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EnvisionRheumat Profile picture
@ERheumat
Jun 4, 2022 • 7 tweets • 6 min read • Read on X
Scrolly
#EULAR2022
How To Treat (HOT)
Anti-phospholipid syndrome Image
#EULAR2022
How To Treat (HOT)
Anti-phospholipid syndrome
🩸Primary Thromboprophylaxis
🩸Aspirin is recommended but might not be sufficient
🩸VKA use is asso. ⬆️ Bleeding risk (Risk>Benefit) ImageImageImageImage
#EULAR2022
How To Treat (HOT)
Anti-phospholipid syndrome
🩸Secondary Prophylaxis
🩸INR: 2-3 for venous thrombosis (Controversial)
🩸Is not effective in preventing arterial events though ImageImageImageImage
#EULAR2022
How To Treat (HOT)
Anti-phospholipid syndrome
🩸For Recurrent/Arterial Thrombosis
🩸INR 3-4 or 2-3 with LDA might be needed
🩸We still need more data on this
🩸The role of NOACs is controversial might be tried in low risk pts who don't tolerate VKA ImageImage
#EULAR2022
How To Treat (HOT)
Anti-phospholipid syndrome
🩸CAPS: Triple therapy
🩸GC+ IVIG/PLEX+ anticoagulation works well ImageImageImageImage
#EULAR2022
How To Treat (HOT)
Anti-phospholipid syndrome
🩸 Ritux and Eculizumab have shown some efficacy in refractory CAPS ImageImageImage
#EULAR2022
How To Treat (HOT)
Anti-phospholipid syndrome
🩸Obstetric APS
🩸1 Prophylaxis: LDA or LDA+LMWH
🩸2 Prophylaxis: LMWH + LDA
🩸Refractory: LMWH+LDA+HCQ+ Low dose steroids (Upto 15mg/day) ImageImage

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More from @ERheumat

EnvisionRheumat Profile picture
Feb 21, 2023
SSc-ILD-an overview by Chris Denton
This was a Masterclass in SSc-ILD
🧵Alert
2/n
🫁ILD is associated with a poorer outcome
🫁 Dyspnea in SSc could be multifactorial
🫁 Tissue Oxygen delivery is also ⬇️ Significantly
3/n
 🫁HRCT is often the investigation of choice for the evaluation extent of ILD and the ILD pattern
🫁 UIP has a poorer prognosis than NSIP
Read 10 tweets
EnvisionRheumat Profile picture
Nov 13, 2022
#ACR22 #ACR2022
12S129. Purple Peripheries: Vasculopathy VS Vasculitis
Philip Seo is awesome as always
The most common cause is Cardiovascular followed by Rheumatic
More commonly vasculopathy than Vasculitis
#ACR22 #ACR2022
12S129. Purple Peripheries: Vasculopathy VS Vasculitis
Algorithm for Digital ischemia in Rheum
Mx for Gangrene in SSc
#ACR22 #ACR2022
12S129. Purple Peripheries: Vasculopathy VS Vasculitis
Large and Small vessel rarely cause Digital gangrene
Read 7 tweets
EnvisionRheumat Profile picture
Nov 13, 2022
#ACR2022 #ACR22
12S130. Rheumatology Secrets and Pearls
Dr John Stone, at his best
🎯RA may present with asymmetric arthritis
🎯AAV might present with migratory oligoarthritis, which is steroid responsive
🎯Only a quarter of RA patients go into remission during pregnancy
#ACR2022 #ACR22
12S130. Rheumatology Secrets and Pearls
🎯Following trends is more important in pregnancy that stat values (ESR/Complements)
🎯Proteinuria⬆️ creat ⬇️ due to ⬆️ GFR and maternal Blood volume in pregnancy
#ACR2022 #ACR22
12S130. Rheumatology Secrets and Pearls
🎯Puffy fingers may be the first sign of SSc in RNApolIII SSc and No Raynaud's - May present with SRC
🎯ACEi are best kept reserved for SRC
Read 6 tweets
EnvisionRheumat Profile picture
Nov 13, 2022
#ACR2022 #ACR22
12S130. Rheumatology Secrets and Pearls
Jason Kolfenbach, with his wonderful pearls
1. Vasculitis Pearls
🦪For Steroids ➡️ Less is more
🦪Be very careful in stopping Rx in AAV pts
🦪Don't give up on PLEX in suspected AAV Anti-GBM may have ANCA positivity.
#ACR2022 #ACR22
12S130. Rheumatology Secrets and Pearls
🦪Not all Skin thickening = SSc
🦪Lipodermatosclerosis (with inverse 🍾 sign)
🦪Thyroid disease important mimics
🦪PPI can cause diarrhoea
🦪FVC/DLCO ratio can help diagnose ILD/PAH
#ACR2022 #ACR22
12S130. Rheumatology Secrets and Pearls
🦪30% SLE pts have APS
🦪DLE uncommonly progresses to SLE
🦪PPIs, NSAIDs, Anti-HTN meds commonly cause SCLE
Read 5 tweets
EnvisionRheumat Profile picture
Nov 12, 2022
#ACR2022 #ACR22
12S102. Year in Review 👌🏻
1st to be discussed was the Gloria Trial
Glucocorticoids effective but safety an issue ImageImageImage
#ACR2022 #ACR22
12S102. Year in Review 👌🏻
Next to the most discussed study of the year
Oral surveillance trial
The CV risk is higher in those with ASCVD - NNH 16😳 ImageImageImage
#ACR2022 #ACR22
12S102. Year in Review 👌🏻
Next to the Proderm Study
Cost, thromboembolism a concern in the first positive phase 3 RCT in myositis Image
Read 5 tweets
EnvisionRheumat Profile picture
Jun 6, 2022
#EULAR2022
What is New (WIN)
IgG4
🔆IgG4 is a multi-organ Disease
🔆usually >50
🔆M:F - 3:1
🔆CD4+ cytotoxic cell implicated
🔆 Classification criteria known
#EULAR2022
What is New (WIN)
IgG4
🔆➕ve correlation with smoking (IgG4 retroperitoneal fibrosis)
🔆 blue Collar Jobs have ⬆️IgG4 (pancreato biliary)
🔆d/t toxic exposures 👉🏻 asbestosis, mineral dust
#EULAR2022
What is New (WIN)
IgG4
🔆Role of AutoAb suspected
🔆Anti-IL1RA👉🏻Mediates Inflammation and fibrosis
🔆Anti-Annexin A11👉🏻 damage biliary bicarbonate umbrella
Read 10 tweets

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