In this episode of MD Newsline, Dr. Jill Weintraub, founder of Integrative Rheumatology Consultants, explores the complexities of axial spondyloarthritis, a chronic inflammatory condition that often goes undiagnosed for years.

Dr. Weintraub provides a comprehensive overview of this umbrella disease, including its radiographic and non-radiographic forms, and explains why early recognition is critical to preventing long-term damage. She highlights the key differences between inflammatory and mechanical back pain, the challenges in diagnosing women, and the role of advanced imaging such as MRI.

The conversation also dives into the interplay between genetics, the gut microbiome, and immune system dysfunction, as well as how modern therapies—from TNF inhibitors to JAK inhibitors—are transforming patient outcomes. Dr. Weintraub emphasizes the importance of integrating lifestyle interventions like exercise and physical therapy alongside medical treatment to improve long-term quality of life.

Episode Highlights:

Understanding Axial Spondyloarthritis
Dr. Jill Weintraub explains axial spondyloarthritis as an umbrella of inflammatory diseases primarily affecting the spine, while also involving joints and entheses. She distinguishes between radiographic (ankylosing spondylitis) and non-radiographic forms, emphasizing how evolving definitions are improving diagnosis.

Recognizing Inflammatory Back Pain
A key diagnostic feature is inflammatory back pain, typically presenting before age 40 with morning stiffness that improves with movement. Dr. Weintraub contrasts this with mechanical back pain and highlights why this distinction is critical in clinical practice.

Diagnostic Challenges and Delays
Diagnosis can take years, especially in women, due to atypical presentations and central sensitization of pain. She stresses the importance of patient advocacy and clinician awareness to reduce delays.

Role of Imaging and Clinical Evaluation
MRI of the pelvis with appropriate sequences is essential for early detection, particularly in non-radiographic disease. However, Dr. Weintraub underscores that diagnosis remains largely clinical, as lab markers may often appear normal.

Genetics, Microbiome, and Immune Interplay
The episode explores how genetic factors like HLA-B27, combined with environmental triggers and gut microbiome imbalances, contribute to disease development and progression.

Treatment Strategies and Biologic Selection
Dr. Weintraub discusses how treatment is tailored to the whole patient, comparing TNF inhibitors, IL-17 inhibitors, and JAK inhibitors, while weighing risks such as infection, cardiovascular events, and long-term safety.

Importance of Exercise and Integrative Care
Exercise, physical therapy, and lifestyle interventions are essential components of treatment. While supplements and diet can support symptom relief, they are not substitutes for disease-modifying therapies.

Managing Overlapping Conditions
She highlights the importance of coordinating care for patients with related conditions such as psoriasis, uveitis, and inflammatory bowel disease, ensuring treatment choices address multiple disease pathways.

Future Directions in Research
Emerging research on the gut microbiome offers promising insights into new therapeutic targets, potentially transforming how axial spondyloarthritis is managed in the future.

Early recognition of inflammatory back pain is critical in axial spondyloarthritis. A combination of clinical awareness, appropriate imaging, and personalized treatment—including both pharmacologic and lifestyle approaches—can significantly improve patient outcomes and prevent long-term disease progression.

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In this episode of MD Newsline, Dr. Justin Morales, Addiction Psychiatry Fellow at Mass General Brigham Harvard Medical System, explores how our understanding of addiction has evolved from a simple reward-pathway model to a comprehensive biopsychosocial framework.

Dr. Morales discusses substance use disorders alongside emerging behavioral addictions such as social media overuse, gaming, and binge behaviors. He explains how dopamine signaling, reward-based learning, and executive function circuits influence compulsivity and craving—and why modern overstimulation may blur the line between habit and addiction.

The conversation also examines cannabis potency trends, co-occurring psychiatric conditions, sports psychiatry, and emerging neuromodulation treatments for addiction.

Dr. Morales outlines the shift from a narrow neurochemical model to a holistic framework incorporating biology, psychology, and social environment. Treatment may involve medication, therapy, and social interventions working together rather than in isolation.

While behavioral addictions like social media overuse are not formally classified the same way as substance use disorders in DSM-5, clinicians can adapt similar criteria—such as functional impairment, compulsivity, and high-risk behaviors—to assess severity.

Modern cannabis products are significantly more potent than in prior decades. Dr. Morales highlights growing concerns about high-THC exposure potentially contributing to psychosis and mood destabilization.

Over half of individuals with substance use disorders have a co-occurring psychiatric condition. Dr. Morales discusses common treatment pitfalls—such as addressing depression without addressing substance use—and emphasizes integrated care.

Social media and gaming platforms leverage reward-based learning similar to substances. The brain adapts to chronic overstimulation, which may lead to reduced baseline motivation and mood flattening.

Although strong research evidence is limited, reducing overstimulation may help the brain recalibrate toward homeostasis and improve natural reward sensitivity.

Dr. Morales explains how clinicians may treat different substances pharmacologically while addressing underlying psychological drivers—such as avoidance or emotional numbing—through unified therapy strategies.

Athletes face unique pressures tied to performance, injury, career transitions, and identity fusion. Substance use and mood disorders may emerge during times of injury or role changes.

With increasing financial and performance stakes at younger ages, adolescent athletes face heightened mental health risk before full neurodevelopment.

Emerging treatments—including transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS)—target brain circuits involved in executive function and craving, particularly the prefrontal cortex.

Addiction involves planning, coordination, and decision-making processes—not simply impulsivity. Targeting prefrontal control circuits may influence compulsive behaviors and substance-seeking.

Effective addiction and sports psychiatry care requires collaboration among psychiatrists, psychologists, social workers, trainers, coaches, and family members to identify behavioral changes early and provide coordinated support.

Addiction in the modern era extends beyond substances to include digital and behavioral reinforcers embedded in everyday life. A biopsychosocial framework—combined with integrated treatment, executive function support, and collaborative care—offers the most effective approach for addressing substance use disorders and behavioral addictions alike.

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