Polymyalgia Rheumatica N008

Current RMA Instruments:

Changes from previous Instruments:

ICD Coding:

• ICD-10-AM Codes: M35.3

Brief description

Polymyalgia Rheumatica (PMR) is a chronic inflammatory rheumatic disorder characterized by persistent pain and stiffness in the shoulders, hips, and neck. Sometimes, there is also lower back pain and stiffness. Older adults are commonly affected.

This SoP covers cases in which Polymyalgia Rheumatica occurs in isolation and without the commonly associated condition of Giant Cell Arteritis. Therefore, there is systemic inflammation without vascular involvement. 

Confirming the diagnosis

The diagnosis is made from clinical evaluation, with pathology test results (elevated ESR and/or CRP) generally required for confirmation. Imaging (e.g. ultrasound or MRI) may also be undertaken and show inflammation in the affected areas. For people who are able to tolerate corticosteroids, a trial to assess for responsiveness to this treatment may be undertaken. 

To establish this diagnosis, the assessment and/or management may involve consultation with the following medical specialists: a rheumatologist, a geriatrician or a general medicine physician. However, general practitioners are commonly able to confirm this diagnosis with the appropriate test results and trial of treatment. 

Additional diagnoses covered by SOP

• Rheumatic polymyalgia (older name for this condition)

Conditions not covered by SOP

• Polymyalgia Rheumatica co-existent with Giant Cell Arteritis/temporal arteritis *  Giant Cell Arteritis SoP 

^* another SOP applies 

Clinical onset

The onset of Polymyalgia Rheumatica is typically subacute or gradual, though some individuals may experience a more acute onset of symptoms. The clinical onset refers to the earliest point in time, as identified by the treating doctor, when symptoms and signs consistent with the diagnosis of Polymyalgia Rheumatica were observed.

Clinical worsening

Most people respond well to treatment for this condition and will achieve remission with appropriate management. The normal course of isolated, treated Polymyalgia Rheumatica is for the condition to gradually resolve over 1 to 2 years (occasionally it may be longer). Monitoring for the commonly associated condition of Giant Cell Arteritis and for complications from steroid treatment is required. These can arise but are separate conditions and not worsening of the Polymyalgia Rheumatica. The factors that are considered causal to clinical onset are also relevant for clinical worsening, as well as the inability to obtain appropriate management for the condition.