What Causes Polymyalgia Rheumatica to Flare Up?

What is polymyalgia rheumatica?

PMR is an inflammatory condition that causes pain and stiffness in the shoulders and often the hips. It most often affects people over 50, and the pain and stiffness are worse in the morning (MedlinePlus, Polymyalgia rheumatica). The cause is unknown.

Low-dose steroids usually ease symptoms within a day or two. The dose is then slowly lowered, and treatment often lasts 1 to 2 years. For most people, PMR goes away after that, but in some, symptoms return when the dose is reduced.

What causes polymyalgia rheumatica to flare up?

1. Lowering steroids. This is the big one. A review of real-world studies found that 43% of people with PMR had at least one relapse within a year of starting treatment, and 51% were still on steroids at 2 years. The speed of tapering was one of the factors studied (Floris et al., 2022). The 2026 British Society for Rheumatology guideline also notes many people relapse during tapering (BSR, 2026).

2. Infections. In one study of 58 people with PMR, about 1 in 4 linked the start of their illness to something in their environment, such as flu, a chest infection or a vaccination (Reumatologia, 2020). Getting run down by a cold or virus is a common story before a flare.

3. Doing too much, too soon. Many people feel so much better on steroids that they overdo it. The muscles and the tissue around them then pay for it.

4. Stress and poor sleep. These can make any inflammatory pain feel worse, and they are worth managing during a taper.

Does stress affect polymyalgia rheumatica?

Many people with PMR say stress makes their symptoms worse, and stress is known to affect the immune system. There is not strong research proving stress causes PMR flares, but lowering stress during a taper is sensible and does no harm.

What helps a PMR flare?

• Call your doctor. Do not change your steroid dose on your own. Your doctor may hold the taper or adjust the dose.
• Slow, gentle movement. Shoulder rolls, gentle arm swings and short walks help keep stiff areas moving.
• Warmth in the morning. A warm shower or heat pack on the shoulders and hips can ease morning stiffness.
• Plan your day. Do the harder jobs later in the morning, when stiffness usually eases.
• Look after your bones. Long-term steroids can affect bone strength, so ask about calcium, vitamin D and bone checks.

Why is PMR worse in the morning?

Morning stiffness is the classic sign of PMR. Inflammation builds up while you lie still overnight, and the tissue around the shoulders and hips stiffens. Once you start moving, it slowly loosens. It can take a while each morning before you feel "normal". If your mornings are getting longer again during a taper, tell your doctor, because it can be an early sign of a flare.

Simple things help: gentle stretches in bed before getting up, a warm shower first thing, and leaving more time in the morning so you are not rushing. Our PMR research page explains why this stiffness may sit in the tissue around the joints.

Warning signs: when to get help fast

PMR can occur with a related condition called giant cell arteritis (GCA), which affects blood vessels to the head and eyes (MedlinePlus). Contact a doctor urgently if you get a new headache, pain in the jaw when chewing, scalp tenderness, or any change in your vision. Also contact your doctor if you have fever or stiffness in your shoulders and neck that does not go away.

Can polymyalgia rheumatica go away on its own?

MedlinePlus says that without treatment, PMR does not get better. With treatment, most people find it goes away after 1 to 2 years, though some need longer.

The fascia link

Here is something many people with PMR are never told. When doctors look at PMR with contrast MRI scans, the inflammation is not mainly inside the joints. A study of 40 people with PMR found inflammation around the tendons of the pelvic girdle on both sides in every single patient, a pattern the authors called the "hallmark" of PMR (Clin Exp Rheumatol, 2018). A second study found this pattern around tendons and joint capsules could tell PMR apart from other causes of hip pain very accurately (Rheumatology, 2020).

The tissue around tendons and joint capsules is connective tissue, the same family as fascia, the web-like layer wrapped around every muscle. Fascia is full of pain-sensing nerves (Tesarz et al., 2011). This helps explain why PMR feels like deep stiffness around the shoulders and hips rather than pain inside a single joint.

It also raises a question many people ask when the steroids come down and the stiffness creeps back: what is happening to that tissue? Our PMR research page looks at what newer research is finding.

Frequently asked questions

What causes polymyalgia rheumatica to flare up?

Most flares happen while steroids are being lowered. About 4 in 10 people relapse in the first year. Infections, overdoing it, stress and poor sleep may also play a part.

Does stress affect polymyalgia rheumatica?

Many people say stress makes their PMR feel worse, and stress affects the immune system, but there is not strong research proving it causes flares. Lowering stress during a taper is sensible.

Can polymyalgia rheumatica go away on its own?

MedlinePlus says PMR does not get better without treatment. With treatment, it goes away for most people after 1 to 2 years, though some need longer.

Does magnesium help polymyalgia rheumatica?

There is no good research showing magnesium treats PMR. Ask your doctor about calcium and vitamin D, which are often recommended to protect bones during long-term steroid use.

Can polymyalgia rheumatica cause fatigue?

Yes. MedlinePlus lists fatigue as a common symptom alongside shoulder and hip pain and stiffness. It usually improves as the inflammation comes under control.