Discover and read the best of Twitter Threads about #rheumatology

Most recents (22)

🆕 2022 ACR Guidelines for Vaccines in Patients with Rheumatic & MSK Diseases, PART 1 💉

#RheumTwitter #Rheumatology
2022 ACR Guidelines for Vaccines in Patients with Rheumatic & MSK Diseases, PART 2 🔽
Read 3 tweets
The journey to the diagnosis of Sweet syndrome and its differentials is too sweet 🍬🍩🍫

Let's explore the sweetness.

@rabihmgeha @DxRxEdu @Sharminzi @DrCindyCooper @jackpenner @sargsyanz @rav7ks @RebeccaEBerger @RosenelliEM @CPSolvers @MithuRheum #MedTwitter #rheumatology
#1 Malignancies & Sweet syndrome

- AML (common)
- MDS (common)
- CML
- MM
- Hodgkin's lymphoma
- NHL
- Mycoses fungoides
- Cutaneous T-cell lymphoma
- Hairy cell leukemia
- Solid tumors

#oncology #hematology #MedTwitter
#2 Autoimmune disorders & Sweet syndrome

- IBD (common)
- Behcet (common)
- SLE (common)
- RA (common)
- Relapsing polychondritis
- Sarcoidosis
- Sjogren's
- Familial Mediterranean fever
- Undifferentiated connective tissue disease
- Erythema nodosum

#rheumatology #MedTwitter
Read 8 tweets
I'll be adding short important points which would hopefully help in remembering certain concepts during #PLAB preparation, to this thread🧵every now and then as I take them out from my scattered notes. Feel free to comment your tips and tricks which would help others, as well 👇
Please don't take any of these as medical advice 😂🙏. Real life stuff is much more nuanced. These are just clinchers for the sake of the exam.
#PLAB
1. Drug contraindications...
-Avoid BAN drugs in Asthma (Beta blockers, aspirin, NSAIDS) &
-DAMN drugs in diarrhoea (Diuretics, ACEIs, Metformin, NSAIDs)
#PLAB
Read 60 tweets
The Gut #Microbiome is implicated in the pathogenesis of inflammatory arthritides & other health conditions

Gut dysbiosis is a broad term relating to an 'imbalance' of gut microbiota associated with an unhealthy outcome

I find this an interesting topic with several unknowns

🧵 Image
"Gut inflammation is strongly associated with #Spondyloarthritis (SpA), as exemplified by the high prevalence of inflammatory bowel disease (IBD) and the even higher occurrence of subclinical gut inflammation in patients with #SpA."

nature.com/articles/s4158… Image
"Gut #Microbiome composition differs across regions and ethnicities, changes over time, and can be influenced by multiple factors, including, among others, diet, lifestyle, hormonal cycles, disease, comorbidity..."

'Gut microbiome in #Rheumatic diseases'
ard.bmj.com/content/80/11/… Image
Read 11 tweets
#SíndromePulmónRiñón: Ayudas diagnósticas
Radiología: infiltrados con patrón alveolar de distribución simétrica, predominio central y en bases pulmonares; sin embargo, hay casos en los que los hallazgos pueden ser focales – unilaterales y discernir con otras entidades puede ser difícil.
Gasimetría arterial: hipoxemia (PaO2 menor de 60mmHg); el mecanismo de esta condición es secundaria a “shunt” y alteración de la difusión, lo que explica la pobre respuesta al oxígeno a alto flujo en la mayoría de los casos.
Read 10 tweets
Getting my biologic: a thread. Buckle up, it’s a long one, with the backstory for context. #spoonie #healthcare #autoimmunedisease #RheumTwitter #rheumatology #spooniechat #invisiblepain #chronicillnessawareness #autoimmune
I have a condition called ankylosing spondylitis (AS), which is an autoimmune inflammatory arthritis that mainly affects the spine, but can spread to other joints as well. In other words, my body thinks that my joints are the enemy…
...so my immune system attacks them, causing inflammation and pain. This sounds bad, and it is, but what’s worse is over time this inflammation can erode your joints.
Read 78 tweets
Multisystem inflammatory syndrome in children is driven by zonulin-dependent loss of gut mucosal barrier.. @vipintukur @ProfSomashekhar @naveenthacker @iapindia @INDIANJOURNALO4 @VirusesImmunity @EditorIndPed @ICMRDELHI @MoHFW_INDIA @iiscbangalore Image
Weeks after #SARS-CoV-2 inf or exposure, some children develop a severe, life-threatening illness called Multisystem Inflammatory Syndrome in Children (#MIS-C). GI symptoms are common in MIS-C pts & severe hyperinflammatory response ensues with potential for ❤️ complications.
👉🏽As proof of concept, they treated a #MIS-C patient with #larazotide, a #zonulin antagonist, & monitored impact on antigenemia and clinical response.
👉🏽in MIS-C, prolonged + of SARS-CoV-2 in t GI tract ➡️ to release of zonulin, a biomarker of intestinal permeability,
Read 14 tweets
Inspired by recent posts from @AaronGoodman33 , here is my attempt to review briefly the interplay between Hematology and Autoimmune phenomena.

It's magic when that fusion occurs.

Any comments & suggestions appreciated.

#MedTwitter @rabihmgeha @DxRxEdu @CPSolvers
CLL & Autoantibodies:

1.) WAIHA (IgG), CAD (IgM), PCH

2.) PRCA, Autoimmune Neutropenia

3.) C1-NH (acquired angioedema)

4.) GM-CSF (Pulmonary alveolar Proteinosis)

5.) Factor VIII, vWD, V (Coagulopathy)

6.) ADAMTS13 (TTP)

7.) CFH & CFI (aHUS)

contd...

#MedTwitter
8.) CaSR (Hypocalcemia or Hypercalcemia)

9.) Desmoglein, BPAG1 Envoplakin, Periplakin (Paraneoplastic Pemphigus)

10.) ITP, Evans syndrome

11.) Insulin or Insulin receptor (Hypoglycemia or Hyperglycemia)

12.) C3 Nephritic factor (MPGN1)

#MedTwitter #hematology
Read 8 tweets
Still can't get over how good the #RheumMadness scouting reports are.

Common themes:
✅Most teams are convinced they will win their first round match-up (🤔)
✅Everyone is worried about AAV/SLE teams

Are we being blinded by the bright and shiny AAV/SLE trials?

I say yes.

🧵
First, let's acknowledge that these trials (BLISS-LN, TULIP, PEXIVAS, ADVOCATE) are amazing and definitely worthy competitors. But clinical trials aren't new in #Rheumatology and the other teams offer so much to our field.
IgG4-RD Classification Criteria:

✅Disease many in our field don't understand
✅Describe common + rare manifestations
✅Emphasize IgG4-RD 🆚 mimickers

Think it's too rare to win? We don't even know prevalence (likely under-recognized)!

Hence the criteria...
Read 18 tweets
#Rheumatology Fun

Let’s take a deep dive into a unique subset of rheumatic diseases 👇

This week's RTL guest tweetorial from @MithuRheum! Image
CASE 1:

🔹A 52 yo male presents to clinic w/ 6 months of hand ulcerations on the dorsal surface of the hands & elbow, oral ulcers, a violaceous periorbital rash and mild arthralgias

🔸CT chest demonstrates nodular opacities Image
Based on the clinical presentation and photograph of the ulcers, which of the following is the most likely diagnosis?

🤔
Read 24 tweets
1/ Dec. 18, ⁦@AmerMedicalAssn⁩ wrote to ⁦@HHSGov⁩ urging it to withdraw the recently issued Most Favored Nation (MFN) Model interim final rule (IFR): tinyurl.com/yajlvlb7

Issue has broad impact on patients, e.g. those who have #cancer, GI, #rheumatology disorders.
2/ This IFR would:

•Impact pricing and availability of many of the most expensive Medicare drugs nationwide

•Have serious detrimental impacts on patient access to needed medications

•Create strain and uncertainty for physician practices
3/ @AmerMedicalAssn has long supported efforts to address escalating prescription #drugprices and reduce financial burdens on patients.

However, the MFN IFR is deeply flawed.
Read 7 tweets
"Ever get the feeling you've been cheated?" (John Lydon)

The publication of this letter & the nature of its correction raises questions about the reliability of the academic record.

@llantwit @FFLMUK @RCPath @AAPTTweets @mike4path @Richard56 @JJPJ #autopsy

THREAD

1/14
When the letter by Won Sriwijitalai & Viroj Wiwanitkit was published in #JFLM, fact-checking journalists @SureAndShare in Thailand shared their concerns about it on @Twitter & @Facebook.

2/14
@SureAndShare were concerned that they were unable to verify who the 1st author was (or where they worked), or the death of a #forensic #medical professional from #COVID19. They cautioned against sharing the story.

3/14
Read 15 tweets
All right #dermtwitter & #medtwitter, it's time for the...

@MedDermSoc & @DermHospitalist Mini-Symposium on #COVID19 & #dermatology!!

I will be attempting to #livetweet the Zoom meeting!

Join along if you'd like. I will be using the h/t #COVIDDerm!

@RoxanaDaneshjou @dschless
Let's get started!!!!

Your cohosts are super excited to have you join. To give a little background, this meeting was planned in ~1 week, and we have over 500 RSVPs!

@MishaRosenbach now kicking us off with #COVIDDerm! Image
.@DrEstherFreeman is speaking and reminding us all to register our #COVID19 #dermatology cases in the @AADskin #COVID registry!

Reminder to do so here:
aad.org/covidregistry

#COVIDDerm
Read 39 tweets
Patients with autoimmune diseases, such as #lupus and #RheumatoidArthritis, are having trouble filling their prescriptions since Trump touted their medicine as an experimental treatment for #Covid19. /thread news-journalonline.com/news/20200405/…
“The hasty and inappropriate interpretation of the literature by public leaders has potential to do serious harm" write 2 rheumatology experts in the Annals of Internal Medicine. annals.org/aim/fullarticl…
FL pharmacists report "nearly all of the new prescriptions for #hydroxychloroquine are being issued for the prescribing practitioners themselves or family members of the prescribing practitioners." Some drs are prescribing it to healthy people as a #Covid19 preventative.
Read 12 tweets
Hidroxychloroquine (HQ) basics for non-rheum in COVID-19:
- Increases endosomal pH, interferes with the glycosylation of cellular receptors of SARS-CoV2.
- In vitro activity in SARS-CoV and SARS-CoV2.

Proposed dosing (COVID-19): 400 mg bid 1 day➡️200 mg bid 4 days. Longer tx?
Usually very well tolerated, most of adverse effects after months/years of therapy!
Better profile compared to chloroquine.

- Retinopathy. After long time-exposure, risk factors: > 5 mg/kg/day, renal insufficiency, tamoxifen use, obesity...
Not a problem for short term.
- Skin. Pruritus, rash, photosensibility...

- Myopathy. Rare. Usually long term use (1 year-10 years). Neuromyopathy (lisosomal changes, vacuoles in biopsy). Simmetrical weakness+/- sensitive symptoms.
Read 7 tweets
“Around 2012 or 2013, researchers identified evidence that gadolinium retention was connected to illness in patients with normal kidney function.” scholar.google.com/scholar_case?c…
“In September 2017, after the FDA voted to add concerns about gadolinium retention on warning labels, [gadolinium-based contrast agent] manufacturers, including Defendants, issued a new joint warning to patients with normal kidney function.” scholar.google.com/scholar_case?c…
“The warning [RE: #gadolinium retention] also directed physicians to advise patients of these concerns.”

Consent: valued in the United States since the Nuremberg trials of 1947 🇺🇸 scholar.google.com/scholar_case?c…

☢️#radiology
🥼#nephrology
🏥#publichealth ⚠️#patientsafety
💉#MRIdye
Read 4 tweets
Derm/Rheum Consult 1: 82yoW w/ HTN, breast can, new annular rash. Skin bx eosinophilic lymphocytic infiltrate. Gave 1mg/kg steroids.
ANA+ with centromere pattern, CREST?
==>#UnmaskSx with Steroids when tapering steroids.
==>Deep perivascular infiltrate on bx = Derm IDK!

1/
Derm/Rheum Case 2: 78yoF MGUS,HFpEF, rash on legs. ?purpura. w/u Cryocrit normal , RF+ skin bx C3 in vessel walls, LCV.
Dx: Type II Cryo
Learning Pearl: Retiform purpura "angular stellate rash" pic below and diagram -> VASCULITIS or VASCULOPATHY

#dermtwitter #rheumatology
2/
Derm/Rheum 3: Bullous Rash? DDx: Bullous Lupus vs. Epidermal Bullous Acquisita (EBA) vs. Bullous Pemphigoid
Learning Pearl:
Minimal trauma w/ blisters = EBA, treat with dapsone +/- prednisone
Consult Derm!

3/
Read 7 tweets
CUTANEOUS LUPUS – a #tweetorial/#medthread!!

We all learn about Systemic Lupus Erythematosus (SLE) in medical school, but did you know there are multiple forms #lupus can take in the #skin?

#Meded #FOAMed #dermtwitter #medtwitter #rheumtwitter #dermatologia pc: @dermnetnz
1/
It wasn’t until #dermatology residency I learned about all the subtypes of cutaneous lupus (CLE)! I thought it was all just one disease: SLE. But in reality there are many forms of CLE, each with its own implications on systemic involvement and effect on the patient.
2/
Let’s start with the 3 subtypes:
Acute, Subacute, and Chronic Cutaneous Lupus Erythematosus (ACLE, SCLE, CCLE). CCLE is aka Discoid.
Each subtype "overlaps" with SLE in a different way.

Eg: ACLE overlaps completely with SLE, so they all have SLE! 👇
onlinelibrary.wiley.com/doi/abs/10.111…
3/ Image
Read 17 tweets
It's #tweetorial time! Read on for a #medthread on:

Cutaneous Small Vessel #vasculitis (CSVV)!

#MedEd #FOAMEd #dermtwitter #dermatology #medtwitter #rheumtwitter pc: @dermnetnz
1/
I've heard different ways to organize the vasculitides over the years, but by the far the most common is by vessel size. As a #dermatologist, I see the small vessel vasculitides most often, so we'll focus on that today. Yes, Takayasu's important, but I'll save that for later!
2/
There is a relatively limited list of possible diagnoses with CSVV. I've included the most common below.

The blue I lump together as they are similar, and biopsy results help you differentiate.
The red are the ANCA-associated.
The green are the unique ones.
3/
Read 20 tweets
“Gadolinium-based contrast agents: Stimulators of myeloid-induced renal fibrosis and major metabolic disruptors,“ is now in press—sciencedirect.com/science/articl…

#gadolinium
#neurology 🧠
#radiology ☢️
#patientsafety
#publichealth
#toxicology
#dermatology
#nephrology
Gadolinium-based “magnetic resonance imaging contrast agent treatment impaired renal function, induced pathologic damage, and increased kidney fibrosis,” sciencedirect.com/science/articl…

#gadolinium
#nephrology
#radiology ☢️
#patientsafety
#publichealth
#toxicology
Read 11 tweets
“Notably, in recently published rodent studies, complete clearance of the brain took up to 6 months after injection of a large amount of” gadolinium-based contrast agents. journals.lww.com/investigativer… @HrsQuiet
#gadolinium
#neurology 🧠
#radiology ☢️
#patientsafety
#publichealth
“[S]o it can be assumed that the total clearance—if achieved at all—might also take months in humans,” after gadolinium-based contrast administration— journals.lww.com/investigativer… @HrsQuiet
#gadolinium
#neurology 🧠
#radiology ☢️
#patientsafety
#publichealth
#toxicology
Read 4 tweets
“Despite significant differences in the thermodynamic stability between non-ionic Omniscan and ionic Magnevist, the [#gadolinium ☠️] concentrations were about the same in the brain,” nibib.nih.gov/sites/default/…
#radiology ☢️ #patientsafety #publichealth #neurology 🧠 #dermatology
“Chronic symptoms attributed to [gadolinium-based contrast agent] exposure:” paresthesias, dysesthesias, clouded mentation, skin discoloration, skin changes, skin thickening, bone pain, bone/joint pain, muscle spasms, arthralgia, muscular weakness—nibib.nih.gov/sites/default/…
“Chronic symptoms attributed to [gadolinium-based contrast agent] exposure:” fatigue/asthenia, digestive symptoms, nausea, vomiting, diarrhea. nibib.nih.gov/sites/default/…
#gadolinium #radiology ☢️ #patientsafety #publichealth #neurology 🧠 #dermatology #nephrology #rheumatology
Read 14 tweets

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