What is the diagnostic approach for polymyalgia rheumatica?

• A. Muscle biopsy
• B. Imaging
• C. Clinical diagnosis; there is no specific test
• D. Serology for ANA

Answer: (C)

Polymyalgia rheumatica is diagnosed clinically because there isn’t a single test that proves it. The typical picture is new, abrupt onset of aching and morning stiffness in the shoulder and hip girdles in adults over 50, with stiffness lasting a significant time each morning, and elevated inflammatory markers such as ESR or CRP. Other tests, like muscle biopsy or ANA serology, don’t establish PMR and are not diagnostic. Imaging can help rule out other conditions and may show inflammatory changes around bursae or joints, but it doesn’t by itself confirm PMR. A low-dose corticosteroid response is common and can support the diagnosis, though the clinical pattern and exclusion of other diseases remain the foundation of the approach.