Polymyalgia Rheumatica Treatment

What Is Polymyalgia Rheumatica?

Polymyalgia rheumatica is an inflammatory condition that causes deep, aching pain and stiffness across the shoulders, neck, upper arms, hips and thighs. It almost always affects adults over the age of 50, comes on over days to weeks rather than years, and responds to anti-inflammatory treatment rather than surgery. The condition is common enough that most rheumatologists see it regularly, yet unfamiliar enough that many patients have never heard the name before their diagnosis.

The first sign is often a changed morning. Getting out of bed, lifting the arms to dress, turning in a chair, climbing stairs or rising from a low seat becomes unexpectedly difficult. The stiffness is usually worst after waking or after sitting still, and it may ease somewhat as the day goes on. Because polymyalgia rheumatica appears at a stage of life when independence and routine matter deeply, the sudden loss of easy movement is unsettling. Patients ask reasonable questions: Is this arthritis? A muscle disease? Could it be cancer, an infection or another autoimmune condition? Will treatment mean long-term medication?

The honest answers are reassuring but not simple. Polymyalgia rheumatica is a treatable inflammatory disorder, and most patients improve substantially once treatment starts. At the same time, it needs careful diagnosis, because its symptoms overlap with many other conditions, and it needs ongoing monitoring, because it is linked to a related vascular disease called giant cell arteritis that can threaten vision if it goes unrecognised. Good care confirms the diagnosis, relieves the inflammation, protects daily function and manages corticosteroid therapy safely over time. This page explains each of those steps in turn.

PMR Medical Abbreviation: What Does PMR Stand For?

The PMR medical abbreviation stands for polymyalgia rheumatica. Broken down, the name is descriptive rather than mysterious: poly means many, myalgia means muscle pain, and rheumatica refers to the rheumatic, or inflammatory musculoskeletal, family of diseases. You may see PMR written in clinic letters, blood test requests and discharge summaries. The abbreviation is worth knowing for another reason: PMR is also used in other medical contexts, such as physical medicine and rehabilitation, so when reading about your condition it helps to check that the source is discussing the inflammatory disease and not something else that shares the letters.

Is PMR Disease a Type of Arthritis?

PMR disease is not arthritis in the everyday sense, although the two are related and sometimes confused. Arthritis means inflammation or damage within the joints themselves. In polymyalgia rheumatica, the inflammation sits mainly in the structures around the joints — the bursae and tendon sheaths of the shoulder and hip girdles — which is why the pain feels muscular and widespread rather than localised to a single swollen joint. Despite the name, the muscles themselves are not damaged: muscle enzyme tests are typically normal, and true muscle weakness is not a feature. This distinction matters in practice, because treatments and expectations for PMR differ from those for osteoarthritis, rheumatoid arthritis and genuine muscle diseases.

Polymyalgia Rheumatica Symptoms

Polymyalgia rheumatica symptoms centre on pain and stiffness in the shoulder and hip girdles, affecting both sides of the body and worst in the morning or after rest. The shoulders are involved most often, followed by the neck, hips, upper arms and thighs. The hands and feet are less commonly the main sites, although some patients notice swelling or discomfort in peripheral joints, and a few develop puffy swelling of the hands.

Morning stiffness is the defining feature. Many patients report stiffness lasting longer than 30 to 45 minutes after waking, and returning after any long period of inactivity — a car journey, a film, an afternoon in a chair. Alongside the pain and stiffness, some people experience fatigue, low-grade fever, reduced appetite, unintentional weight loss or a general sense of being unwell. These systemic symptoms reflect the fact that PMR is a whole-body inflammatory process, not a mechanical injury.

That inflammatory character is a useful clue. Mechanical problems such as tendon strain or worn joints usually hurt more with use and settle with rest. PMR behaves differently: the pain can be present without any injury, it does not improve fully with rest, and ordinary pain relievers often make little difference. When a person over 50 develops new, bilateral, inflammatory-pattern stiffness of the shoulders and hips, PMR belongs high on the list of explanations to consider.

What Are the Common Symptoms of a Polymyalgia Rheumatica (PMR) Flare-Up?

A PMR flare-up usually looks like the original illness returning: morning stiffness lengthens again, the deep aching in the shoulders and hips comes back, and everyday movements that had become easy grow difficult once more. Flares most often appear while the corticosteroid dose is being reduced or after treatment has stopped. Fatigue and a vague sense of being unwell may accompany the returning stiffness, and inflammatory blood markers often rise, although symptoms can precede any change in the blood tests. Not every ache during treatment is a flare — coexisting shoulder, hip or spine problems can cause pain of their own — which is why returning symptoms are best assessed by the treating team rather than assumed to be one thing or the other.

Polyarthralgia or Polymyalgia Rheumatica: What Is the Difference?

Polyarthralgia simply means pain in several joints; it is a description of a symptom, not a diagnosis. Polymyalgia rheumatica, by contrast, is a specific inflammatory disease with a characteristic pattern: shoulder and hip girdle stiffness, onset after 50, prolonged morning stiffness and, usually, raised inflammatory markers. Many different conditions can produce polyarthralgia — viral infections, rheumatoid arthritis, osteoarthritis, thyroid disorders and more — and part of the diagnostic work in suspected PMR is deciding whether widespread joint pain fits the PMR pattern or points somewhere else. If your referral letter mentions polyarthralgia, it means the pattern still needs to be defined, not that a diagnosis has been made.

Causes and Risk Factors of Polymyalgia Rheumatica

The exact cause of polymyalgia rheumatica is not known. What is well established is the profile of the people it affects: almost always adults over 50, with risk rising with age, and more women than men, although men certainly develop it. It is reported more often in people of northern European ancestry, which, together with certain immune-system gene associations, suggests that inherited susceptibility plays a part. On that background, the immune system begins to drive inflammation in the tissues around the shoulders and hips, and ageing of the immune system itself is thought to contribute.

What Causes PMR Polymyalgia Rheumatica?

No single cause of PMR polymyalgia rheumatica has been identified; current understanding points to a combination of genetic predisposition, immune-system changes with age and possibly environmental exposures. Researchers have investigated seasonal patterns and preceding infections as potential contributors, but no infection or exposure has been proven to cause the disease, and PMR is not contagious. It is also not caused by anything the patient did or failed to do — it is not the result of overuse, poor posture or lack of exercise. The close relationship with giant cell arteritis, which shares the same age group and inflammatory signature, suggests the two conditions sit on a spectrum of related immune-driven inflammation.

What Triggers Polymyalgia Rheumatica?

No specific trigger for the onset of polymyalgia rheumatica has been confirmed, although patients often look for one, and some recall a preceding illness or stressful period. Once the disease is established and treated, the more practical question is what can provoke a flare: reducing the corticosteroid dose too quickly is the most common association, and intercurrent illness can sometimes coincide with returning symptoms. Because tapering speed is the one flare-related factor clinicians can actually control, the tapering plan — and the willingness to slow it down when symptoms stir — is where most of the preventive effort goes.

How Polymyalgia Rheumatica Is Diagnosed

There is no single test that proves polymyalgia rheumatica. Diagnosis rests on recognising the clinical pattern, supporting it with blood tests, and — just as importantly — excluding the conditions that can imitate it. Evaluation begins with a detailed history: when the symptoms started, which areas are affected, how long morning stiffness lasts, whether there is fever or weight loss, and whether there are any features suggesting giant cell arteritis. A medication review matters too, because certain drugs can cause muscle symptoms that mimic PMR.

Physical examination focuses on the shoulders, neck, hips, spine and peripheral joints. In PMR, pain and stiffness limit movement, but true muscle weakness is not the main finding. If weakness is prominent, other diagnoses — inflammatory muscle disease, nerve compression, neurological conditions — must be considered instead. Where giant cell arteritis is a concern, the examination extends to the temporal arteries, pulses, blood pressure in both arms and a review of visual symptoms.

Blood tests usually include the inflammatory markers erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These are elevated in most patients with active PMR, but not in all, so normal markers do not entirely exclude the diagnosis and raised markers do not confirm it on their own. Additional tests commonly assess for anaemia, liver and kidney function, muscle enzymes, rheumatoid arthritis antibodies and thyroid disease, since an underactive or overactive thyroid can produce aching, fatigue and stiffness that resemble PMR. When fever or systemic symptoms are prominent, input from the infectious diseases team may help exclude hidden infection, and unexplained weight loss may prompt broader evaluation, sometimes involving the medical oncology department, because malignancy can occasionally present with PMR-like symptoms.

Imaging is used selectively rather than routinely. Ultrasound of the shoulders and hips can show the bursitis and tenosynovitis typical of PMR and can help distinguish inflammation from tendon tears or degenerative joint disease. Magnetic resonance imaging may be useful in complex cases to assess deeper inflammatory changes or rule out structural problems. If inflammation of larger arteries is suspected, vascular imaging may be recommended. The purpose of each test is the same: to make the diagnosis more accurate and to catch any condition that would change the treatment.

One caution deserves emphasis. Corticosteroids improve many inflammatory conditions temporarily, so a good response to a trial of steroids supports PMR but does not prove it. Starting treatment before an adequate evaluation can mask another disease and delay the correct diagnosis. Specialist assessment before, or soon after, treatment begins is the safeguard against that trap.

How Polymyalgia Rheumatica Is Treated

Treatment for polymyalgia rheumatica is medical, not surgical, and its goals are straightforward: reduce the inflammation quickly, restore daily function, prevent complications and use the lowest effective medication dose for the shortest necessary time. The mainstay is corticosteroid therapy, most commonly oral prednisone or an equivalent. Many patients notice meaningful improvement soon after starting — sometimes strikingly so — although the complete course of treatment typically extends over months and sometimes longer, depending on symptoms, blood test trends and relapse risk.

PMR treatment is a monitored programme, not simply a prescription. The physician begins with a dose matched to symptom severity and the patient’s medical profile, then reduces it gradually according to response — a process called tapering. Taper too fast and symptoms tend to return; stay on higher doses longer than necessary and the risk of steroid side effects rises. Striking that balance requires experienced judgement and regular reassessment rather than a fixed schedule applied to everyone.

Because corticosteroids act on many body systems, good PMR care attends to more than the stiffness. Bone health is a priority, since steroids can thin bone: calcium and vitamin D guidance, osteoporosis screening and, for some patients, preventive bone medication may be discussed. Blood pressure, blood sugar, weight, mood, sleep, infection risk and eye health are all monitored, and stomach protection or vaccination review may be relevant for some patients. Where needed, care is coordinated with endocrinologists, ophthalmologists or cardiologists. When symptoms are atypical, severe, recurrent or hard to control on steroids alone, a rheumatologist may consider steroid-sparing medication such as methotrexate to reduce reliance on corticosteroids.

One point about stopping deserves explanation rather than alarm. During months of corticosteroid treatment, the body’s own steroid production can become suppressed, because the adrenal glands scale back when medication supplies cortisol from outside. Stopping abruptly can leave the body temporarily short of its own cortisol — a state that echoes, in mechanism, the adrenal insufficiency seen in Addison disease. This is why tapering decisions belong with the treating doctor, and why a gradual, supervised reduction protects both against relapse and against adrenal problems.

What Is the Newest Treatment for Polymyalgia Rheumatica?

The newest direction in polymyalgia rheumatica treatment is biological medication targeting the interleukin-6 pathway, one of the chemical signals driving the inflammation. An interleukin-6 receptor blocker, sarilumab, has been approved in some countries for patients whose PMR keeps relapsing or who cannot taper corticosteroids adequately; related medicines in the same class continue to be studied. These are specialist-prescribed injections, not first-line therapy: corticosteroids remain the standard initial treatment, and biological options are considered case by case by a rheumatologist, weighing relapse history, steroid side effects and other medical conditions. For patients who have relapsed repeatedly, these newer options are typically among the topics a rheumatologist weighs when revising the treatment plan.

Can Polymyalgia Rheumatica Be Cured?

No treatment for polymyalgia rheumatica is currently described as a cure; what treatment reliably does is control the inflammation while the disease runs its course, and in many patients the disease eventually enters lasting remission and medication can be stopped. This is worth keeping in mind when reading personal accounts titled “how I cured my polymyalgia rheumatica”. Such stories usually describe remission — which is a real and common outcome — reached alongside conventional treatment, and sometimes attribute it to a diet, supplement or regimen that has not been shown to treat the disease. No diet or supplement has been proven to replace anti-inflammatory treatment for active PMR, and changes to prescribed medication are decisions for the treating doctor. Healthy eating, activity and sleep genuinely support wellbeing during treatment; they are companions to medical care, not substitutes for it.

Step by Step: The Polymyalgia Rheumatica Care Pathway

Although every plan is individualised, PMR care tends to follow a recognisable sequence:

1. Comprehensive consultation. The physician maps the symptom pattern, its speed of onset, systemic features such as fever or weight loss, current medications, previous rheumatic disease, cancer history, infections and the chronic conditions that will shape treatment safety.
2. Physical examination. Shoulders, neck, hips, spine and peripheral joints are assessed for inflammatory limitation, with checks for true weakness, temporal artery tenderness and other signs that would point away from PMR or towards giant cell arteritis.
3. Laboratory testing. ESR and CRP establish a baseline for monitoring; blood count, liver, kidney and thyroid tests, muscle enzymes and autoimmune markers are added as the picture requires. Results are interpreted together with the clinical findings, never in isolation.
4. Selective imaging. Ultrasound, MRI or vascular imaging is used when it would genuinely change the assessment — to confirm inflammatory patterns, exclude structural disease or evaluate the arteries.
5. Starting corticosteroids. The dose reflects symptom severity, body size, comorbidities and whether giant cell arteritis is suspected; suspected arteritis follows a different, more urgent pathway with higher doses and specialist involvement. Patients receive clear instructions on taking the medication, the side effects to watch for and when to contact their care team.
6. Early response review. Improvement is assessed within days to a few weeks. Strong improvement supports the diagnosis; a weaker response than expected sends the physician back to the differential diagnosis, further testing or additional specialist opinions.
7. Gradual tapering. Once symptoms are controlled, the dose is reduced step by step, adjusted to symptoms and inflammatory markers, with the pace slowed if the disease stirs.
8. Ongoing monitoring. Follow-up visits track symptom control, mobility, sleep, mood, blood pressure, blood sugar, weight and bone health, with bone density testing, vitamin D assessment or fall-risk review where appropriate. Patients leave with written guidance for follow-up testing and dose adjustments between visits.

The duration of this pathway varies. Some patients complete treatment within a relatively limited period; others need a longer taper because of relapse or persistent inflammation. Recovery is a process rather than a single event, and the aim throughout is not only less pain but preserved strength, independence and long-term safety.

Polymyalgia Rheumatica and Giant Cell Arteritis

Polymyalgia rheumatica is closely associated with giant cell arteritis, an inflammation of medium and large arteries — most famously those of the temple and scalp — that occurs in the same age group. Not every patient with PMR develops giant cell arteritis, and not every patient with arteritis has PMR, but the overlap is frequent enough that every PMR assessment includes screening for it. The features clinicians watch for are new headache, scalp tenderness, jaw pain when chewing, vision changes, double vision, unexplained fever and tenderness over the temples. Clinicians treat these features as urgent, because untreated giant cell arteritis can cause permanent vision loss and other vascular complications, and because its treatment differs from standard PMR therapy — typically higher corticosteroid doses started without delay. This is the single most important reason why PMR is monitored throughout its course rather than treated and forgotten.

Can You Die From Polymyalgia Rheumatica?

Polymyalgia rheumatica itself is rarely a direct threat to life; it is a painful and disabling condition, not usually a lethal one. The serious risks associated with a PMR diagnosis come from elsewhere: from unrecognised giant cell arteritis, with its potential for vision loss and vascular complications; from the indirect effects of untreated pain, such as immobility, deconditioning and falls in older adults; and from corticosteroid side effects when treatment is prolonged and unmonitored — bone fractures, worsened diabetes, raised blood pressure and infection susceptibility among them. Each of these risks is precisely what structured monitoring exists to manage. Framed honestly: the disease is treatable, the treatment is manageable, and the dangerous scenarios are largely the ones in which neither is being watched.

Why Acting Early Matters

Early evaluation matters because untreated inflammatory pain erodes life quickly. Patients who cannot move comfortably become less active, sleep poorly, lose confidence and decondition; in older adults, that chain of events contributes to falls, loss of independence and worsening of other chronic conditions. The sooner the inflammation is identified and treated, the shorter that chain gets.

Timely diagnosis also spares patients months of ineffective treatment. It is common for people with unrecognised PMR to cycle through pain medications, physiotherapy courses and injections aimed at mechanical problems before the inflammatory nature of the condition is spotted. Supportive measures have their place, but they cannot substitute for anti-inflammatory treatment when PMR is active. The reverse error matters just as much: corticosteroids started without adequate evaluation can temporarily improve many diseases, masking the real diagnosis and delaying its treatment.

The most compelling argument for early, structured care is the giant cell arteritis association described above. Prompt recognition and treatment of arteritis protects vision; that protection depends on someone assessing for it in the first place, which is built into a proper PMR pathway from day one.

Finally, early care makes the treatment itself safer. Risk factors for osteoporosis, diabetes, hypertension, stomach irritation, infection, cataracts and mood changes can be identified before steroids begin, and preventive measures put in place from the start. Prevention organised at the beginning of treatment is far easier than damage control months into it.

Benefits of Polymyalgia Rheumatica Treatment

When the diagnosis is accurate and the treatment is monitored, PMR care offers concrete benefits for daily life and long-term health:

Benefit	What It Means for You
Reduction in inflammatory pain and stiffness	Many patients experience easier movement, especially in the shoulders, neck and hips, as the inflammation comes under control.
Improved morning function	Getting out of bed, dressing, bathing and walking become less difficult as morning stiffness shortens.
Clearer diagnosis	A structured evaluation distinguishes PMR from arthritis, muscle disease, infection, cancer-related symptoms and other inflammatory disorders.
Relapse monitoring	Regular follow-up catches returning symptoms early, allowing medication adjustments before function declines significantly.
Safer corticosteroid use	Monitoring supports the lowest effective dose and reduces the risk of side effects affecting bones, blood sugar, blood pressure, eyes and mood.
Assessment for giant cell arteritis	Screening for warning signs identifies the patients who need urgent vascular or eye-related evaluation.

Recovery Timeline After Starting PMR Treatment

Recovery varies from person to person, but the following timeline reflects what many patients experience when PMR is diagnosed and treated appropriately.

Time Period	What Patients Can Expect
Day 1	Evaluation includes medical history, physical examination and blood tests. If PMR is likely and urgent alternatives have been considered, corticosteroid treatment may begin.
First week	Many patients begin to feel less stiffness and pain. The care team reviews the response and watches for side effects or features suggesting another diagnosis.
First month	Symptoms and inflammatory markers are reassessed. If improvement is appropriate, a gradual tapering plan begins or continues.
Several months	Medication is reduced step by step. Follow-up focuses on relapse prevention, bone health, blood pressure, blood sugar and return to daily activity.
Longer term	Some patients complete therapy after sustained remission; others need a longer taper or additional rheumatology management because of relapse or steroid-related concerns.

Does PMR Ever Go Away?

Yes — for many patients, PMR eventually goes away, in the sense that the disease enters remission and medication can be withdrawn without symptoms returning. The route there is rarely a straight line. Some people complete a taper on the first attempt; others relapse once or more along the way and need the dose raised temporarily before descending again; a smaller group needs longer-term management with a rheumatologist, sometimes including steroid-sparing medication. What the condition generally does not do is destroy joints or muscles in the way that some other rheumatic diseases can, so patients who reach remission are usually left without structural damage from the disease itself. The practical implication is patience: the taper serves the remission, and rushing it is the commonest way to postpone it.

How to Recover From Polymyalgia Rheumatica?

Recovery from polymyalgia rheumatica rests on three things: taking the anti-inflammatory treatment as prescribed, keeping every monitoring appointment, and rebuilding activity as the inflammation settles. Once movement becomes easier, gentle, regular activity — walking, stretching, gradually restored routines — helps reverse the deconditioning that painful weeks or months leave behind. Physiotherapy can help patients who have lost strength, have balance concerns or carry coexisting shoulder, hip or spine problems, with exercise introduced sensibly and adjusted to pain level, age, cardiovascular status and fall risk. Attention to bone health, sleep and weight supports the body through the steroid course. Just as important is reporting returning stiffness early rather than enduring it: a small, prompt adjustment to the plan is easier than recovering lost ground after a full flare.

Factors That Influence Outcomes

The outcome of PMR treatment depends first on diagnostic accuracy. Patients with a classic symptom pattern, elevated inflammatory markers and a strong response to corticosteroids usually follow a straightforward path. When symptoms are unusual — one-sided pain, normal inflammatory markers, true muscle weakness, prominent systemic illness — additional evaluation becomes important, because the greatest risk in PMR care is confidently treating the wrong disease.

Response to initial corticosteroid therapy is the next signpost. Substantial improvement supports the diagnosis; incomplete or absent improvement prompts reconsideration. Some patients also carry coexisting conditions — osteoarthritis, rotator cuff disease, spinal stenosis — that continue to cause pain even after the PMR inflammation improves. Recognising these overlapping problems keeps expectations realistic and may direct physiotherapy or other supportive care at the right target.

The tapering schedule strongly influences both relapse risk and medication safety. Too rapid, and symptoms tend to return; too slow, and steroid exposure accumulates unnecessarily. The best schedule is individual, shaped by symptoms, blood test trends, previous relapses and other medical conditions — and by a patient who reports recurrence early instead of waiting for it to become severe.

Comorbidities shape the plan throughout. Diabetes may become harder to control during corticosteroid therapy; hypertension, osteoporosis, glaucoma, cataracts, mood disorders and infection history all call for specific attention. A patient at high fracture risk may need a more intensive bone-protection strategy; a patient with cardiovascular risk may need closer monitoring of blood pressure, weight and metabolic markers. Effective PMR care always runs on two tracks at once: controlling the disease and preventing treatment-related harm.

Patient understanding is a genuine determinant of success, not a courtesy. Patients who know why the steroids are being given, why the taper is gradual, what a flare feels like and which giant cell arteritis features their clinicians consider urgent are better equipped to participate in their own care. Written instructions matter especially when follow-up will continue with a different physician from the one who began the treatment, because they let that physician continue monitoring with a clear picture of the plan.

Finally, movement itself influences the outcome. Inflammation control opens the door; walking through it — literally — is what restores confidence, strength and independence. Patients who resume activity as symptoms permit tend to regain function faster than those who wait for every last ache to disappear.

How Acibadem Approaches Polymyalgia Rheumatica Evaluation

The lasting value of a PMR assessment lies almost entirely in its quality: diagnostic clarity, a considered treatment plan and a second opinion where the picture is uncertain. PMR overlaps with many other disorders, and its treatment stretches over months of medication management, so the initial evaluation carries long consequences.

At Acibadem, suspected polymyalgia rheumatica is evaluated through a structured pathway by physicians familiar with inflammatory rheumatic disease and with the broader differential diagnosis of pain and stiffness in older adults. Where the case requires it, care draws on rheumatology, internal medicine, radiology, ophthalmology, endocrinology, cardiology, and physical medicine and rehabilitation. This multidisciplinary reach matters most when symptoms suggest giant cell arteritis, when imaging is needed, when corticosteroid risks are high, or when another diagnosis must be excluded before treatment proceeds. The diagnostic toolkit — laboratory testing, musculoskeletal ultrasound, cross-sectional imaging and vascular assessment where clinically indicated — is applied selectively: the right test for the right patient, not testing for its own sake.

Because PMR treatment does not end when a patient leaves the hospital, planning for continuity is part of the clinical work itself. Patients typically leave with a written tapering plan, a schedule of follow-up blood tests, guidance about side effects and clear documentation that any physician involved in their ongoing care can work from. A second-opinion review, where sought, examines previous blood tests, imaging, medication history and symptom response in order to answer the practical questions that decide the next months: Is PMR the most likely diagnosis? Is the current steroid dose appropriate? Can tapering continue safely? Are side effects being monitored? Is there any evidence of giant cell arteritis or of another condition altogether?

Individual circumstances shape every plan. A patient with diabetes needs a different monitoring strategy from one with osteoporosis or eye disease; a patient who has already relapsed during tapering needs a revised schedule rather than a repeat of the old one; a patient with features of giant cell arteritis needs a different and faster pathway entirely. The point of a structured, multidisciplinary evaluation is precisely that these distinctions are made deliberately rather than by default.

Living With Polymyalgia Rheumatica: What Good Care Looks Like

Polymyalgia rheumatica is disruptive and frightening when it first appears, and it asks for patience during the months that follow — but it is also one of the more gratifying conditions in rheumatology to treat, because well-managed inflammation usually gives patients their mornings back. The measure of good care is not only how quickly the pain eases. It is whether the diagnosis was confirmed rather than assumed, whether the taper was paced to the disease rather than the calendar, whether bones, blood pressure, blood sugar and eyes were watched while the steroids did their work, and whether anyone was checking, throughout, for the warning features of giant cell arteritis. A person recently diagnosed with PMR is entitled to expect all of these things from their care, wherever it takes place — and when relapse, troublesome side effects or an uncertain taper complicate the course, a reassessment of the plan is part of good care rather than a sign of failure. Managed this way, most people with polymyalgia rheumatica move steadily from stiff, difficult mornings back towards the ordinary, undramatic mobility they had before the disease arrived — which is, in the end, the whole aim of treatment.