14 October 2026
Today, we publish our updated guideline for the treatment of polymyalgia rheumatica (PMR). The guideline updates the previous BSR/BHPR guideline published in 2009 and reflects new evidence, current practice and BSR’s latest guideline development standards.
PMR is a common inflammatory rheumatic condition in older adults. Glucocorticoids remain the cornerstone of treatment, but many people relapse during tapering or experience harm from prolonged glucocorticoid exposure. The updated guideline focuses on treatment of confirmed PMR and aims to support safe, effective and individualised care.
Guideline Working Group Co-chair, Dr Max Yates, said:
“Our previous guideline, published in 2009, predated BSR’s current framework for guideline development. These updated recommendations draw on new evidence and have been developed using that robust framework, giving clinicians a strong evidence base to support treatment decisions in PMR.”
The guideline was developed by a multidisciplinary guideline working group including rheumatologists, general practitioners, nurses, pharmacists, physiotherapists, researchers and experts by experience. It includes overarching principles, treatment recommendations and practical guidance on when to involve rheumatology.
Key messages from the guideline include:
The guideline applies to people with confirmed PMR.
- It updates the previous 2009 BSR/BHPR guideline.
- It recommends earlier consideration of rheumatology input after relapse, rather than waiting until prolonged glucocorticoid use, with practical thresholds for discussion with or referral to rheumatology.
- Recommendations on glucocorticoid initiation and tapering.
- It includes early consideration of methotrexate and IL-6 receptor antagonist use in selected people with PMR.
- It highlights the importance of glucocorticoid toxicity monitoring and bone protection.
- It emphasises shared decision-making, patient education and support to recognise relapse, treatment toxicity and possible GCA symptoms.
To support implementation, the guideline is accompanied by a summary sheet and a dedicated Guideline Collection, bringing the key resources together in one place for clinicians and teams using the recommendations in practice. Plus watch out for our dedicated webinar series, coming up to help breakdown how the changes will be relevant to your practice.
We’re looking for MDT members to help us understand how the guideline is being used in practice by completing the audit tool in their departments. If you’d like to be involved, please contact guidelines@rheumatology.org.uk.
The guideline is endorsed by the Primary Care Rheumatology and Musculoskeletal Medicine Society (PCRMM) and the Royal College of General Practitioners (RCGP), helping to support wider awareness and implementation across primary and secondary care. All BSR guidelines are published open access in Rheumatology and are available free of charge via the BSR website.