Polymyalgia rheumatica (PMR) is an inflammatory condition that mainly affects adults over 50. It commonly causes pain and stiffness around the shoulders, neck and hips, with symptoms often being worse in the morning or after periods of inactivity. Although PMR usually responds well to corticosteroid treatment, it can affect mobility, daily activities and quality of life. It can also be associated with more serious health problems, particularly giant cell arteritis (GCA).
Knowing about Polymyalgia Rheumatica complications can help you recognise warning signs early and understand why regular medical follow-up is important. Some complications result from the inflammatory disease itself, while others are associated with the long-term corticosteroid treatment commonly needed to control PMR. The main Polymyalgia Rheumatica complications, the risks of untreated PMR, potential treatment-related problems and when you should seek urgent medical attention.
What Is Polymyalgia Rheumatica?
What Is Polymyalgia Rheumatica? Polymyalgia rheumatica is an inflammatory disorder that usually develops relatively quickly. Common symptoms include aching and stiffness in both shoulders, the neck and the hip area. Some people also experience fatigue, low-grade fever, reduced appetite or unintended weight loss.
The condition is different from ordinary muscle soreness caused by exercise or ageing. The inflammation can make everyday activities such as getting out of bed, dressing, raising your arms or getting out of a chair difficult.
Corticosteroids such as prednisolone are the main treatment. Many people experience significant improvement within a few days of starting treatment, but therapy often needs to continue for many months and sometimes around two years or longer. The dose is usually reduced gradually according to symptoms and medical assessment.
Because Polymyalgia Rheumatica treatment can be prolonged, understanding both PMR itself and the possible effects of medication is important.
1. Giant Cell Arteritis
The most important complication associated with PMR is giant cell arteritis, also called temporal arteritis.
Giant cell arteritis is an inflammatory disease affecting medium and large arteries, particularly arteries around the head and sometimes the aorta and its major branches. PMR and giant cell arteritis are closely linked, and some people develop symptoms of both conditions.
Possible Polymyalgia Rheumatica symptoms of giant cell arteritis include:
- A new or persistent headache
- Scalp tenderness
- Pain in the jaw while chewing or talking
- Double vision
- Blurred vision
- Partial or complete loss of vision
- Unusual tiredness or flu-like symptoms
This complication requires urgent medical attention. Inflammation affecting blood vessels supplying the eyes can cause permanent vision loss if treatment is delayed.
If you have PMR and suddenly develop a new headache, jaw pain while eating or any change in vision, contact a healthcare professional urgently.
2. Vision Loss
Vision loss deserves particular attention because it can occur as a consequence of giant cell arteritis rather than PMR itself.
Inflammation of arteries supplying the eye can interfere with blood flow. Vision changes may initially be temporary, but untreated giant cell arteritis can result in permanent blindness.
This is one reason doctors routinely ask people with PMR about headaches, jaw discomfort and visual symptoms.
Do not wait for your next routine appointment if you experience sudden or unexplained vision changes.
3. Stroke Risk
Another potentially serious complication associated with giant cell arteritis is stroke.
Because giant cell arteritis causes inflammation in blood vessels, it can interfere with normal circulation. NHS guidance notes that untreated temporal arteritis can lead to serious complications including stroke and blindness.
The risk of stroke should not make someone with PMR panic. Most people with PMR do not develop these severe complications. The important point is that symptoms suggesting giant cell arteritis require rapid assessment and treatment.
4. Aortic Problems
Giant cell arteritis can sometimes involve large arteries, including the aorta. Inflammation affecting the aorta can contribute to complications such as an aortic aneurysm, in which part of the artery becomes weakened and enlarged.
An aneurysm may not cause obvious symptoms, which is why appropriate follow-up can be important for people who have had giant cell arteritis.
Aortic complications are not a typical feature of uncomplicated PMR. They are more closely associated with the large-vessel involvement that can occur with giant cell arteritis.
5. Persistent Pain and Stiffness
One of the more common Polymyalgia Rheumatica health problems is ongoing pain and stiffness when inflammation is not adequately controlled.
Untreated or poorly controlled PMR can make movement difficult. Simple activities such as walking, climbing stairs, bathing, dressing or getting out of a chair may become challenging. Persistent symptoms can also interfere with sleep and normal daily routines.
If symptoms return while reducing your corticosteroid dose, tell your doctor rather than changing the dose yourself. Relapses can occur, and treatment may need adjustment.
6. Reduced Mobility and Loss of Independence
Pain and stiffness can encourage people to move less. Over time, reduced physical activity can contribute to weakness and loss of physical fitness.
For an older adult, this may have a larger impact because maintaining strength and balance is important for independence. Difficulty getting out of a chair or walking comfortably may also make normal activities more demanding.
Appropriate treatment, gradual physical activity and advice from a healthcare professional can help maintain mobility.
7. Relapses
PMR can return after symptoms have improved. A relapse means that symptoms become active again, often while the corticosteroid dose is being reduced or after treatment has ended.
Common signs of a relapse can include:
- Increased shoulder stiffness
- Return of hip or neck pain
- Longer morning stiffness
- Reduced ability to perform everyday activities
- Increasing fatigue
Relapses do not necessarily mean that treatment has failed. Your doctor may adjust the corticosteroid dose or consider another medicine in people who experience repeated relapses or difficulty reducing steroids.
8. Osteoporosis and Fracture Risk
Some of the most important Polymyalgia Rheumatica risks are related to long-term corticosteroid treatment.
Prednisolone and other corticosteroids can weaken bones and increase the risk of osteoporosis. This is particularly important because PMR primarily affects older adults, who may already have an increased risk of bone loss and falls.
Your healthcare professional may assess your fracture risk and recommend appropriate measures to protect your bones.
Depending on your individual circumstances, this can include:
- Adequate calcium and vitamin D
- Weight-bearing physical activity when appropriate
- Fall-prevention measures
- Bone-density assessment
- Medicines for osteoporosis when indicated
Do not start or stop supplements or osteoporosis medicines without discussing them with your healthcare professional.
9. High Blood Pressure
Long-term corticosteroid therapy can contribute to increased blood pressure.
People taking prednisolone for PMR may therefore need regular monitoring, particularly if they already have cardiovascular risk factors.
A healthy eating pattern, appropriate physical activity and regular medical monitoring can help manage cardiovascular health while PMR is being treated.
10. High Blood Sugar and Diabetes
Corticosteroids can increase blood glucose levels. For some people, this can worsen existing diabetes or contribute to steroid-related diabetes.
Your doctor may monitor blood glucose during prolonged treatment, particularly if you have diabetes or other risk factors.
Possible symptoms of high blood sugar can include increased thirst, frequent urination, unusual tiredness and blurred vision. However, some people have no obvious symptoms, which is why medical monitoring is useful.
11. Increased Risk of Infection
Corticosteroids suppress aspects of the immune system. Long-term treatment can therefore increase susceptibility to certain infections. NHS guidance specifically notes an increased risk of infections during prednisolone treatment, including infections involving varicella-zoster, the virus responsible for chickenpox and shingles.
Tell your healthcare professional if you develop signs of infection such as persistent fever, worsening cough, painful urination or unusual skin changes.
If you are taking long-term steroids, ask your doctor which vaccinations and preventive measures are appropriate for you.
12. Muscle Weakness
Muscle weakness is another potential problem associated with prolonged corticosteroid use.
This can be confusing because Polymyalgia Rheumatica itself causes pain and difficulty moving. If you develop increasing weakness despite improving inflammation, discuss it with your healthcare professional.
Appropriate physical activity and rehabilitation can sometimes help maintain muscle strength, but exercise should be adjusted to your ability and medical condition.
13. Weight Gain and Metabolic Changes
Increased appetite and weight gain can occur during prednisolone treatment.
Weight gain can sometimes contribute to additional health concerns, including high blood pressure, blood glucose problems and reduced mobility.
A balanced diet and appropriate physical activity can help manage weight during treatment. If appetite or weight changes become significant, discuss them with your healthcare team rather than making extreme dietary changes.
14. Eye Problems
Long-term corticosteroid treatment can increase the risk of certain eye problems, including cataracts and glaucoma.
This is different from the sudden vision loss associated with giant cell arteritis.
Any new vision problem should be evaluated. Sudden vision loss, double vision or significant visual disturbance in someone with PMR requires urgent assessment because it may indicate giant cell arteritis.
15. Stomach Problems
Corticosteroids can contribute to stomach-related side effects, including indigestion and stomach ulcers.
The risk can vary depending on your other medicines and individual health circumstances. Tell your doctor if you develop persistent abdominal pain, severe indigestion or other concerning digestive symptoms.
16. Mood and Mental Health Changes
Steroids can sometimes affect mood and mental wellbeing. Possible effects include anxiety, irritability, depression, confusion and other changes in mental state.
If you notice a major change in your mood or behaviour after starting or changing corticosteroid treatment, contact your healthcare professional.
Severe mental health symptoms or thoughts of self-harm require immediate medical attention.
What Happens With Untreated Polymyalgia Rheumatica?
The phrase untreated Polymyalgia Rheumatica can sound alarming, but PMR itself is generally treatable and usually responds well to corticosteroids.
The main concern with leaving symptoms untreated is persistent inflammation, pain, stiffness and reduced mobility. More importantly, someone diagnosed with Polymyalgia Rheumatica can also develop giant cell arteritis, which has potentially serious consequences.
Untreated or unrecognised giant cell arteritis can cause permanent vision loss and may increase the risk of other vascular complications.
For this reason, PMR should be medically evaluated rather than managed solely with home remedies or over-the-counter pain medicines.
How Can You Reduce Polymyalgia Rheumatica Risks?
You cannot prevent every PMR complication, but several steps can reduce avoidable risks.
Follow your Polymyalgia Rheumatica treatment plan
Take corticosteroids exactly as prescribed. Do not suddenly stop prednisolone or another steroid after prolonged treatment because abrupt withdrawal can cause serious problems.
Attend follow-up appointments
Regular appointments allow your healthcare team to monitor symptoms, inflammatory markers when appropriate and potential treatment side effects.
Monitor bone health
Ask whether you need an assessment of osteoporosis or other bone-protection measures, especially if you expect to remain on corticosteroids for a prolonged period.
Stay physically active safely
Gentle, appropriate activity can help maintain mobility and strength. Your exercise programme should reflect your age, fitness, symptoms and other health conditions.
Know the warning signs of giant cell arteritis
Learn to recognise new headaches, scalp tenderness, jaw pain when chewing and visual changes. These symptoms should not be ignored.
When Should You Seek Urgent Medical Help?
If you have PMR and develop any of the following symptoms, seek urgent medical attention:
- Sudden or new vision loss
- Double vision
- Blurred vision
- A new severe or persistent headache
- Scalp tenderness
- Jaw pain while chewing or talking
- Symptoms suggesting a stroke, such as sudden weakness, facial drooping or difficulty speaking
These Polymyalgia Rheumatica symptoms can indicate giant cell arteritis or another serious condition and require prompt assessment.
Final Thoughts
The most important Polymyalgia Rheumatica complications to know about include giant cell arteritis, vision loss and other vascular complications, as well as problems associated with prolonged corticosteroid treatment. Osteoporosis, high blood pressure, high blood sugar, infections, muscle weakness, weight gain and eye problems can all require monitoring during long-term therapy.
PMR is generally manageable when properly diagnosed and treated. Regular follow-up helps doctors balance control of inflammation with the lowest effective corticosteroid dose and monitor for treatment-related problems.
Most importantly, never ignore new headache, jaw pain or vision changes while living with PMR. Rapid assessment is essential when giant cell arteritis is suspected.
Medical Disclaimer
This article is for general educational purposes only and does not replace professional medical advice, diagnosis or treatment. Polymyalgia rheumatica and its complications can vary from person to person. If you have symptoms of PMR, are taking corticosteroids or develop new headaches, jaw pain or vision changes, speak with a qualified healthcare professional promptly. Do not change or stop prescribed corticosteroid treatment without medical guidance.
