Polymyalgia rheumatica
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Initial tests
Laboratory tests
- FBC
- CRP
- Rheumatoid factor
- Anti-CCP antibodies
- Serum electrolytes
- Serum calcium
- AST
- ALT
- GGT
- Alkaline phosphatase
- Serum creatinine with eGFR
- Fasting plasma glucose
- Lipid profile (before treatment)
- Urine dipstick
- Serum protein electrophoresis (depending on the context)if neededTo be considered in addition to the baseline tests [3]; classed “depending on the context” by the COFER [1].
- TSH (depending on the context)if neededTo be considered in addition to the baseline tests (endocrine diagnoses to rule out) [3]; “depending on the context” for the COFER [1].
- CK (depending on the context)if neededTo be considered in addition to the baseline tests [3] (myositis, differential diagnosis); “CK, myositis assay”: depending on the context for the COFER [1].
- 25-hydroxyvitamin D (depending on the context)if needednon-French guidelineTo be considered in addition to the baseline tests before corticosteroid therapy [3].
- Antinuclear antibodies (ANA)if neededMore extensive serology according to clinical signs and the probability of an alternative diagnosis, to rule out a disease that mimics polymyalgia rheumatica [3]; “depending on the context” for the COFER [1].
- ANCAif neededMore extensive serology according to clinical signs and the probability of an alternative diagnosis, to rule out a disease that mimics polymyalgia rheumatica [3]; “depending on the context” for the COFER [1].
- HIV serologyif neededThe table of initial tests from the French Society of Rheumatology (2024) classes them among the pre-treatment tests, without detailing the indication [2]; the 2015 EULAR/ACR list does not cite them [3]. Reserve for at-risk patients or before a steroid-sparing treatment.
- Hepatitis B serologyif neededThe table of initial tests from the French Society of Rheumatology (2024) classes them among the pre-treatment tests, without detailing the indication [2]; the 2015 EULAR/ACR list does not cite them [3]. Reserve for at-risk patients or before a steroid-sparing treatment.
- Hepatitis C serology (pre-treatment tests, depending on the context)if neededThe table of initial tests from the French Society of Rheumatology (2024) classes them among the pre-treatment tests, without detailing the indication [2]; the 2015 EULAR/ACR list does not cite them [3]. Reserve for at-risk patients or before a steroid-sparing treatment.
- IGRA (QuantiFERON) (pre-treatment tests, depending on the context)if neededThe French Society of Rheumatology table (2024) cites QuantiFERON among the pre-treatment tests [2]; the 2015 EULAR/ACR retains tuberculosis tests only according to the clinical picture [3].
- Not a laboratory test: chest X-ray at the doctor's discretion (to rule out another diagnosis); X-rays of the shoulders and pelvis, ultrasound of the shoulders and hips depending on the context.
Also consider
- Headache or jaw claudication? Giant cell arteritis associated or suspected: see the page "Artérite à cellules géantes (maladie de Horton)".
Do not order
Monthly follow-up (corticosteroid tapering)
Laboratory tests
- CRP
Also consider
- Corticosteroids for several months? To monitor the effects of corticosteroid treatment, see the page "Treatment: long-term corticosteroids".
- Fracture risk on corticosteroids? For bone monitoring on corticosteroid treatment, see the page "Osteoporosis".
Sources (10)
- Collège français des enseignants de rhumatologie
- Wendling D, Al Tabaa O, Chevet B, et al. Recommendations of the French Society of Rheumatology for the management in current practice of patients with polymyalgia rheumatica. Joint Bone Spine. 2024;91(4):105730. Version française : Revue du rhumatisme. 2024;91(6):694-713.
- Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2015;74(10):1799-807.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 1139 (25-OH vitamine D, indications limitées), 1804 (CRP) ; absence d'acte actif pour la vitesse de sédimentation.
- Dasgupta B, Cimmino MA, Maradit-Kremers H, et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2012;71(4):484-92.
- Mukhtyar CB, et al. 2025 EULAR recommendations for the management of polymyalgia rheumatica and primary large vessel vasculitis. Ann Rheum Dis. 2026 (publié en ligne le 21 juillet 2026).
- Raleigh MF, Stoddard J, Darrow HJ. Polymyalgia Rheumatica and Giant Cell Arteritis: Rapid Evidence Review. Am Fam Physician. 2022;106(4):420-426.
- Toyoda T, Bhide S, Boland C, et al. The 2026 British Society for Rheumatology guideline for the treatment of polymyalgia rheumatica. Rheumatology (Oxford). 2026;65(10):keag502.
- Buttgereit F, Boyadzhieva Z, Reisch M, et al. Recommendations of the German, Austrian and Swiss rheumatology and other medical societies for the management of polymyalgia rheumatica. Rheumatology (Oxford). 2026;65(2):keaf646.
- Pseudo-polyarthrite rhizomélique et artérite à cellules géantes en 2019