Polymyalgia Rheumatica vs Fibromyalgia
Polymyalgia Rheumatica and Fibromyalgia are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Polymyalgia Rheumatica vs Fibromyalgia at a glance
- Polymyalgia Rheumatica: Inflammatory syndrome of shoulder and hip girdle stiffness in adults over 50; dramatic response to low-dose steroids.
- Fibromyalgia: Centralized pain syndrome with widespread tenderness, fatigue, and sleep and cognitive disturbance; normal labs and imaging.
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Side-by-side comparison
| Feature | Polymyalgia Rheumatica | Fibromyalgia |
|---|---|---|
| At a glance | Inflammatory syndrome of shoulder and hip girdle stiffness in adults over 50; dramatic response to low-dose steroids. | Centralized pain syndrome with widespread tenderness, fatigue, and sleep and cognitive disturbance; normal labs and imaging. |
| Classic presentation | Subacute onset of bilateral shoulder and hip girdle aching and stiffness; Morning stiffness >45 minutes (often hours); Difficulty rising from a chair or lifting arms above the head; Constitutional symptoms in 30-50%: fatigue, low-grade fever, anorexia, weight loss; No true muscle weakness once pain is controlled; Restricted active… | Diffuse musculoskeletal pain >3 months in multiple body regions, often migratory; Profound fatigue, especially morning fatigue and after exertion; Nonrestorative sleep, frequent awakenings; Cognitive symptoms — word-finding difficulty, decreased concentration ('fibro fog'); Headache, paresthesias, dizziness; GI symptoms (IBS overlap),… |
| Workup / key labs | 2012 EULAR/ACR provisional criteria: age ≥50, bilateral shoulder pain, abnormal CRP or ESR, plus weighted morning stiffness, hip involvement, absence of other joint pain, and absence of RF/anti-CCP.; ESR — characteristically >40 mm/h (often >50-100); CRP elevated and may be more sensitive; CBC — normochromic normocytic anemia,… | 2016 ACR criteria: widespread pain index (WPI) and symptom severity scale (SSS) — pain in 4 of 5 body regions for ≥3 months with WPI ≥7 and SSS ≥5 (or WPI 4-6 and SSS ≥9), and no alternative diagnosis.; Goal is to exclude alternative explanations — not to confirm fibromyalgia; CBC, CMP, TSH, CRP, ESR, CK, vitamin D, vitamin B12;… |
| Imaging | Shoulder ultrasound or MRI — subacromial-subdeltoid bursitis, biceps tenosynovitis, glenohumeral synovitis (supportive but not required); Temporal artery ultrasound or biopsy if GCA features develop; PET-CT in atypical cases — can show large-vessel uptake | Generally NOT indicated — incidental findings on MRI commonly mislead; Image only if focal red-flag findings emerge (true weakness, focal joint signs, neurologic deficits) |
| First-line treatment | Prednisone 12.5-25 mg/day — dramatic improvement within 48-72 hours is both therapeutic and diagnostic; Slow taper over 1-2 years guided by symptoms and inflammatory markers (typical schedule: reduce by 2.5 mg every 2-4 weeks until 10 mg, then 1 mg every 1-2 months); Bone-protective therapy: calcium 1000-1200 mg/day, vitamin D 800-2000… | Patient education — emphasize that pain is real, reflects altered central pain processing, and is not destructive or progressive; Aerobic exercise — graded, low-impact (walking, swimming, cycling); cornerstone of treatment; Sleep hygiene and treatment of sleep disorders (OSA, restless legs); Cognitive behavioral therapy and… |
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