Differential diagnosis of RA-like arthritis based on the pattern of joint involvement is fascinating

Here is a 🧵 exploring this journey

#medtwitter #RheumTwitter @CPSolvers @rabihmgeha @DrCindyCooper @DxRxEdu @Sharminzi @sargsyanz @rav7ks @RosenelliEM @AnnKumfer @jackpenner
Various patterns of hand joint involvement

- PIP +DIP +1st CMC = OA
- MCP +PIP +Wrist = RA
- 2nd & 3rd MCP = Hemochromatosis
- Wrist +2nd MCP + 2nd PIP + all DIP= PsA
- Dactylitis/Sausage digits = PsA, Sickle cell anemia, Polyarticular gout, Sarcoidosis

#medtwitter @MithuRheum
Infections causing RA-like pattern

- Parvovirus B19
- HTLV-1
- Rubella
- HBV, VZV, Mumps (Large joints more common)
- HIV
- Arboviruses: Chikungunya, Dengue
- Poncet's disease/ Tuberculous Rheumatism

#medtwitter
RA-like pattern in Connective tissue diseases

- Rhupus (RA+SLE)
- MCTD (SLE+SSc+PM/DM)
- Fibroblastic Rheumatism (RA+SSc like)
- Multi-centric reticulohistiocytosis
- Anti synthetase syndrome
- Anti MDA-5
- SLE
- IBD/Bowel arthritis dermatitis syndrome
-Relapsing polychondritis
RA-like pattern +/- large joints in Autoinflammatory diseases

- Palindromic Rheumatism
- SAPHO syndrome
- CRMO
- PAPA
- Schnitzler syndrome
- Deficiency of IL-1R antagonist
- Deficiency of IL-36R antagonist
- CANDLE syndrome
- Blau syndrome
RA-like pattern in Metabolic disorders

- Farber disease
- Alpha-1 antitrypsin deficiency
- Hemochromatosis
- Crystallopathies

#medtwitter
RA-like pattern in malignancies

- Angioimmunoblastic T-cell lymphoma
- HTLV and Adult T-cell leukemia
- Acute palmar fascitis with polyarthritis (Ovarian CA)
- Paraneoplastic arthritis
Miscellaneous entities mimicking arthritis

- RS3PE (Relapsing seronegative symmetric synovitis with pitting edema)
- PVNS (Pigmented villonodular synovitis)
- Thyroid acropachy
- HOA
- Vit A toxicity
- Voriconazole induced periostitis
- CRPS/Causalgia
- Charcot arthropathy

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More from @KirtanPatolia

28 Oct
Not many entities in Medicine are as intricate as Paraproteinemias

As we celebrate National Internal medicine day today, here is a 🧵exploring its various associations and complications

#MedTwitter #hematology @AnnKumfer @RebeccaEBerger @Sharminzi @rabihmgeha @DxRxEdu @rav7ks
Entities that can feature a monoclonal protein/M component:

-MM
-WM
-MGUS
-MGCS
-MGRS
-Splenic Marginal Zone Lymphoma (HCV)
-CLL & MBL
-Heavy Chain disease (Gamma, Alpha & Mu)

There are various others indirectly associated with the M component. More to follow
Skin manifestations

-Scleromyxedema
-NXG
-Neutrophilic dermatosis
-Pyoderma gangrenosum
-Cutaneous macroglobulinosis
-POEMS: hypertrichosis, hyperpigmentation, hemangiomata, clubbing
-Clarkson/Systemic capillary leak syndrome
-Erythema elevatum et diutinium

#dermtwitter
Read 9 tweets
25 Oct
Guillain barre / GBS has an interesting differential diagnosis that has crucial management implications

Here is a thread based on what I have learned from my dear residents, attendings & journals

#MedTwitter #NeuroTwitter @rabihmgeha @DxRxEdu @AaronLBerkowitz @rav7ks
#1 GBS

- Infxs (C. jejuni, Mycoplasma, EBV, CMV, Zika,Influenza, HIV)
- Ascending weakness
- Cranial nerve involvement (CN 7)
- Usually no bowel/bladder disturbances
- Cyto-albuminologic dissociation and areflexia (may not manifest very early on)
- Rx - IVIG & Plasmapheresis
#2 GBS Variants and antibodies:

- AIDP
- Facial diplegia and paresthesia
- AMAN & AMSAN (GM1, GD1a)
- Phayngeal-Cervical-Brachial weakness (GT1a/GQ1b)
- Miller Fisher (GQ1b) (Areflexia + Ataxia + Opthalmoplegia)
- Bickerstaff encepahlitis (GQ1b)
- Pure Autonomic variant
Read 11 tweets
19 Oct
Adult-onset Still's disease/sJIA is beyond fascinating. The myriad of symptoms it can present with overlaps with many other disorders

Here is a thread exploring its spectrum

Any suggestions appreciated

#MedTwitter @CPSolvers @rabihmgeha @DxRxEdu @sargsyanz @rav7ks
Still's disease/sJIA classic symptoms
- Fever (Quotidian)
- Sore throat
- Synovitis/Arthralgia
- Hepatosplenomegaly
- Rash (Evanescent Salmon colored)
- Lymphadenopathy
- Anemia + Leukocytosis + Thrombocytosis + Hyperferritenemia + elevated ESR
- Rx (IL-1 inhibition)
Still's mimic #1 - Acute Rheumatic Fever

- Fever
- Sore throat (follows GAS pharyngitis)
- Arthralgia/Arthritis
- Rash (Erythema Marginatum)
- Elevated ESR
- Chorea
- Myopericarditis
Read 10 tweets
26 Apr
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

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