Objective To summarize the clinical performance of patients with polymyalgia rheumatica (PMR) and analyze the misdiagnosed cases to improve the diagnostic processes. Methods The clinical data, response to treatment and the spectrum of disease misdiagnosed at first visit in 38 patients with PMR were analyzed retrospectively. Results Sex ratio of male to female in the study population was 1︰2.8 and mean disease onset age±standard deviation (SD) was (68.2±10.4) years. Twenty-two patients (57.9%) presented with neck and shoulder pain. Shoulder and pelvic girdle aching were reported in 16 patients (42.1%). Tender in knee and hip joints were observed in 18 patients (47.3%). Seventeen patients (44.7%) accompanied with morning stiffness. Twenty patients exhibited fever. Eleven patients (28.9%) developed giant cell arteritis. Elevated erythrocyte sedimentation rate (ESR) [(85.8±30.2)mm/h] were observed in all patients. Twenty-four patients (63.1%) were misdiagnosed at first as respiratory infectious diseases or bone and joint disorders. Eighteen patients (47.3%) accepted glucocorticoid mono-therapy. Fifteen patients (39.4%) received combination therapy of glucocorticoid and methotrexate. Five patients (13.1%) were treated with glucocorticoid plus Tripterygium wilfordii. Conclusion PMR is a common rheumatic disease characterized by aching pain in the proximal muscle groups. It mainly affects middle aged people and elderly and is accompanied by fever, arthritis and marked elevation of ESR. Response to glucocorticoid treatment is rapid and dramatic in PMR. Improvement in the diagnosis and treatment of PMR should be pursued due to the increase of incidence in elderly population.