Is It Fibromyalgia or Polymyalgia Rheumatica? (2022)

Both fibromyalgia and polymyalgia rheumatica (PMR) involve chronic pain and can seem similar. However, they're very different conditions. Fibromyalgia is a condition in which pain and other sensory signals are not processed normally by the central nervous system. PMR, though, while characterized by musculoskeletalpain and stiffness, is related to inflammation that's likely autoimmune in nature.

Is It Fibromyalgia or Polymyalgia Rheumatica? (1)

Because of their apparent similarities, it's possible for PMR to be misdiagnosed as fibromyalgia or vice versa. It's also possible for either condition to be overlooked in someone who's already diagnosed with the other.

These two conditions, however, are very different and require different treatments. Knowing the symptoms of both can help you recognize whether you may have a new or undiagnosed condition that needs to be addressed.

What Is Fibromyalgia?

In fibromyalgia, the central nervous system takes pain signals and "turns up the volume" through a complex mechanism that's believed to involve extra nerve structures, abnormal nerve function, and neurotransmitter imbalances in the brain.

While fibromyalgia does involve some amount of immune-system dysfunction and some cases may have an inflammatory component, this condition is not classified as autoimmune or inflammatory. (Some subgroups may involve autoimmunity but research is still inconclusive on that.) Fibromyalgia is a neurological condition that many experts consider to be on the spectrum of central sensitivity syndromes. It's sometimes referred to as a neuroimmune or a neuro-endocrine-immune condition because of its complexity.

The most common fibromyalgia symptoms include:

  • Hyperalgesia (amplified pain)
  • Abnormal pain types such as allodynia (pain from stimuli that shouldn't be painful) and paresthesia (abnormal nerve sensations, such as "zings" or tingling)
  • Cognitive dysfunction, often called "fibro fog," which can involve language impairment, poor short-term memory, and inability to multitask
  • Fatigue
  • Sensitivities to heat, cold, light, noise, chemical fragrances, and food

Fibromyalgia pain is not confined to certain areas and it can be all over the body. By definition, pain must be present in the spine and in all four quadrants of the body. Each individual can have places where their pain is typically worst, but most people with this illness have some degree of pain all over their bodies.

This condition can cause any of a few dozen other potential symptoms, as well. The effects may come on suddenly, especially after an illness or physical trauma (surgery, car accident, childbirth), or develop slowly over several months or even years.

The Big List of Fibromyalgia Symptoms

What Is Polymyalgia Rheumatica?

PMR is an inflammatory disease that's believed to be autoimmune, meaning that the body is attacking its own healthy tissues because it mistakes them for infectious organisms such as viruses or bacteria. This condition is seen almost exclusively in people over the age of 50.

Among people older than 50, about 0.5% have PMR, making it a rare disease. (To give you a comparison, fibromyalgia impacts between 2% and 4% of the U.S. population.)

A 2014 study inRheumatology Internationalsuggested that PMR may be present in about 3% of people with fibromyalgia. If that's true, it'd make it considerably more common in people with fibromyalgia than in the general population.

PMR generally causes muscle pain and stiffness in specific parts of the body, including the:

  • Shoulders
  • Neck
  • Upper arms
  • Hips
  • Buttocks
  • Thighs
  • Sometimes the wrists, elbows, or knees

The stiffness is almost always worst in the morning when it can severely limit the ability to perform basic tasks, such as getting out of bed and getting dressed.

PMR can include other symptoms as well, such as:

(Video) Fibromyalgia VS Polymyalgia Rheumatica

  • Fatigue
  • Low-grade fever
  • Loss of appetite
  • Malaise (a general feeling of unwellness)
  • Depression

When this disease strikes, symptoms generally come on quickly.

Polymyalgia Rheumatica vs. Fibromyalgia
FeaturesPolymyalgiaFibromyalgia
InflammationHigh levels, joints and connective tissueAbsent or at low levels, possibly in the fascia
AutoimmunityHas features of autoimmunitySome subgroups may involve autoimmunity
AgeMost common over 65Most common in women of childbearing age
Pain LocationsSpecific areasWidespread
Time of DayPain often worst in morningPain often worse at night
Differentiating SymptomsLow-grade fever, loss of appetite, malaiseAbnormal pain types, cognitive dysfunction, sensitivities
OnsetUsually rapidMay be rapid or develop over time

Is Polymyalgia Rheumatica Worse Than Fibromyalgia?

Every person’s experience is different, so it’s impossible to say definitively whether one disorder is worse than another. However, there are aspects of fibromyalgia that may make it harder to manage than PMR. For instance:

  • Fibromyalgia can occur at any age, making it harder to work and parent.
  • It is a chronic disorder that can be difficult to control while polymyalgia can usually be managed with steroids.
  • Eventually, PMR goes away while fibromyalgia is a lifelong condition.
  • Fibromyalgia has been associated with higher than average levels of PTSD.

Diagnosis

No single blood test can diagnose PMR. Healthcare providers consider the full range of symptoms along with a blood sedimentation (or "sed") rate. An elevated sed rate is an indicator of inflammation.

In people with fibromyalgia, the sed rate is typically normal or just slightly elevated. Along with symptoms, fibromyalgia can be diagnosed by a tender-point exam, in which the healthcare provider checks for a heightened pain response but putting pressure on specific points throughout the body. Sometimes a set of two questionnaires that evaluate the full range of symptoms and their severities is used in the diagnosis of this condition.

Why Is Polymyalgia Mistaken for Fibromyalgia?

The difficulty in diagnosing PMR can lead to confusion and a possible misdiagnosis at first. Cases in which the circumstances match common fibromyalgia situations, such as women who feel pain in the shoulders and arms, are more likely to be initially classified as fibromyalgia until further tests can show it to be PMR.

Treatment

PMR is generally treated with steroids and can often be well controlled. Steroids are not considered effective in fibromyalgia and achieving control is difficult. Fibromyalgia treatment regimens generally include multiple approaches, including:

  • Medications, such as anticonvulsants and/or antidepressants
  • Supplements
  • Acupuncture
  • Physical therapy, gentle massage therapy, or chiropractic treatments
  • Low-impact, specifically tailored exercise, such as warm-water exercise, yoga, Tai Chi, and qi gong

Make sure to discuss treatment options and any side effects you experience with your healthcare provider to determine the best ones for you.

How to Manage Polymyalgia Rheumatica

A Word From Verywell

If you suspect you have one or both of these conditions—polymyalgia rheumatica and fibromyalgia—bring it up with your healthcare provider. You're the expert on your pain, which is invisible to the healthcare provider, so be prepared to describe its nature, triggers, and timing in detail. The diagnostic process may not be easy, but it's important to be patient and persistent so you can ultimately get the right management plan to relieve your symptoms.

Frequently Asked Questions

  • Can COVID-19 trigger polymyalgia rheumatica?

    Researchers have been looking at cases in which COVID-19 may have caused PMR, but the data is not conclusive and more studies are being done.

    Learn More:COVID-19 News and Updates

  • Can a blood test detect polymyalgia rheumatica?

    (Video) USMLE INTERNAL MEDICINE PEARL: Quick differences Fibromyalgia, Polymyositis & Polymyalgia rheumatica

    No. A blood test won't specifically detect PMR, but it can check for inflammation, a sign of PMR. It can also be used to rule out other diseases that might cause the pain you're experiencing.

    Learn More:Preparing for a Blood Draw

  • What diseases can mimic PMR?

    Other conditions that are similar to PMR include:

    • Giant cell arteritis, an inflammatory disease that affects the arteries
    • Polymyositis, a rare disease that causes weakening of muscles and connective tissue
    • Fibromyalgia, a chronic disorder in which you may feel pain throughout the body.

    Learn More:What You Should Know About Polymyositis

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Guggino G, Ferrante A, Macaluso F, Triolo G, Ciccia F. Pathogenesis of polymyalgia rheumatica. Reumatismo. 2018;70(1):10-17. doi:10.4081/reumatismo.2018.1048

  2. LeebBF,BirdHA,NesherG, et al. EULAR response criteria for polymyalgia rheumatica: results of an initiative of the European Collaborating Polymyalgia Rheumatica Group (subcommittee of ESCISIT). Annals of the Rheumatic Diseases.2003;62:1189-1194. doi:10.1136/ard.2002.002618

  3. Haliloglu S, Carlioglu A, Akdeniz D, et al. Fibromyalgia in patients with other rheumatic diseases: prevalence and relationship with disease activity. Rheumatol Int. 2014;34:1275. doi:10.1007/s00296-014-2972-8

  4. Acharya S, Musa R. Polymyalgia rheumatica. In: StatPearls [Internet]. Treasure Island (FL): StatPearls.

  5. Arthritis Foundation. What is the Difference Between Fibromyalgia and Polymyalgia?

  6. Coppens E, Van Wambeke P, Morlion B, et al. Prevalence and impact of childhood adversities and post-traumatic stress disorder in women with fibromyalgia and chronic widespread pain. Eur J Pain. 2017;21(9):1582-1590. doi:10.1002/ejp.1059

  7. Creaky Joints. What Is Polymyalgia Rheumatica? These Are the Signs You Could Have It.

  8. Theoharides TC, Tsilioni I, Arbetman L, et al. Fibromyalgia syndrome in need of effective treatments.J Pharmacol Exp Ther. 2015;355(2):255–263. doi:10.1124/jpet.115.227298

  9. Hsu TYT, D’Silva KM, Patel NJ, Fu X, Wallace ZS, Sparks JA. Incident systemic rheumatic disease following COVID-19. The Lancet Rheumatology. 2021;3(6):e402-e404. doi:10.1016/S2665-9913(21)00106-5

  10. American Academy of Family Physicians. Giant Cell Arteritis and Polymyalgia Rheumatica.

  11. National Organization for Rare Disorders. Polymyalgia Rheumatica.

Additional Reading

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