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Rheumatic cardiomyopathy

Last edited: 4/14/2026

Overview

Polymyalgia rheumatica (PMR) is an inflammatory disorder characterized by pain and stiffness in the neck, shoulder, and hip girdles, typically affecting individuals over 50 years old. It often coexists with or precedes giant cell arteritis (GCA). 230

Diagnosis

  • Key Diagnostic Criteria: Morning stiffness ≥ 45 minutes, elevated erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP), bilateral shoulder and pelvic girdle pain/stiffness 121625.
  • Recommended Tests: ESR and CRP levels, complete blood count, thyroid function tests, imaging (e.g., ultrasound, MRI) to rule out other conditions 916.
  • Differentiation from GCA: Temporal artery biopsy may be necessary if GCA is suspected 2830.

    • Management

  • First-Line Treatment: Low-dose glucocorticoids (e.g., prednisolone 7.5-20 mg/day), aiming for rapid symptom relief 21520.
  • Adjunctive Treatments: Methotrexate as a glucocorticoid-sparing agent in cases of relapse or adverse effects from glucocorticoids 1213.
  • Monitoring: Regular assessment of inflammatory markers, side effects of glucocorticoids, and gradual tapering under rheumatological supervision 1520.

    • Special Populations

  • Elderly: Commonly affected; careful monitoring of glucocorticoid side effects essential 2415.
  • Comorbidities: No specific differences noted in polypharmacy or comorbidities at diagnosis compared to osteoarthritis 4.

    • Key Recommendations

  • Early Referral: Early referral to rheumatology for suspected PMR to ensure prompt diagnosis and treatment 6 (Evidence: Moderate).
  • Glucocorticoid Initiation: Initiate low-dose glucocorticoids promptly for symptom control 215 (Evidence: Strong).
  • Monitoring Adrenal Function: Assess for glucocorticoid-induced adrenal insufficiency post-cessation of therapy 3 (Evidence: Moderate).
  • Consider Methotrexate: Use methotrexate as a glucocorticoid-sparing agent in appropriate cases 1213 (Evidence: Weak).
  • Regular Follow-Up: Ensure regular follow-up to monitor disease activity and manage glucocorticoid side effects 20 (Evidence: Moderate).

    • References

    1 Nielsen EL, Donskov AO, Våben CS, Nielsen AW, Frølund LL, Hansen IT et al.. Rheumatologist assessment in established polymyalgia rheumatica. Rheumatology (Oxford, England) 2026. link 2 Buttgereit F, Boyadzhieva Z, Reisch M, Schneider M, Brabant T, Daikeler T et al.. Recommendations of the German, Austrian and Swiss rheumatology and other medical societies for the management of polymyalgia rheumatica. Rheumatology (Oxford, England) 2026. link 3 Hansen SB, Dreyer AF, Jørgensen NT, Al-Jorani H, Bislev LS, Boesen VB et al.. Changes in Adrenal Function and Insufficiency Symptoms After Cessation of Prednisolone. JAMA network open 2025. link 4 Cimmino MA, Camellino D, Clini PV, Cutolo M, Hysa E. Polypharmacy and comorbidities are not higher at diagnosis in patients with polymyalgia rheumatica compared to osteoarthritis. Clinical and experimental rheumatology 2025. link 5 Wendling D, Al Tabaa O, Chevet B, Fakih O, Ghossan R, Hecquet S et al.. Recommendations of the French Society of Rheumatology for the management in current practice of patients with polymyalgia rheumatica. Joint bone spine 2024. link 6 Keller KK, Mukhtyar CB, Nielsen AW, Hemmig AK, Mackie SL, Sattui SE et al.. Recommendations for early referral of individuals with suspected polymyalgia rheumatica: an initiative from the international giant cell arteritis and polymyalgia rheumatica study group. Annals of the rheumatic diseases 2024. link 7 Hysa E, Casabella A, Gotelli E, Campitiello R, Schenone C, Genova C et al.. Polymyalgia rheumatica and giant cell arteritis induced by immune checkpoint inhibitors: A systematic literature review highlighting differences from the idiopathic forms. Autoimmunity reviews 2024. link 8 Sattui SE, Xie F, Wan Z, Clinton C, Domsic RT, Curtis JR. Treatment of Polymyalgia Rheumatica by Rheumatology Providers: Analysis from the American College of Rheumatology RISE Registry. Arthritis care & research 2024. link 9 Mekenyan L, Karalilova R, Todorov P, Tepeliev N, Batalov A. Imaging methods in polymyalgia rheumatica: a systematic review. Rheumatology international 2023. link 10 Manzo C. Clinical practice guidelines for patients with polymyalgia rheumatica: the need for an active involvement of all stakeholder is still unmet. Reumatismo 2020. link 11 Ughi N, Sebastiani GD, Gerli R, Salvarani C, Parisi S, Ariani A et al.. Reply to the Letter to the Editor: The Italian Society of Rheumatology clinical practice guidelines for the management of polymyalgia rheumatica. Reumatismo 2020. link 12 Ruediger C, Nguyen L, Black R, Proudman S, Hill C. Efficacy of methotrexate in polymyalgia rheumatica in routine rheumatology clinical care. Internal medicine journal 2020. link 13 Ughi N, Sebastiani GD, Gerli R, Salvarani C, Parisi S, Ariani A et al.. The Italian Society of Rheumatology clinical practice guidelines for the management of polymyalgia rheumatica. Reumatismo 2020. link 14 Bellan M, Sainaghi PP, Pirisi M. The real evidence for polymyalgia rheumatic as a paraneoplastic syndrome. Reumatismo 2018. link 15 Albrecht K, Huscher D, Buttgereit F, Aringer M, Hoese G, Ochs W et al.. Long-term glucocorticoid treatment in patients with polymyalgia rheumatica, giant cell arteritis, or both diseases: results from a national rheumatology database. Rheumatology international 2018. link 16 Matsui K, Maruoka M, Yoshikawa T, Hashimoto N, Nogami M, Sekiguchi M et al.. Assessment of 2012 EULAR/ACR new classification criteria for polymyalgia rheumatica in Japanese patients diagnosed using Bird's criteria. International journal of rheumatic diseases 2018. link 17 Gerardi MC, Rutigliano IM, Scrivo R, Priori R, Riccieri V, Valesini G. "In sickness and in health": the peculiar occurrence of polymyalgia rheumatica in married cohabiting couples--a case series and review of the literature. Clinical rheumatology 2016. link 18 Wakura D, Kotani T, Takeuchi T, Komori T, Yoshida S, Makino S et al.. Differentiation between Polymyalgia Rheumatica (PMR) and Elderly-Onset Rheumatoid Arthritis Using 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: Is Enthesitis a New Pathological Lesion in PMR?. PloS one 2016. link 19 Helliwell T, Brouwer E, Pease CT, Hughes R, Hill CL, Neill LM et al.. Development of a Provisional Core Domain Set for Polymyalgia Rheumatica: Report from the OMERACT 12 Polymyalgia Rheumatica Working Group. The Journal of rheumatology 2016. link 20 Schirmer M, Dejaco C, Dasgupta B, Matteson EL. Polymyalgia rheumatica: strategies for efficient practice and quality assurance. Rheumatology international 2015. link 21 Macchioni P, Boiardi L, Catanoso M, Pazzola G, Salvarani C. Performance of the new 2012 EULAR/ACR classification criteria for polymyalgia rheumatica: comparison with the previous criteria in a single-centre study. Annals of the rheumatic diseases 2014. link 22 Dalkılıç E, Tufan AN, Hafızoğlu E, Hafızoğlu M, Tufan F, Oksuz F et al.. The process from symptom onset to rheumatology clinic in polymyalgia rheumatica. Rheumatology international 2014. link 23 Ornetti P, Guillibert-Karras C, Garrot JF, Gros F, Gérard N, Julien L et al.. Study of professional practices among rheumatologists in Burgundy: initial corticotherapy in polymyalgia rheumatica. Clinical rheumatology 2011. link 24 Binard A, Lefebvre B, De Bandt M, Berthelot JM, Saraux A. Validity of the polymyalgia rheumatica activity score in primary care practice. Annals of the rheumatic diseases 2009. link 25 Dasgupta B, Salvarani C, Schirmer M, Crowson CS, Maradit-Kremers H, Hutchings A et al.. Developing classification criteria for polymyalgia rheumatica: comparison of views from an expert panel and wider survey. The Journal of rheumatology 2008. link 26 Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE. Use of physician services in a population-based cohort of patients with polymyalgia rheumatica over the course of their disease. Arthritis and rheumatism 2005. link 27 Doran MF, Crowson CS, O'Fallon WM, Hunder GG, Gabriel SE. Trends in the incidence of polymyalgia rheumatica over a 30 year period in Olmsted County, Minnesota, USA. The Journal of rheumatology 2002. link 28 George E, Dieppe PA. Arthritis or arteritis. Clinical rheumatology 1994. link 29 Brelsford WG, Goodman RE. Effect of hemiparesis on polymyalgia rheumatica. The Journal of rheumatology 1988. link 30 Sewell JR. Polymyalgia rheumatica. British journal of hospital medicine 1986. link 31 Kyle MV, Hazleman BL, King RH. Polymyalgia rheumatica/giant cell arteritis in husband and wife. Clinical rheumatology 1984. link 32 Garfinkel D, Bograd H, Salamon F, Aderka D, Shoenfeld Y, Weinberger A et al.. Polymyalgia rheumatica and temporal arteritis in a married couple. The American journal of the medical sciences 1984. link 33 Turner RM. Polymyalgia rheumatica: a general practice experience. The Journal of the Royal College of General Practitioners 1983. link 34 Silman AJ, Currey HL. Polymyalgia rheumatica in a defined elderly community. Rheumatology and rehabilitation 1982. link 35 Mowat AG. Strathpeffer Spa: Dr William Bruce and polymyalgia rheumatica. Annals of the rheumatic diseases 1981. link 36 Thompson K, Roberts PF. Chronic hepatitis in polymyalgia rheumatica. Postgraduate medical journal 1976. link

    Original source

    1. [1]
      Rheumatologist assessment in established polymyalgia rheumatica. — Nielsen EL, Donskov AO, Våben CS, Nielsen AW, Frølund LL, Hansen IT et al. Rheumatology (Oxford, England) (2026)
    2. [2]
      Recommendations of the German, Austrian and Swiss rheumatology and other medical societies for the management of polymyalgia rheumatica. — Buttgereit F, Boyadzhieva Z, Reisch M, Schneider M, Brabant T, Daikeler T et al. Rheumatology (Oxford, England) (2026)
    3. [3]
      Changes in Adrenal Function and Insufficiency Symptoms After Cessation of Prednisolone. — Hansen SB, Dreyer AF, Jørgensen NT, Al-Jorani H, Bislev LS, Boesen VB et al. JAMA network open (2025)
    4. [4]
      Polypharmacy and comorbidities are not higher at diagnosis in patients with polymyalgia rheumatica compared to osteoarthritis. — Cimmino MA, Camellino D, Clini PV, Cutolo M, Hysa E Clinical and experimental rheumatology (2025)
    5. [5]
      Recommendations of the French Society of Rheumatology for the management in current practice of patients with polymyalgia rheumatica. — Wendling D, Al Tabaa O, Chevet B, Fakih O, Ghossan R, Hecquet S et al. Joint bone spine (2024)
    6. [6]
      Recommendations for early referral of individuals with suspected polymyalgia rheumatica: an initiative from the international giant cell arteritis and polymyalgia rheumatica study group. — Keller KK, Mukhtyar CB, Nielsen AW, Hemmig AK, Mackie SL, Sattui SE et al. Annals of the rheumatic diseases (2024)
    7. [7]
      Polymyalgia rheumatica and giant cell arteritis induced by immune checkpoint inhibitors: A systematic literature review highlighting differences from the idiopathic forms. — Hysa E, Casabella A, Gotelli E, Campitiello R, Schenone C, Genova C et al. Autoimmunity reviews (2024)
    8. [8]
      Treatment of Polymyalgia Rheumatica by Rheumatology Providers: Analysis from the American College of Rheumatology RISE Registry. — Sattui SE, Xie F, Wan Z, Clinton C, Domsic RT, Curtis JR Arthritis care & research (2024)
    9. [9]
      Imaging methods in polymyalgia rheumatica: a systematic review. — Mekenyan L, Karalilova R, Todorov P, Tepeliev N, Batalov A Rheumatology international (2023)
    10. [10]
      Clinical practice guidelines for patients with polymyalgia rheumatica: the need for an active involvement of all stakeholder is still unmet. — Manzo C Reumatismo (2020)
    11. [11]
      Reply to the Letter to the Editor: The Italian Society of Rheumatology clinical practice guidelines for the management of polymyalgia rheumatica. — Ughi N, Sebastiani GD, Gerli R, Salvarani C, Parisi S, Ariani A et al. Reumatismo (2020)
    12. [12]
      Efficacy of methotrexate in polymyalgia rheumatica in routine rheumatology clinical care. — Ruediger C, Nguyen L, Black R, Proudman S, Hill C Internal medicine journal (2020)
    13. [13]
      The Italian Society of Rheumatology clinical practice guidelines for the management of polymyalgia rheumatica. — Ughi N, Sebastiani GD, Gerli R, Salvarani C, Parisi S, Ariani A et al. Reumatismo (2020)
    14. [14]
      The real evidence for polymyalgia rheumatic as a paraneoplastic syndrome. — Bellan M, Sainaghi PP, Pirisi M Reumatismo (2018)
    15. [15]
      Long-term glucocorticoid treatment in patients with polymyalgia rheumatica, giant cell arteritis, or both diseases: results from a national rheumatology database. — Albrecht K, Huscher D, Buttgereit F, Aringer M, Hoese G, Ochs W et al. Rheumatology international (2018)
    16. [16]
      Assessment of 2012 EULAR/ACR new classification criteria for polymyalgia rheumatica in Japanese patients diagnosed using Bird's criteria. — Matsui K, Maruoka M, Yoshikawa T, Hashimoto N, Nogami M, Sekiguchi M et al. International journal of rheumatic diseases (2018)
    17. [17]
      "In sickness and in health": the peculiar occurrence of polymyalgia rheumatica in married cohabiting couples--a case series and review of the literature. — Gerardi MC, Rutigliano IM, Scrivo R, Priori R, Riccieri V, Valesini G Clinical rheumatology (2016)
    18. [18]
      Differentiation between Polymyalgia Rheumatica (PMR) and Elderly-Onset Rheumatoid Arthritis Using 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: Is Enthesitis a New Pathological Lesion in PMR? — Wakura D, Kotani T, Takeuchi T, Komori T, Yoshida S, Makino S et al. PloS one (2016)
    19. [19]
      Development of a Provisional Core Domain Set for Polymyalgia Rheumatica: Report from the OMERACT 12 Polymyalgia Rheumatica Working Group. — Helliwell T, Brouwer E, Pease CT, Hughes R, Hill CL, Neill LM et al. The Journal of rheumatology (2016)
    20. [20]
      Polymyalgia rheumatica: strategies for efficient practice and quality assurance. — Schirmer M, Dejaco C, Dasgupta B, Matteson EL Rheumatology international (2015)
    21. [21]
      Performance of the new 2012 EULAR/ACR classification criteria for polymyalgia rheumatica: comparison with the previous criteria in a single-centre study. — Macchioni P, Boiardi L, Catanoso M, Pazzola G, Salvarani C Annals of the rheumatic diseases (2014)
    22. [22]
      The process from symptom onset to rheumatology clinic in polymyalgia rheumatica. — Dalkılıç E, Tufan AN, Hafızoğlu E, Hafızoğlu M, Tufan F, Oksuz F et al. Rheumatology international (2014)
    23. [23]
      Study of professional practices among rheumatologists in Burgundy: initial corticotherapy in polymyalgia rheumatica. — Ornetti P, Guillibert-Karras C, Garrot JF, Gros F, Gérard N, Julien L et al. Clinical rheumatology (2011)
    24. [24]
      Validity of the polymyalgia rheumatica activity score in primary care practice. — Binard A, Lefebvre B, De Bandt M, Berthelot JM, Saraux A Annals of the rheumatic diseases (2009)
    25. [25]
      Developing classification criteria for polymyalgia rheumatica: comparison of views from an expert panel and wider survey. — Dasgupta B, Salvarani C, Schirmer M, Crowson CS, Maradit-Kremers H, Hutchings A et al. The Journal of rheumatology (2008)
    26. [26]
      Use of physician services in a population-based cohort of patients with polymyalgia rheumatica over the course of their disease. — Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE Arthritis and rheumatism (2005)
    27. [27]
      Trends in the incidence of polymyalgia rheumatica over a 30 year period in Olmsted County, Minnesota, USA. — Doran MF, Crowson CS, O'Fallon WM, Hunder GG, Gabriel SE The Journal of rheumatology (2002)
    28. [28]
      Arthritis or arteritis. — George E, Dieppe PA Clinical rheumatology (1994)
    29. [29]
      Effect of hemiparesis on polymyalgia rheumatica. — Brelsford WG, Goodman RE The Journal of rheumatology (1988)
    30. [30]
      Polymyalgia rheumatica. — Sewell JR British journal of hospital medicine (1986)
    31. [31]
      Polymyalgia rheumatica/giant cell arteritis in husband and wife. — Kyle MV, Hazleman BL, King RH Clinical rheumatology (1984)
    32. [32]
      Polymyalgia rheumatica and temporal arteritis in a married couple. — Garfinkel D, Bograd H, Salamon F, Aderka D, Shoenfeld Y, Weinberger A et al. The American journal of the medical sciences (1984)
    33. [33]
      Polymyalgia rheumatica: a general practice experience. — Turner RM The Journal of the Royal College of General Practitioners (1983)
    34. [34]
      Polymyalgia rheumatica in a defined elderly community. — Silman AJ, Currey HL Rheumatology and rehabilitation (1982)
    35. [35]
      Strathpeffer Spa: Dr William Bruce and polymyalgia rheumatica. — Mowat AG Annals of the rheumatic diseases (1981)
    36. [36]
      Chronic hepatitis in polymyalgia rheumatica. — Thompson K, Roberts PF Postgraduate medical journal (1976)
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