Beyond Back Pain: Recognizing and Treating Axial Spondyloarthritis Early

Beyond Back Pain: Recognizing and Treating Axial Spondyloarthritis Early

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. Key Takeaway 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. Resources Website: https://mdnewsline.com/ [https://mdnewsline.com/] Newsletter: https://mdnewsline.com/subscribe/ [https://mdnewsline.com/subscribe/] Contact with Dr. Jill Weintraub: Here [https://jillweintraubmd.com/about]

Addiction, Overstimulation, and Performance in Sports Psychiatry

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. Episode Highlights: The Biopsychosocial Model of 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. Substance vs. Behavioral Addictions 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. Cannabis Potency and Psychiatric Risk 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. Co-Occurring Mood Disorders 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. Digital Overstimulation and Dopamine 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. Dopamine Detox: Myth or Medicine? Although strong research evidence is limited, reducing overstimulation may help the brain recalibrate toward homeostasis and improve natural reward sensitivity. Integrated Treatment for Multiple Addictions 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. Sports Psychiatry and Identity 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. Youth Sports and Escalating Pressure With increasing financial and performance stakes at younger ages, adolescent athletes face heightened mental health risk before full neurodevelopment. Neuromodulation in Addiction 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. Executive Function and Craving Addiction involves planning, coordination, and decision-making processes—not simply impulsivity. Targeting prefrontal control circuits may influence compulsive behaviors and substance-seeking. Collaborative Care Model 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. Key Takeaway 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. Resources: Website: https://mdnewsline.com/ [https://mdnewsline.com/] Newsletter: https://mdnewsline.com/subscribe/ [https://mdnewsline.com/subscribe/] Contact with Dr. Justin Morales: Here [https://www.linkedin.com/in/psychdrjm/]

Beyond Statins: Modern Cholesterol Care, Risk Assessment, and the Future of Lipid Therapy

In this episode of MD Newsline, Dr. Amber Johnson, Assistant Professor of Medicine and General Cardiologist at the University of Chicago, provides an in-depth look at modern cholesterol management and cardiovascular risk reduction. She discusses evolving lipid guidelines, aggressive LDL-C targets, statin intolerance, and the growing role of non-statin therapies. Dr. Johnson also explores emerging research on lipoprotein(a), hypertriglyceridemia, and future directions in lipid-lowering treatment. Episode Highlights Evolving Cholesterol Management and ASCVD Risk Dr. Johnson explains how cholesterol treatment has become more aggressive over the past decade, driven by robust evidence linking LDL cholesterol to cardiovascular events. She emphasizes LDL-C as the primary treatment target and discusses the role of HDL, triglycerides, and inflammatory markers such as high-sensitivity CRP, particularly in women. Lifestyle Modification and Population-Level Prevention Heart-healthy lifestyle interventions remain foundational to cardiovascular prevention. Dr. Johnson highlights the American Heart Association's Life's Essential Eight, including physical activity, diet, sleep, and smoking cessation, as critical components of long-term risk reduction. Key Updates in 2025 Dyslipidemia Guidelines Dr. Johnson reviews the 2025 ESC/EAS-focused update, emphasizing lower LDL-C targets for high- and extreme-risk patients. She discusses the increasing use of PCSK9 inhibitors, adjunct lipid-lowering therapies, and the recommendation for routine lipoprotein(a) screening as a risk-modifying factor. Risk Assessment and Personalized Treatment Decisions For primary prevention patients, Dr. Johnson outlines how risk calculators, coronary artery calcium scoring, and comorbidities such as diabetes and metabolic syndrome guide lipid-lowering intensity. She also addresses how updated endocrine and diabetes guidelines influence earlier and more aggressive treatment strategies. Statin Intolerance and Treatment Sequencing Persistent barriers to statin use include side effect concerns, cost, and polypharmacy. Dr. Johnson shares practical strategies for managing statin intolerance, including dose adjustments, switching statins, alternate-day dosing, and the addition of non-statin therapies such as ezetimibe, bempedoic acid, and PCSK9 inhibitors. Non-Statin Therapies and New Treatment Options Dr. Johnson discusses when to escalate therapy to PCSK9 inhibitors, including monoclonal antibodies and siRNA-based agents like inclisiran. She also explains how cost, access, and insurance coverage influence real-world treatment decisions. Triglycerides and Emerging Lipid Targets While triglycerides are often overlooked, Dr. Johnson reviews their clinical significance, particularly in severe hypertriglyceridemia. She discusses lifestyle interventions, fibrates, omega-3 therapies, and emerging agents targeting ANGPTL3 and APOC-3. The Role of Lipoprotein(a) Routine Lp(a) screening is gaining momentum due to its strong association with cardiovascular disease and aortic stenosis. Dr. Johnson reviews current guideline recommendations, clinical utility, and ongoing outcome trials such as OCEAN and HORIZON that may soon reshape treatment options. Special Populations and Complex Care Dr. Johnson addresses lipid management in patients with chronic kidney disease, HIV, inflammatory diseases, and cancer, emphasizing individualized therapy and careful consideration of drug–drug interactions. Future Directions in Lipid Therapy Looking ahead, Dr. Johnson explores long-acting therapies and gene-editing approaches such as CRISPR, while highlighting the importance of health equity, access to care, and sustainable lifestyle interventions. Key Takeaway Dr. Johnson underscores that lower LDL cholesterol is better, with no identified lower limit of harm, and highlights the growing importance of lipoprotein(a) screening in cardiovascular risk assessment. As lipid therapies continue to evolve, combining guideline-driven care, patient-centered decision-making, and equitable access remains essential to improving long-term cardiovascular outcomes. Resources Website: https://mdnewsline.com/ [https://mdnewsline.com/] Newsletter: https://mdnewsline.com/subscribe/ [https://mdnewsline.com/subscribe/] Contact with Dr. Amber Johnson: Here [https://www.uchicagomedicine.org/find-a-physician/physician/amber-e-johnson]

Understanding Alzheimer's Disease: Biomarkers and Early Detection

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. Episode Highlights 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. Key Takeaway 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. Resources MD Newsline Website: https://mdnewsline.com/ [https://mdnewsline.com/] Newsletter: https://mdnewsline.com/subscribe/ [https://mdnewsline.com/subscribe/] Contact with Dr. Rudolph J. Castellani: Here [https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=53137]

Innovation, Access, and the Future of Cardiac Care

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. Episode Highlights 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. Key Takeaway 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. Resources Website: https://mdnewsline.com/ [https://mdnewsline.com/] Newsletter: https://mdnewsline.com/subscribe/ [https://mdnewsline.com/subscribe/] Connect with Dr. Quentin Youmans: Here [https://chinchilla-reed-sjhz.squarespace.com/40-under-40-awardees/2021/quentin-youmans]