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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In this episode of MD Newsline, Dr. Rudolph J. Castellani, a neuropathologist and Director of the Division of Neuropathology at Northwestern University, offers a deep dive into the biology, diagnosis, and ongoing controversies surrounding Alzheimer's disease. He explores how Alzheimer's is defined clinically and pathologically, the evolving role of biomarkers in early detection, and why modifying biomarkers has not yet translated into meaningful clinical improvement for patients. Dr. Castellani also discusses the promise and limitations of artificial intelligence, personalized medicine, and lifestyle interventions in Alzheimer's research and care.

Defining Alzheimer's Disease
Dr. Castellani explains how Alzheimer's disease can be defined clinically—through progressive memory and cognitive decline—or pathologically, based on hallmark brain lesions such as amyloid plaques and neurofibrillary tangles identified post-mortem. These structural changes remain central to diagnosis but do not fully explain disease progression.

The Role of Amyloid and Biomarkers
Amyloid beta, a key component of senile plaques, can now be detected through cerebrospinal fluid testing, blood-based biomarkers, and PET imaging. Dr. Castellani discusses how biomarkers help identify disease presence earlier but raises important questions about whether amyloid is a driver of disease or merely an associated marker.

Early Detection: Promise and Ethical Concerns
While biomarkers allow detection before symptoms appear, Dr. Castellani highlights the ethical dilemma of diagnosing asymptomatic individuals. He questions whether early identification without effective intervention may increase anxiety without improving outcomes.

Therapies and Clinical Trial Limitations
New anti-amyloid therapies, including FDA-approved agents, show only marginal cognitive benefit in highly selected trial populations. Dr. Castellani emphasizes caution when extrapolating these results to broader, more diverse patient groups and underscores the potential risks and toxicities associated with these treatments.

Artificial Intelligence and Predictive Modelling
AI and machine learning may enhance predictive modeling by integrating biomarkers, genetics, and cognitive data. However, Dr. Castellani notes that prediction alone is insufficient without therapies that meaningfully alter disease progression.

Age of Onset and Risk Factors
Alzheimer's disease can present as early as a patient's 30s in rare genetic cases or later in life in sporadic forms. Dr. Castellani reviews known risk factors, including APOE genotype, hypertension, diabetes, hearing loss, and traumatic brain injury, while stressing that many associations remain poorly understood.

Personalized Medicine and Genetic Counseling
Genetic testing—particularly for APOE and pathogenic mutations—plays a role in personalized risk assessment. Dr. Castellani emphasizes the importance of careful counseling, as not all individuals want or benefit from knowing their genetic risk.

Supportive and Interdisciplinary Care
With no curative treatments available, interdisciplinary care involving neurologists, neuropsychologists, and social workers is essential. Dr. Castellani highlights the importance of caregiver support, expectation management, and access to specialized centers.

Lifestyle and Prevention
Although lifestyle changes may not alter the underlying biology of Alzheimer's disease, healthy diet, exercise, and reducing inflammation and oxidative stress can improve quality of life and overall health.

Dr. Castellani underscores that while biomarkers and amyloid-focused therapies dominate current Alzheimer's research, they have not yet delivered meaningful clinical improvement. A broader research approach—beyond amyloid—combined with realistic expectations, ethical care, and strong support systems is essential for patients and families navigating Alzheimer's disease.

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In this episode of MD Newsline, Dr. Quentin Youmans, a heart failure cardiologist at Northwestern Medicine, explores the rapidly evolving landscape of advanced heart failure care. He shares insights into guideline-directed medical therapy, emerging device-based interventions, and the growing role of personalized medicine in improving outcomes for patients with complex cardiovascular disease. Dr. Youmans also addresses health disparities, access challenges, and the importance of multidisciplinary collaboration in modern cardiology.

Advances in Guideline-Directed Medical Therapy (GDMT)
Dr. Youmans discusses the four pillars of GDMT for heart failure with reduced ejection fraction and how rapid initiation and optimization of therapy can significantly improve patient outcomes. He emphasises early sequencing, close follow-up, and collaboration with pharmacy teams to ensure patients receive maximal benefit.

Device-Based Therapies in Advanced Heart Failure
Innovations such as transcatheter mitral valve repair, pulmonary artery pressure monitoring, and advanced hemodynamic devices are reshaping heart failure care. Dr. Youmans explains how these technologies help reduce hospitalizations, improve symptoms, and support earlier intervention in high-risk patients.

Health Disparities and Access to Care
A major focus of the conversation centers on racial, socioeconomic, and geographic disparities in heart failure outcomes. Dr. Youmans highlights efforts to expand access through community-based clinics, telehealth, and outreach to rural and underserved populations.

Sex-Based Differences and Cardiovascular Risk Across the Lifespan
Dr. Youmans explores how pregnancy-related conditions such as preeclampsia increase long-term cardiovascular risk for women. He underscores the need for coordinated care between cardiology, OB-GYN, and primary care to support prevention and long-term monitoring.

Multidisciplinary and Collaborative Care Models
Heart failure management increasingly relies on collaboration across specialties, including nephrology, endocrinology, interventional cardiology, and surgery. Dr. Youmans discusses how integrated care models improve decision-making and patient outcomes, particularly in complex cases involving CKM (cardiovascular-kidney-metabolic) syndrome.

Personalized Medicine and Biomarkers
Biomarkers such as BNP play a growing role in risk stratification and treatment monitoring. Dr. Youmans explains how future approaches may tailor therapies based not only on biology, but also on patients' social environments and barriers to care.

Emerging Therapies and the Future of Heart Failure Treatment
From SGLT2 inhibitors and GLP-1 receptor agonists to new mineralocorticoid receptor antagonists, Dr. Youmans reviews promising pharmacologic advances for both HFrEF and HFpEF. He also shares perspectives on future innovations, including fully implantable LVADs, organ preservation technologies, and transplant expansion strategies.

Dr. Youmans emphasizes that the future of heart failure care lies at the intersection of innovation, equity, and collaboration. By combining advanced therapies with patient-centered communication and improved access, clinicians can meaningfully transform outcomes for diverse patient populations.

Connect with Dr. Quentin Youmans: Here

In this episode of MD Newsline, Dr. Joel Wright, a rheumatology fellow at UCLA, provides an in-depth, practical discussion on axial spondyloarthritis and related spondyloarthritides. Dr. Wright breaks down evolving disease definitions, diagnostic challenges, imaging interpretation, and modern treatment strategies, while emphasizing a holistic, patient-centered approach to care. The conversation highlights how early recognition and individualized therapy can significantly improve long-term outcomes.

Defining Axial vs. Peripheral Spondyloarthritis

Dr. Wright explains the modern classification of spondyloarthritis, distinguishing axial disease—which primarily affects the spine and sacroiliac joints—from peripheral spondyloarthritis and psoriatic arthritis. He discusses why the shift away from the term ankylosing spondylitis allows for earlier diagnosis before irreversible spinal fusion occurs.

Recognizing Red Flags Across Specialties

Inflammatory back pain remains the most important clinical clue, particularly pain that worsens at rest, improves with exercise, and is associated with prolonged morning stiffness. Dr. Wright also highlights extra-musculoskeletal signs—such as uveitis, psoriasis, and inflammatory bowel disease—that should prompt early referral to rheumatology.

Classification Criteria vs. Clinical Judgment

While ASAS classification criteria are useful for research, Dr. Wright emphasizes that real-world diagnosis relies on clinical expertise. Patients may not meet strict criteria early in the disease course, yet still warrant diagnosis and treatment based on symptoms, exam findings, labs, and imaging.

MRI Use and Common Diagnostic Pitfalls

MRI of the sacroiliac joints plays a central role in early detection, but Dr. Wright cautions against overreliance on imaging alone. Bone marrow edema can be seen in athletes, postpartum patients, or with aging, underscoring the importance of correlating MRI findings with clinical context.

Biomarkers and Emerging Research

HLA-B27, ESR, and CRP remain useful tools, though many patients have normal inflammatory markers. Dr. Wright discusses emerging biomarkers, including antibodies such as anti-CD74, and the need for more reliable tools to support earlier diagnosis.

Treatment Algorithms and Medication Selection

NSAIDs remain first-line therapy and may slow radiographic progression. For patients with inadequate response, Dr. Wright outlines escalation to biologics, including TNF inhibitors, IL-17 inhibitors, and JAK inhibitors—while tailoring choices based on comorbidities such as uveitis or inflammatory bowel disease.

Treat-to-Target and Monitoring

Early disease requires more frequent follow-up to assess response and adjust therapy. Dr. Wright explains realistic timelines for evaluating NSAIDs and biologics while balancing treat-to-target goals with clinic capacity.

The Role of Exercise and Non-Pharmacologic Care

Physical therapy, structured exercise, and low-impact activities such as swimming and cycling are foundational to care. Dr. Wright emphasizes the mental and physical benefits of movement, posture training, and holistic therapies alongside medication.

Managing Comorbidities and Special Populations

The discussion covers cardiovascular risk screening, adherence challenges in younger patients, biologic tapering in remission, pregnancy considerations, and care for older adults with established structural damage. Shared decision-making remains central across all scenarios.

Dr. Wright underscores that axial spondyloarthritis requires early recognition, thoughtful interpretation of imaging, and individualized treatment strategies. Combining pharmacologic therapy with exercise, multidisciplinary care, and patient education is essential to improving quality of life and preventing long-term disability.

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In this episode of MD Newsline, Dr. Marianna Cortese, a medical doctor and epidemiologist at the Harvard T.H. Chan School of Public Health, shares groundbreaking research on the link between vitamin D, Epstein-Barr virus (EBV), and the risk of multiple sclerosis (MS). Her work, conducted within the U.S. military cohort, sheds new light on racial, genetic, and environmental factors influencing MS development and potential prevention strategies.

Dr. Cortese discusses how vitamin D levels and immune response modulation play a role in MS prevention, and how EBV infection—now recognized as the leading cause of MS—interacts with genetic susceptibility and immune regulation. She also explores the future of AI in epidemiological research, the challenges of defining "deficiency" across diverse populations, and how personalized medicine may change MS prevention and treatment.

Understanding the Vitamin D–MS Connection
Dr. Cortese explains her landmark study assessing vitamin D levels in over 1,400 MS cases and double the number of controls from a U.S. military cohort. The findings show that higher vitamin D levels are associated with a 60% lower risk of MS, even among individuals who already meet current "sufficient" vitamin D thresholds.

Epstein-Barr Virus as a Causal Factor
She details how EBV infection precedes nearly all MS diagnoses, increasing risk 32-fold in those infected compared to those who remain uninfected. The 2022 Science paper by her team was pivotal in confirming EBV as the primary cause of MS.

Racial and Genetic Differences in Vitamin D Physiology
Dr. Cortese emphasizes that Black populations may metabolize vitamin D differently, which could explain why prior studies found weaker associations between vitamin D levels and MS risk. Her ongoing work includes genotyping vitamin D transport proteins and analyzing ethnic variations in MS susceptibility.

Public Health Implications and Future Research
Given vitamin D's safety, affordability, and widespread deficiency, Dr. Cortese advocates for revised supplementation guidelines tailored to disease prevention. She also highlights future research directions involving AI-driven data analysis, omics studies, and therapeutic vaccines or antivirals targeting EBV.

A Look Toward MS Prevention and Treatment
Dr. Cortese envisions a future where antiviral therapies against EBV could transform MS management—potentially leading to disease-modifying or curative interventions. Meanwhile, maintaining sufficient vitamin D remains a key, accessible step for reducing risk.

Dr. Cortese's research bridges decades of inquiry into how vitamin D and EBV intersect to influence MS risk. Her findings reinforce the importance of immune health, genetic understanding, and early prevention, paving the way for more personalized and equitable approaches to neurological care.

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