guidelines

polymyalgia rheumatica (pmr)

nice cks: diagnostic pattern (age >50, shoulder/hip girdle pain), baseline tests to exclude mimics, and a pragmatic prednisolone taper with monitoring.

last reviewed: 2026-02-13
based on: NICE CKS: Polymyalgia rheumatica (accessed Feb 2026)
reviewer: Dr Kola Tytler MBBS CertHE MBA MRCGP
view official NICE source

Executive summary

  • Classic PMR: age >50 with bilateral shoulder (± hip) girdle pain and morning stiffness; raised inflammatory markers are typical.
  • Exclude mimics: infection, malignancy, inflammatory arthritis, myopathy, hypothyroid, drug-induced causes.
  • Prednisolone response should be brisk (symptom improvement within days): lack of response should trigger diagnostic review.

Baseline tests (pragmatic set)

  • FBC, U&Es, LFTs, ESR/CRP, calcium, CK, TFTs, HbA1c/glucose (steroid planning).
  • Consider RF/anti-CCP if inflammatory arthritis is plausible; consider CXR/other tests if red flags for malignancy/infection.

Steroid initiation + taper (example framework)

  • Starting dose: commonly prednisolone 15 mg OD (individualise).
  • Taper principle: reduce gradually once controlled; slow down at lower doses to reduce relapse.
  • Monitoring: symptoms + ESR/CRP trends; watch for steroid harms (BP, glucose, osteoporosis, cataract, infection risk).
  • Bone protection: assess fracture risk; calcium/vitamin D and bisphosphonate per risk/local guidance.

Always screen for giant cell arteritis at each contact.

Transparency

This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.