Understanding Hip Pain in Polymyalgia Rheumatica: Causes, Diagnosis, and Treatment

Introduction

Polymyalgia rheumatica (PMR) is an inflammatory disorder best known for causing pain and stiffness in the shoulders and neck. However, hip pain is also a significant and sometimes overlooked symptom that can deeply affect mobility and quality of life. In this article, we’ll explore why hip pain occurs in PMR, the challenges in diagnosing it, and the most effective ways to manage this often-debilitating symptom. By understanding the causes and treatments, both patients and healthcare providers can work together to better address hip pain linked to PMR.

What Causes Hip Pain in PMR?

For people with PMR, hip pain usually results from inflammation around the hip joints, particularly in the bursae—small sacs that cushion the joints—and the synovial lining of the joint itself. PMR occurs when the body’s immune system triggers widespread inflammation, which is picked up in blood tests showing high levels of markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). This inflammation leads directly to symptoms of pain and stiffness.

Imaging studies have shown that more than half of people with active PMR have bursitis—swelling in the soft tissues around the hips and other large joints. PMR almost always affects people over 50, and it is commonly marked by aching and stiffness in the hip, shoulder, and neck regions. Understanding this inflammatory process explains why hip pain is common and sometimes severe for those living with PMR.

Why Is Hip Pain in PMR Hard to Diagnose?

Hip pain from PMR often mimics more common conditions like osteoarthritis or rheumatoid arthritis, which means getting the correct diagnosis isn’t always straightforward. This overlap of symptoms can create delays in treatment. Careful exams and a thorough review of a patient’s medical history are essential. Doctors will check for hip tenderness or limited mobility, and imaging techniques such as ultrasound or MRI can help spot inflammation that regular X-rays may miss.

Many illnesses—including autoimmune diseases, infections, and even cancers—can resemble PMR, so physicians need to consider and rule out other possibilities. Blood tests for raised CRP and ESR support the diagnosis, but there’s no definitive single test for PMR. That’s why doctors look at the entire picture: clinical symptoms, blood results, and imaging together. Because PMR is relatively common in older adults, being aware of this disease and its typical lab result patterns can help ensure the diagnosis isn’t missed.

How Is Hip Pain in PMR Treated?

The mainstay of treatment for hip pain in PMR is low-dose glucocorticoids, like prednisolone. These medications quickly tamp down inflammation, often bringing dramatic relief and better mobility, sometimes within days. Treatment usually starts with a moderate dose and is gradually reduced over time according to how well the patient responds and any side effects.

Early treatment is especially important because hip pain can severely limit daily activities. If patients can’t tolerate steroids or need to lower their dose, other medications like methotrexate may be added to help manage symptoms and reduce reliance on steroids. Every patient’s situation is unique, so treatment needs to be tailored to balance the benefits and potential risks, especially since PMR mainly affects older adults. Ongoing monitoring and adjustments are a key part of long-term care.

Conclusion and Looking Ahead

Hip pain is a major symptom of polymyalgia rheumatica that requires careful attention. Because underlying inflammation can mimic other conditions, early identification using clinical exams, blood tests, and imaging is crucial. Treatment with glucocorticoids, and sometimes additional medications, provides effective relief for most people. Looking ahead, new research may improve diagnosis and expand treatment options even further. With increased awareness and timely, patient-centered care, those with hip pain from PMR can look forward to improved management and better quality of life.