Pathogenesis, Diagnosis and Management of Polymyalgia Rheumatica

  • Dario CamellinoEmail author
  • Andrea Giusti
  • Giuseppe Girasole
  • Gerolamo Bianchi
  • Christian Dejaco
Review Article


Polymyalgia rheumatica is an inflammatory rheumatic disease of the elderly characterised by pain and stiffness in the neck and pelvic girdle, and is the second most common inflammatory rheumatic condition in this age group, after rheumatoid arthritis. Polymyalgia rheumatica can occur independently or in association with giant cell arteritis, which is the most common form of primary vasculitis. The diagnosis of polymyalgia rheumatica is usually based on clinical presentation and increase of inflammatory markers. There are no pathognomonic findings that can confirm the diagnosis. However, different imaging techniques, especially ultrasonography, can assist in the identification of polymyalgia rheumatica. Glucocorticoids are the cornerstone of the treatment of polymyalgia rheumatica, but they might be associated with different adverse events. A subgroup of patients presents with a refractory disease course and, in these cases, adding methotrexate as a steroid-sparing agent could be useful. In this review, we summarise the latest findings regarding the pathogenesis, diagnosis and management of polymyalgia rheumatica and try to highlight the possible pitfalls, especially in elderly patients.


Compliance with Ethical Standards


No sources of funding or writing assistance were received for the preparation of this article.

Conflict of interest

Dario Camellino has received consultancy and speaker fees from AbbVie, Celgene, Janssen-Cilag, Lilly, Mylan and Sanofi; none related to this article. Andrea Giusti has received consultancy and speaker fees from Abiogen, Amgen, EffRx, Eli Lilly, Internis, Labatec, NewBridge, PharmaLink and UCB; none related to this article. Giuseppe Girasole has received speaker fees from Abiogen; none related to this article. Gerolamo Bianchi has received honoraria and/or consulting fees from Abbvie, Abiogen, Alfa-Sigma, Amgen, BMS, Celgene, Chiesi, Eli Lilly, GSK, Janssen, Medac, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Sanofi Genzyme and Servier. Christian Dejaco has received consultancy fees and honoraria from AbbVie, Celgene, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Sandoz and UCB and unrestricted grant support from Celgene.


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of RheumatologyLa Colletta Hospital, Azienda Sanitaria Locale 3ArenzanoItaly
  2. 2.Autoimmunology Laboratory, Department of Internal MedicineUniversity of GenoaGenoaItaly
  3. 3.Dienst für Rheumatologie, Servizio di reumatologia, Südtiroler Sanitätsbetrieb, Azienda Sanitaria dell’Alto Adige, Krankenhaus Bruneck, Ospedale di BrunicoBruneckItaly
  4. 4.Department of RheumatologyMedical University GrazGrazAustria

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