sitting still for a long time, like on a long car ride, can make stiffness worse. The ACR lists disturbed sleep, trouble getting dressed (such as putting on socks), and trouble getting in and out of a car or up from a sofa (ACR).
  • Whole-body symptoms can include extreme tiredness, loss of appetite, weight loss and depression (NHS); MedlinePlus also lists fever and weakness (MedlinePlus).

Pain in the shoulders or hips has many causes. See our shoulder, hips and neck guides, and our arthritis guide — rheumatoid arthritis is one of the conditions that must be ruled out (NHS).

How it is diagnosed

There is no single test for PMR. The NHS says diagnosis can be a lengthy process, because PMR shares symptoms with more common conditions such as rheumatoid arthritis that must be ruled out first (NHS). A 2025 EULAR recommendation says everyone with suspected PMR should be referred for specialist assessment (Mukhtyar et al., 2026).

  • Blood tests for inflammation. The erythrocyte sedimentation rate (ESR, or “sed rate”) and C-reactive protein (CRP) are used to check inflammation. If both are normal, PMR is unlikely; sometimes ESR is normal and CRP is raised, so both are usually done together. High levels do not automatically mean PMR (NHS). The ACR notes that not everyone with PMR has high levels, but the tests help rule out other diseases such as rheumatoid arthritis (ACR). An ESR alone cannot say which condition is causing inflammation (MedlinePlus); CRP rises and falls with the amount of inflammation (MedlinePlus).
  • Other tests can check for rheumatoid factor and anti-CCP antibodies, infection, kidney function, and an overactive or underactive thyroid (both can cause muscle pain); X-rays and ultrasound may look at bones and joints (NHS). A 2016 JAMA review found ultrasound detects bursitis (an inflamed fluid sac) under the shoulder muscle on both sides in 69% of people with PMR, and said ultrasound may improve diagnostic accuracy (Buttgereit et al., 2016). See our thyroid guide.
  • A checklist. After other causes are ruled out, the NHS says PMR can usually be diagnosed confidently if you are over 50, have shoulder or hip pain, have morning stiffness longer than 45 minutes, have had symptoms for more than 2 weeks, have raised inflammation on blood tests, and your symptoms improve rapidly with steroid treatment (NHS). The 2025 EULAR recommendations add that for most people with suspected PMR, steroid treatment can wait until the diagnosis is confirmed (Mukhtyar et al., 2026) — unlike GCA, below.

The link to giant cell arteritis (GCA)

GCA is a type of vasculitis (inflammation of blood vessels) that mostly involves the arteries of the scalp and head, especially at the temples, which is why it is also called temporal arteritis. It occurs only in adults, usually over 50, more in women than men (ACR).

  • How often they go together. The ACR says that at some point 5 to 15% of people with PMR are diagnosed with GCA, and about half of people with GCA have PMR symptoms; the two can occur together or alone (ACR). The NHS puts the figure for PMR developing into GCA at up to 1 in 5 (NHS). Because estimates differ, the safe rule is the same: report the warning signs, even if your PMR is quiet or you feel well. The ACR stresses that people with active or inactive PMR should report a new headache, vision changes or jaw pain to their doctors (ACR).
  • Symptoms. The most common is a new headache, usually around the temples, though it can be anywhere. Others: fatigue, loss of appetite, weight loss, a flu-like feeling, and jaw pain when chewing (ACR); also scalp tenderness, double vision or loss of vision (NHS). MedlinePlus adds fever, dizziness, and problems with coordination and balance (MedlinePlus).
  • Diagnosis. There is no simple blood test to confirm GCA; the sed rate measures inflammation but is not proof. An ultrasound of the temporal arteries may be done, and a biopsy of the temporal artery is commonly done to confirm (ACR). The NHS says the biopsy is done under local anaesthetic (NHS). The 2016 JAMA review said biopsy remains the standard for a definitive diagnosis, though it may not be needed when typical features are accompanied by characteristic ultrasound or MRI findings (Buttgereit et al., 2016).
  • Treatment cannot wait for the results. The NHS says treatment is started before GCA is confirmed because of the risk of vision loss (NHS). The 2025 EULAR recommendations say suspected GCA should be seen by a specialist within 24 hours, with steroids started without delay while waiting for confirmation (Mukhtyar et al., 2026).

How long does PMR last?

Symptoms should improve within a few days of starting steroid treatment, and most people need treatment for 12 months to 2 years to keep symptoms from returning (NHS, NHS). The ACR says some people need steroids for 2 to 3 years and that symptoms may recur later (ACR). A review of real-world studies found that about 77%, 51% and 25% of people were still taking steroids at 1, 2 and 5 years, and about 43% had at least one relapse in the first year (Floris et al., 2022); the Lancet review puts relapses at 40 to 60% when steroids are reduced (Espigol-Frigole et al., 2023). GCA, too, can return after treatment (ACR).

When to see a provider (not an emergency): the NHS says to see a doctor if you have pain and stiffness for more than a week (NHS). If you are being treated and your aches and stiffness return as the steroid dose comes down, contact your doctor — the dose may need adjusting (NHS). MBHA suggests keeping a short log of how long morning stiffness lasts, so your doctor can see the pattern.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) A rheumatology or primary care doctor confirms the diagnosis and treats PMR with a corticosteroid (prednisone or prednisolone), reduced slowly over a year or more, with regular blood tests and check-ups. Steroid-sparing medicines (methotrexate, or the IL-6 blockers sarilumab and tocilizumab) are added for selected people. Suspected GCA is treated immediately. Medicare Part B covers medically necessary outpatient physical therapy: after the deductible you pay 20% of the Medicare-approved amount. Doctor visits, blood tests and medicines: cost estimate being researched. Symptoms usually improve within days of starting steroids, but treatment commonly lasts 1 to 2 years or longer and about 4 in 10 people relapse in the first year. Steroid side effects, especially bone thinning, need active monitoring.
Chiropractic Spinal and soft-tissue manual therapy. We found little research on chiropractic care for PMR specifically, and the main sources describe steroid medicine, not manipulation, as the treatment. About $55 to $100 for a self-pay follow-up visit and $90 to $200 for a first visit, per The Pricer. Medicare covers only spinal adjustments for a subluxation. No known role in treating the inflammation itself. If used for comfort, share your diagnosis and medicines first; steroids can thin bones, and rare serious problems follow manipulation, especially neck manipulation.
Acupuncture Fine needles at acupuncture points. We found little research on acupuncture for PMR or GCA, so MBHA cannot say whether it helps. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain. Evidence for PMR is lacking. If you try it, use sterile single-use needles and tell the practitioner about steroids and immune-lowering medicines, which raise infection risk.
Herbal medicine No herb or supplement is shown to treat PMR or GCA. The main concern is safety: licorice, St. John’s wort and some “immune” herbs can interact with steroid and immune-lowering medicines. Cost estimate being researched. Use only after checking with your prescriber. The NHS says not to eat real licorice while taking prednisolone.
Massage therapy Hands-on bodywork for tight, aching muscles and relaxation. We found little research on massage for PMR. One national chain: about $125 to $160 for a 60-minute massage for non-members and memberships of about $70 to $90 a month, per The Pricer. Medicare does not cover massage. May ease muscle tension and stress for some people, but it does not treat the inflammation. Ask for gentle pressure: steroids can thin skin and bones.
MBHA Wellness Coach Daily habits that support treatment: taking medicine as prescribed, a symptom log, pacing and gentle movement, fall prevention, sleep, weight and blood pressure checks, avoiding infections. Cost estimate being researched. Supports — never replaces — medical care. Treatment is long, so steady habits and knowing the GCA warning signs matter more than any one technique.

Approach 1 of 6

Conventional medicine (AMA)

PMR is treated with steroid medicine, and the aim is to relieve symptoms with the lowest dose that works. The 2025 EULAR recommendations advise specialist assessment for everyone with suspected PMR or GCA (Mukhtyar et al., 2026). We don’t list doses; your doctor sets and adjusts them.

Corticosteroids (steroid tablets)

  • What they do. Prednisone belongs to the class of medicines called corticosteroids; it treats conditions by reducing swelling and redness and by changing how the immune system works (MedlinePlus). The NHS says prednisolone, the steroid it names, is the main treatment for PMR; it does not cure PMR but helps relieve the symptoms (NHS). The ACR says low-dose corticosteroids can quickly relieve aching and stiffness (ACR).
  • Tapering. The dose is usually reduced gradually, every 1 to 2 months if you are responding well (NHS). The ACR says patients can taper off the drug after about a year, though some need 2 to 3 years (ACR). Relapses are common; when one happens, the dose can be raised again for a short time before another attempt to reduce it (Colombo et al., 2022).
  • Never stop suddenly. Stopping steroids abruptly can make you very unwell (NHS); your body may not have enough natural steroids, causing extreme tiredness, weakness, upset stomach, weight loss and other symptoms (MedlinePlus). Carry a steroid card if you are given one; the NHS says one should be arranged if you take steroids longer than 3 weeks (NHS).
  • Follow-up. The NHS describes appointments every few weeks for the first 3 months and at least every 3 months in the first year, with blood tests for inflammation (NHS).
  • Pain relievers. NSAIDs such as ibuprofen and naproxen are not effective for PMR (ACR); the NHS says paracetamol (acetaminophen) may help while the steroid dose comes down (NHS).

Steroid side effects and how they are managed

Even low-dose steroids can cause side effects, so regular check-ups matter. The ACR lists high blood pressure, osteoporosis (bone loss), weight gain, cataracts, sleeplessness, and bruising or thinning of the skin (ACR). The NHS adds increased appetite, stomach ulcers, and a higher risk of infection, especially chickenpox and shingles — tell a doctor right away if you think you have been exposed — and says the risks should improve as the dose comes down (NHS). Mood and sleep changes, indigestion and headaches are common (NHS), and blurred vision or a dark spot in the middle of your vision can be a rare eye side effect (NHS) — but because vision changes can also signal GCA, report them at once. The Lancet review calls steroid side effects common (Espigol-Frigole et al., 2023). See our blood pressure, diabetes, eyes and shingles guides.

Protecting your bones and stomach

  • Bones. The ACR says older patients with PMR may need osteoporosis medicine to prevent fractures (ACR). For GCA it says steroids can cause bone loss, so your doctor may want a bone density test and suggest vitamin D, calcium or bisphosphonates (ACR). The 2022 ACR guideline for adults taking steroids for more than 3 months strongly recommends an assessment of fracture risk soon after starting (including bone density), and strongly recommends drug treatment for those at medium or higher risk, with the choice made by shared decision-making (Humphrey et al., 2023). See our osteoporosis guide.
  • Stomach and heart. For GCA, the NHS says people may also be given a stomach-protecting medicine (a proton pump inhibitor) and low-dose aspirin to reduce stroke or heart attack risk (NHS). Do not start aspirin on your own — MBHA suggests asking your doctor, since the NHS lists NSAIDs and aspirin among medicines that may not mix well with prednisolone (NHS).

Steroid-sparing medicines

When relapses are frequent, steroids are needed for a long time, or side effects are a problem, doctors add another medicine so the steroid can be reduced. The 2025 EULAR recommendations support adding an interleukin-6 (IL-6) receptor blocker for PMR and GCA in selected patients, with methotrexate as a possible alternative (and upadacitinib, a different type of medicine, for GCA) (Mukhtyar et al., 2026). The ACR also mentions hydroxychloroquine (ACR).

  • Methotrexate is an immunosuppressant medicine. The NHS says it may help people with frequent relapses or those who do not respond to normal steroid treatment (NHS). A 2021 meta-analysis of 4 trials found that adding it to prednisone worked better than prednisone alone and lowered the total steroid dose, though the apparent drop in relapses was not statistically significant (Song and Lee, 2021). A small 2026 trial of 58 people with new PMR found that 80% of those on methotrexate were off steroids and in remission at 52 weeks, versus 46% on placebo (Bolhuis et al., 2026). MedlinePlus lists other uses (such as psoriasis and rheumatoid arthritis) and says it is sometimes used for other autoimmune diseases. Its safety warnings are serious: birth defects, low blood counts, and liver, lung and kidney damage, and taking it daily by mistake instead of weekly has caused severe side effects and deaths (MedlinePlus).
  • Sarilumab (brand name Kevzara) is an IL-6 receptor blocker given by injection. Its FDA label includes adults with PMR who had an inadequate response to corticosteroids or cannot tolerate a steroid taper. In the 52-week trial described in the label, 17 of 60 people (28.3%) on sarilumab with a prednisone taper had sustained remission, versus 6 of 58 (10.3%) on placebo with a taper. The label’s boxed warning is about serious infections, including tuberculosis (testing for latent TB is advised before starting); it also lists low white cell counts, stomach or intestinal tears (more likely with NSAIDs or steroids), and says to avoid live vaccines (FDA label (DailyMed)).
  • Tocilizumab (brand name Actemra) is also an IL-6 blocker. Its FDA label lists GCA in adults, used with a tapering course of steroids, and does not list PMR; it carries a boxed warning for serious infections (FDA label (DailyMed)). In a 251-person trial, sustained remission at 1 year occurred in 56% and 53% of the two tocilizumab groups versus 14% and 18% of the placebo groups, with lower total steroid use (Stone et al., 2017). The ACR notes it was approved for GCA in 2017 (ACR). The Lancet review says tocilizumab and sarilumab have both shown efficacy in randomized trials in PMR, with risks and benefits to weigh (Espigol-Frigole et al., 2023).
  • Newer research. A 2026 trial of secukinumab in people with relapsed PMR found sustained remission in about 41% versus 20% on placebo (Stone et al., 2026). We did not verify its regulatory status; ask your rheumatologist where it stands.

For GCA, the NHS describes two stages: a high initial steroid dose for a few weeks, then a lower dose over a longer time, possibly several years; a small number need steroids for life (NHS). The ACR says the dose is tapered after about a month, and people often come off prednisone after one to two years (ACR). The 2021 ACR and Vasculitis Foundation guideline supports steroid-sparing immunosuppressive medicines in GCA (Maz et al., 2021).

For physical therapy, see Exercise and staying strong.

What it costs

Physical therapy: Medicare Part B covers medically necessary outpatient PT; you pay 20% of the approved amount after the deductible (Medicare.gov). Rheumatology visits, blood tests, bone-density scans and medicines: MBHA cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Some chiropractors treat shoulder, neck and hip pain with joint mobilization or manipulation, soft-tissue work and exercise. We found little research on chiropractic care for polymyalgia rheumatica or giant cell arteritis, and the sources we read for PMR describe steroid medicine, not manipulation, as the main treatment (NHS, ACR). MBHA therefore cannot say chiropractic helps PMR.

Safety questions specific to PMR

  • Get the diagnosis first. Aching shoulders and hips with morning stiffness need blood tests and a medical exam (NHS). A new headache, jaw pain or vision change needs the same-day care described at the top of this guide, not an adjustment.
  • Bones and steroids. Steroids can cause bone loss (ACR). NCCIH says serious problems after spinal manipulation are very rare but may be more likely in people with underlying health problems, and that you should share your health conditions and medicines with the practitioner (NCCIH). MBHA suggests telling your chiropractor you take steroids and have, or may have, osteoporosis, and asking about gentle, low-force techniques.
  • The neck. A type of neck manipulation has been linked to rare tears in neck arteries that can lead to a stroke, though experts disagree on whether manipulation causes them (NCCIH). Because GCA also involves arteries of the head and neck, MBHA suggests avoiding forceful neck manipulation if you have unexplained headache or neck symptoms. See our stroke guide.

What it costs

The Pricer lists about $55 to $100 for a self-pay follow-up visit and about $90 to $200 for a first visit (The Pricer). Medicare Part B covers only spinal adjustments by a chiropractor to correct a subluxation (Medicare.gov).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture uses fine needles at specific points. We found little research on acupuncture for PMR or GCA, and NCCIH’s summary of acupuncture evidence does not mention PMR (NCCIH). MBHA therefore cannot say whether it eases PMR aching, and it does not treat the inflammation or protect against GCA.

Safety

What it costs

The Pricer lists about $90 to $185 per follow-up visit, up to about $230 for a first private visit, and community acupuncture around $50 to $90 (The Pricer). Medicare Part B covers acupuncture, including dry needling, only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We found no herb or supplement shown to treat polymyalgia rheumatica or giant cell arteritis, and we found little research on herbal remedies for either. For people with PMR, the bigger issue is safety, because you may take a steroid for a year or more, sometimes with other immune-lowering medicines.

Herbs that can interact with your medicines

  • Licorice. The NHS says not to eat real licorice or foods containing it while taking prednisolone, as it can increase the amount of medicine in your body and the risk of side effects (NHS). NCCIH says interactions between licorice and corticosteroids have been reported, and that the glycyrrhizin in licorice can cause serious problems such as irregular heartbeat, especially in people with high blood pressure, or heart or kidney conditions (NCCIH). High blood pressure is already a possible steroid side effect (ACR).
  • St. John’s wort. MedlinePlus names it as a herbal product that may interact with prednisone (MedlinePlus). NCCIH says it can interact in dangerous, sometimes life-threatening ways with many medicines (NCCIH), including the immunosuppressant cyclosporine (NCCIH).
  • “Immune-boosting” herbs. NCCIH says cat’s claw might make the immune system more active, which could increase symptoms of autoimmune diseases, and may interact with immunosuppressants; Asian ginseng may worsen autoimmune disorders (NCCIH). The ACR describes GCA as an autoimmune disease (ACR); MBHA suggests asking your rheumatologist before taking any such product.
  • Turmeric and curcumin. NCCIH says we do not know enough to conclude turmeric or curcumin helps any health purpose; the research it summarizes is on fatty liver disease, osteoarthritis and cholesterol, not PMR. Highly absorbable curcumin products have been linked to liver damage (NCCIH). Because methotrexate can also harm the liver (MedlinePlus), tell your doctor if you use it.

Supplements in general

NCCIH notes that strong evidence behind supplement claims, such as “supports a healthy immune system,” is often lacking (NCCIH). Your doctor may recommend calcium while you take prednisone, and MedlinePlus says to talk with your doctor about grapefruit (MedlinePlus); the ACR mentions vitamin D and calcium for bone protection (ACR). Ask your doctor what is right for you rather than self-dosing. Also see our medication safety guide.

Approach 5 of 6

Massage therapy

Massage can ease tight muscles and help you relax. We found little research on massage for polymyalgia rheumatica, and it does not treat the underlying inflammation or protect against GCA. For stiff, aching shoulders and hips it may feel good, but treat it as comfort care alongside medical treatment.

Safety

NCCIH says the risk of harm from massage appears low, but rare serious problems, such as a blood clot, nerve injury or bone fracture, have been reported, some with vigorous deep-tissue work or in people at higher risk of injury, such as older adults (NCCIH). PMR mostly affects people over 50 (ACR), and steroids can cause bone loss and thin, easily bruised skin (ACR). MBHA suggests telling the therapist about your diagnosis and medicines and asking for gentle to moderate pressure. MBHA also suggests skipping massage during a fever or illness, and seeing a doctor about any new headache, jaw pain or vision change before booking a session.

What it costs

Prices vary by location. At one national chain, franchise price lists show about $125 to $160 for a 60-minute massage for non-members, and memberships run about $70 to $90 a month (The Pricer). Tips are extra. Original Medicare does not cover massage therapy (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

PMR treatment is a marathon of a year or more, and the daily habits around it matter. An MBHA Wellness Coach can help you build them, alongside — never instead of — your medical care.

Another approach

Exercise and staying strong

The ACR says that when aches and stiffness respond to treatment, people with PMR can return to a normal lifestyle and regular exercise (ACR). The 2015 EULAR and ACR recommendations cover non-drug approaches (Dejaco et al., 2015), and a 2022 review reports that they include individualized exercise programs to maintain muscle mass and function and to prevent falls, especially in people on long-term steroids (Colombo et al., 2022). The 2026 German, Austrian and Swiss recommendations say older and frail patients should be offered an individualized exercise program (Buttgereit et al., 2026).

How strong is the evidence? Modest. The same 2022 review found no studies that tested whether non-drug treatments work in PMR in its selective literature search (Colombo et al., 2022), so the advice rests on expert opinion. We found little exercise-trial research specific to PMR.

  • Ask your rheumatologist or a physical therapist to design a program for your diagnosis, bone health and balance. MBHA suggests starting gently and building up.
  • Stop and call your doctor if exercise brings on sharp pain, or any new headache, jaw pain or vision change.
  • If your stiffness is worst in the morning, remember it usually eases after about 45 minutes of moving (NHS); a long period of sitting can bring it back (ACR).
  • See our shoulder, hips and osteoporosis guides for related exercise and bone-health information.

Another approach

Steroid safety checklist

A quick list drawn from the sources above; ask your doctor which points apply to you.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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