Discover and read the best of Twitter Threads about #rheumatology

Most recents (24)

☘️Antinuclear Antibodies (ANA)☘️

Here's a 🧵 on another #rheumatology test which can confuse>help if ordered without a 💭 (part 1)

Let's peek into the #immunology lab to learn more about the lab aspect of ANA 🥼🧪👀


#MedTwitter #LupusAwarenessMonth #MedEd Image
🤔 What do we mean by ANA??

🔹As the name suggests, they are antibodies to various nuclear components

🔹These Antigens(Ag) can be related to

1. DNA🧬: DNA, histones, nucleosomes

2. RNA: Smith, RNP, Ro, La

3. Others: ribosomal P, Ku etc

Which one of the following is the oldest test to detect ANA? 📜

Read 12 tweets
Rheumatoid factor

One of the most used & abused tests in #rheumatology

Let's learn a bit about its origin & utility!

#MedEd #MedTwitter #RheumTwitter

(1/15) Image
1️⃣ what is RF actually?🤷‍♀️

They are antibodies directed against the Fc fragment of IgG antibody

(2/15) Image
2️⃣ How & when was it first discovered?📆

1st described by Waaler in 1940, a factor present in 🚶‍♂️serum (in patients with RA & other diseases) that agglutinates 🐑 RBCs when sensitised with sub agglutinating doses of anti-🐑-RBC 🐰 immunoglobulin…

Read 15 tweets
The history of methotrexate began 75 years ago.

A short 🧵 on its history and pivotal moments, covering key trials to show realignment of #hematology #rheumatology, disciplines that belong to each other♥️

#MedTwitter Image
In the early 1940s, folic acid was isolated and found to cure some patients with megaloblastic anemia, not responding to vitamin B 12.
Also, patients with acute leukemia were treated with folic acid or folate conjugates (polyglutamated forms of folic acid)
👉proved ineffective:( Image
The subsequent demonstration by Heinle and Welch that a diet-induced deficiency of folic acid caused a decrease in the leukemia cell count, stimulated efforts, primarily by the Lederle group, to synthesize analogs of folic acid.
Overview of isolation and synthesis of folates👇 Image
Read 15 tweets
A 50-YO ♀️ bitten by her pet rat: fever, myalgia, sore throat, headaches a nonpruritic rash on extremities including palms & soles, arthralgias, knees arthritis.

A punctate wound with central necrosis on L palm, & her R thumb.

#rheumatology #internalmedicine #dermatology
Leukocytosis with neutrophilia
ESR & PCR:⬆️

Purulent R knee synovial fluid:
✔️46 000 cells/mL (88% neutrophils).
✔️Gram stain: scant pleomorphic gram-negative bacilli in chains with lateral bulbar swellings
#microbiology #rheumatologist
Synovial fluid 🧫culture: Streptobacillus moniliformis identified by biochemical testing & confirmed by MALDI-TOF.


#bacteriology #IDtwitter #microbiología
Read 9 tweets
Sensory Ganglionopathy & Sjogren Syndrome

⚡️what is it?

⚡️how to recognize/diagnose it

⚡️what's the underling cause?

latest @HRheuminations is up with link at the end of this ripping 🧶

a thread

#neurology #sjogren #rheumatology
Let's review anatomy 1st

Sensory nerves: travel from skin to the nerve cell body in the Dorsal Root Ganglion (DRG) then⬆️dorsal column of spine to the brain

DRG- ‼️cell body of sensory nerves‼️

Motor nerves: travel from brain and exit ventral (anterior) spinal cord ➡️muscle
Okay, so dorsal root ganglion only contains sensory nerves. This is an important part of the story.

Next important part, Sensory nerves are not all created equal.

Large fiber (myelinated) ➡️ small fiber (unmyelinated)

⭐️and lots in between

⭐️and they do different things
Read 13 tweets
Learning mycobacterial rheumatism from the best @anupamwakhlu !!

#Hansen's disease

✊ Arthritis in 1-78%🙀🙀🙀


🔥Direct inflammation
🧠neuropathic joints

#MedTwitter Image
😵confusing conundrums😵

Hansen's disease may present like

👉Rheumatoid arthritis
👉Carpal Tunnel Syndrome
👉Reactive Arthritis
👉Relapsing Polychondritis (YES!)
👉Vasculitis (Lucio phenomenon)
Read 6 tweets
Discussing problems unique to our region 🌍

🔘Kick-starting the South Asian Rheumatology Symposium with Prof. Syed Atiqul Haq joining us in spirit !

Vaccination in ##Rheumatology

#IRACON22 #vaccine

Pneumococcal 'prime and boost'

🕜PCV13⏩ 8 ⏩ weeks PSV23

🕜PSV23⏩1 year ⏩PCV13

🔁Repeat PSV23 at 5 years and once after 65 years!
👉 Recombinant zoster vaccine (shingrix)


🚫need for past h/o of VZV

2 doses:
first dose 2 weeks prior to immunosuppressant initiation
2nd dose 3 months after end of intensive immunosuppression/ drug holiday

👉Zostavax- more than 50 years if previous VZV exposure
Read 6 tweets
An 85-YO👨‍🦳, chronic kidney disease, gouty arthritis: fever, neck pain & stiffness.

WBC & CRP:⬆️
MRI suggested cervical meningitis (A): enhancement along the epidural space (arrows), & thin enhancement in a portion of the meninges (arrowheads).

#neurology #radiology
CSF: not meningitis, & CSF🧫& molecular tests ➖ for bacteria & mycobacteria

CT: calcifications of the transverse ligament of the atlas (B).

Diagnosed with crowned dens syndrome: 20 mg prednisolone, & his symptoms dramatically improved.

#rheumatology #radres #emergency
However, CSF examination under polarising microscopy revealed monosodium urate crystals (C).
Dual-energy CT confirmed the calcifications to be monosodium urate crystals (D).
Uric acid:⬆️
#neurology #MedEd
Read 5 tweets
The prevalence of #rheumatoidarthritis 🌍 ~1%

🙀 So ~14 million suffer from RA!

So we 👩‍⚕️ have to deal with special situations while managing this fairly common disease!

#MedTwitter #MedEd #rheumatology #RheumTwitter

@MedTweetorials @nihardesai7

Let's begin with one of the most beautiful miracles of life ☺️

#pregnancy in #rheumatoidarthritis

🤔Is it safe to conceive for a patient with RA? 🤰

👉Overall it is safe ☑️☑️☑️

👉But a mild risk of hypertensive disorders, IUGR and need for caesarian section +!

Read 9 tweets
💭When we think of #Rheumatoid #Arthritis , a mental image of this comes up 👇

But does it have to get to this🤔???

🙅NO! Definitely, NO! 🙅

#MedTwitter #MedEd #RheumTwitter #Rheumatology


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🪜The first step is early diagnosis, do not wait until the deformities to form!

💬Think of RA when a patient presents with

🔸Morning stiffness>30 minutes


(2/8) ImageImage
🧪👨‍🔬A positive Rheumatoid factor is seen in ~70% of cases and anti-CCP in ~75% cases, so about 1/5th of the cases may be seronegative!!

So a good history and clinical examination is the king 👑

Read 8 tweets

it's a word we throw around a lot

What does it mean? How can you tell the different causes from one another?


#meded #rheumatology #rheumtwitter #arthritis @VuMedi
Inflammatory arthritis just refers to:

🌟immune cell (typically innate) invading the joint space
🌟 typically neutrophils are the 1st to the scene of the crime Image
Normal synovium has very few cells

if you tap a joint, and there is greater than 2,000 WBC, this is considered "inflammatory"

lots of things can do this:
🌟trauma-foreign body into a joint
🌟infection-septic joint
🌟crystals-gout or pseudogout
Read 13 tweets
Un hilo 🧵 sobre podcasts de Reumatologia.
Una forma muy agradable de mantenerse al día desde cualquier lugar. A mi especialmente me gusta escucharlos temprano en la mañana tomando un café ☕️ #RotReuma
Comenzamos por Un Café por la Reumatologia , de los primeros en la especialidad y en español . Se encuentra en @GlobalRheum…
El piloto se lanzó en junio 2019… #podcast ImageImageImage
ACR on Air , podcast del @ACRheum conducido por @hausmannMD con episodios desde agosto del 2019…

Apple… Image
Read 18 tweets
Cryoglobulinemic Vasculitis

The #vasculitis where antibodies fall out of serum at ❄️ temps and cause all sorts of badness

follow this 🧵to learn the history of these strange proteins

#medtwitter #meded @HRheuminations @LCalabreseDO #rheumatology
it starts in 1933

Dr. Wintrobe is studying the blood of a woman who would later be found to have multiple myeloma

Her WBCs were very low

YET....the buffy coat (where WBCs like to live) was very large.

if her WBCs were low, what was accounting for the large buffy coat? Image
he can't figure it out, so what does he do?

he puts the blood in the freezer so he can ponder why the buffy coat is so thick.

the next day...

A strange precipitate in the tube

...that dissolved away when warmed back up Image
Read 10 tweets
1) I am a big fan of evolutionary medicine --> the study of human evolution and how it can be harnessed for the practice of medicine.

I recently went in for a deep dive into an important topic --> HYPERURICEMIA

Here is what I learnt!
2) Uric acid is the endproduct of purine metabolism in humans --> this is an exception among mammals!

Why does this happen?

1. Lack of uricase
2. Avid renal reabsorption of uric acid
3) Why happened to uricase?

This ancient enzyme, present since bacteria, accumulated a number of mutations approx 10-30 million years ago and gradually lost its function in humans, some higher primates and some New World monkeys.
Read 23 tweets
🆕 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
Welcome everyone to our 2nd Pediatric on Squares Board Review Course
We are starting today until the coming 8 days
Hope it’ll be helpful and enjoyable course
✏️ Note that you still can join and register on the course with accessibility to all recorded session until 27th of August ImageImage
Day 1
1st session: Pulmonology Review
By Dr. Bassem Kurdi @Bassemkurdi

#Pediatric #Pulmonology #MCQ ImageImage
Day 1
2nd session: Keys to Answer MCQs
3rd session: Neonatology review
By: Prof. Abdulrahman Alnemari @aalnemri
#Pediatric #Neonatology #NICU #MCQ ImageImage
Read 23 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)
- MM
- Hodgkin's lymphoma
- 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.
1. Drug contraindications...
-Avoid BAN drugs in Asthma (Beta blockers, aspirin, NSAIDS) &
-DAMN drugs in diarrhoea (Diuretics, ACEIs, Metformin, NSAIDs)
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."… 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'… 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… 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)


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

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