Dear Doctor: I am a 77-year-old man who used to exercise regularly. I was diagnosed with polymyalgia rheumatica a couple of years ago. Sometimes I feel like it is going to disappear, and other times it seems to worsen. Are there any new remedies?

Dear Reader: Polymyalgia rheumatica, also known as PMR, is an inflammatory condition that affects joints and muscles, most often in the neck, shoulders, hips, thighs and lower back. Some patients report a gradual onset of the condition. For others, it appears quickly, seemingly overnight.

Symptoms of PMR include significant muscle pain, accompanied by ongoing stiffness. These both tend to increase after periods of rest or inactivity, and can be severe enough to interrupt sleep. Pain and stiffness are most pronounced in the morning. The stiffness caused by PMR often improves within a few hours after waking -- being active helps, too -- but the pain remains. Additional effects may include flulike symptoms such as fever, malaise and exhaustion. PMR is rarely seen in anyone younger than 50, and is most often diagnosed at age 60 and older. It’s also more common in women than in men.

Although the cause of PMR isn’t known, it is strongly suspected to be an autoimmune disease. That means the body's immune system is attacking its own tissues, giving rise to the systemic inflammation that’s causing the pain and stiffness. Research into PMR has also suggested a genetic component. The condition appears to be more common among people of North European descent than it is among those from the Mediterranean.

As you probably know, having lived with the condition for a few years, the primary treatment for PMR is corticosteroids, such as prednisone. Patients report a swift reduction in pain and stiffness often two or three days after starting steroid therapy. Due to potential complications associated with steroids, including an increased risk of infection, diabetes, high blood pressure and osteoporosis, the goal is to find the lowest dose possible to manage pain. Once symptoms are under control and the results of certain blood tests show improvement, steroid therapy is gradually tapered to the lowest effective dose.

There are currently no new treatments for the condition. A class of medications known as disease-modifying antirheumatic drugs, or DMARDs, are sometimes used to reduce reliance on steroids. And there is increasing interest in the use of monoclonal antibodies, which are lab-created molecules that act on, or with, the immune system.

Some people living with PMR report improvement when they switch to a low-inflammation diet, such as the Mediterranean or DASH diets. Foods that are associated with anti-inflammatory properties include leafy greens, fruit, nuts, whole grains, fatty fish and green tea.

If you haven’t already done so, we urge you to let your doctor know whenever your symptoms get worse. A challenge of aiming for a minimal dose of any medication is that the dosage might drop below what is necessary. Ask your doctor if a slight adjustment in your medication is needed.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I’ve been on a few different medications for depression, but none of them did much of anything. A friend keeps going on about psychobiotics, which to me doesn’t even sound like a real word. What is he talking about?

Dear Reader: Unfortunately, it’s true that antidepressants don’t work for everyone. This makes treating the estimated 16 million Americans who experience at least one major depressive episode each year an ongoing challenge. A study funded by the National Institutes of Health found that only one-third of individuals diagnosed with depression found complete relief through the first course of medication that they were prescribed.

As has happened with you, people living with depression often try several different medications -- or combinations of medications -- in a trial-and-error search for a treatment that works. Even when antidepressants are successful at relieving symptoms, they come with an array of potential side effects, both physical and emotional. And when an antidepressant does work, it’s possible for the patient to build up a tolerance. As a result, the drug becomes less effective over time.

All of this has caused scientists to keep seeking effective treatments. An important area of research pertains to something called the “gut microbiome.” As scientists learn more about the importance of the trillions of microorganisms living in our bodies, they have established a connection between our guts and our brains.

New research shows that the makeup of the gut microbiome plays a significant role not only in mental health, but in cognition as well. The channel of communication runs both ways -- the gut influences the brain, and the brain influences the gut. One theory is that the vagus nerve, which runs from the brain to the gut, acts as an information highway, with messages traveling in both directions. Some scientists have referred to the gut as our “second brain.”

Out of these findings has come the term “psychobiotics,” the one your friend used. Specifically, it refers to the types of live bacteria, or probiotics, that impart positive mental health benefits. Research in mice has shown that infusions of beneficial bacteria to the gut resulted in markedly lower levels of inflammation in the brain. This, in turn, influenced behavior, including lower levels of anxiety and fear when the mice made their way through a stressful maze.

Scientists are still figuring out how these findings in animal studies translate to humans. Someday antidepressants may consist of doses of feel-good bacteria tailored to the needs of each person’s particular gut microbiome. In the meantime, the goal is to develop and maintain a gut microbiome that’s robust and diverse. This is achieved by eating a high-fiber, low-sugar diet that’s filled with plant-based and fermented foods. Exercise has been shown to be helpful to the gut microbiome, too.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I hate having migraines. The pain is brutal, they knock me down for days and everyone thinks I’m just having a bad headache. Why do they happen? Can you tell me about any new therapies?

Dear Reader: For anyone lucky enough to never have had a migraine, it’s much more than just a bad headache. Migraine is an extended, often debilitating full-body experience. Severe throbbing head pain is typically accompanied by nausea and sometimes vomiting. Other symptoms are extreme sensitivity to light, motion and sound. A migraine can last for several hours or several days.

Many people also have a range of symptoms before an attack. Known as a migraine aura, it’s a cluster of visual, sensory and cognitive disturbances such as flashes of light, prickling sensations on the skin and lapses in speech or reasoning. Migraines often conclude with a phase known as postdrome, sometimes known as a migraine hangover. Postdrome can include nausea, continued sensitivity to external stimuli, body aches, exhaustion and problems concentrating. In addition, studies show that individuals with chronic migraine are at higher risk of anxiety and depression.

Despite having been studied for at least 3,000 years, we still don’t have a definitive answer for what causes migraines in an estimated 3 billion people worldwide. It is known to be a complex neurological disorder, likely with a genetic component. Women are three times more likely to suffer from migraines than men.

Behaviors known as “triggers” can launch a migraine. These include a skipped meal, irregular sleep, changes to caffeine intake and emotional or physical stress. Foods associated with migraine include chocolate, fermented foods, aged cheeses, alcohol in general and red wine in particular. Birth control pills and antidepressants are also believed to have an effect on migraine frequency. Unfortunately over-the-counter pain medications, which can provide relief, can also result in a “rebound” headache.

In the past, migraine patients relied on a variety of medications for relief, the majority of them created to treat other conditions. These include antidepressants, hypertension medicines, Botox injections, opioids and a class of drugs called triptans. Vitamins and supplements such as vitamin B2, magnesium, Coenzyme Q10 and melatonin have proven helpful. And although aerobic exercise is known to reduce the frequency and severity of attacks, people who have regular migraines often feel too poorly to exercise regularly.

Most recently, a new class of drugs known as monoclonal antibodies, the first medications developed specifically for migraine sufferers, are offering hope. The FDA approved three such treatments earlier this year. Delivered via a monthly injection, they have been shown to reduce the number of migraine days in some patients by half. They’re costly and don’t work for everyone, but it’s worth checking with your doctor to see if they might be right for you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)