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EnvisionRheumat Profile picture
@ERheumat
Jun 6, 2022 • 10 tweets • 9 min read • Read on X
Scrolly
#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
#EULAR2022
What is New (WIN)
IgG4
Role of Gut microbiota suspected
🔆 changes similar to PSC
🔆⬇️Blautia, ⬇️ Eubacterium seen in IgG4-SC
#EULAR2022
What is New (WIN)
IgG4
🔆Cluster analysis divides IgG4 in 4 Clusters
🔆Head and Neck MC in females and asians
🔆Mikulicz 👉🏻 ⬆️⬆️IgG4 levels
🔆 Renal Inv asso with ⬆️ pancreato biliary, RPF, ⬇️C3, Multisystem inv
#EULAR2022
What is New (WIN)
IgG4
Newer biomarkers being developed
🔆Plasmablast appear promising (But costly)
Acc to Machine learning
🔆IgG4 level
🔆Age
🔆Ig
🔆sIL-2R
Important variables
#EULAR2022
What is New (WIN)
IgG4
🔆Initial Rx with IS might be better
🔆50% flare by 2-3 yrs with RTX Induction
🔆Obinutuzumab in RTX resistant/Failure
#EULAR2022
What is New (WIN)
IgG4
🔆Tocilizumab 🔥>> CYC
🔆Abatacept ❌
#EULAR2022
What is New (WIN)
IgG4
🔆⬆️ malignancy risk with IgG4
🔆Lung Ca⬆️
🔆Pancreas Ca ⬆️
🔆Lymphoma ⬆️
🔆but not Gastric Ca
🔆Most diagnosed with the 1st year of IgG4 diagnosis
#EULAR2022
What is New (WIN)
IgG4
Summary
Must Watch 👌🏻👌🏻

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More from @ERheumat

EnvisionRheumat Profile picture
Dec 18
🧵 1/9 Key insights on AAV treatment from #ACR24. Dr. Langford's session highlighted the latest guidelines and therapeutic strategies. Let's dive in! #Vasculitis #Rheumatology Image
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🎯 2/9 AAV Treatment Goals: Remission, relapse prevention, minimize toxicity, organ damage, and optimize patient quality of life. Keep these in mind when choosing therapies. #AAV #TreatmentGoals Image
📚 3/9 Guidelines: ACR/VF (2021), KDIGO (2024), EULAR (2022), PANLAR (2023) - all provide crucial recommendations. Familiarize yourself with these! #AAVGuidelines #EvidenceBasedMedicine Image
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Read 9 tweets
EnvisionRheumat Profile picture
Dec 8
(1/10) #ACR24 Key Sarcoidosis Takeaways for Rheumatologists:
Sarcoidosis diagnosis relies on clinical probability, not "proof."
Patient-reported outcomes (ROS) are crucial for understanding disease extent & activity, guiding us to occult disease.
Diagnostics have limitations! Image
(2/10) #ACR24 Sarcoidosis epidemiology is complex.
Prevalence & incidence vary globally, with higher rates in Black individuals & females.
While ~80% achieve resolution in 2 years, disparities in diagnosis & treatment lead to poorer outcomes.
More research is needed! Image
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(3/10) #ACR24 Sarcoidosis etiology remains unknown.
Environmental, occupational, & infectious agents are suspected triggers.
Genetic predisposition plays a role.
Remember to consider medication reactions (TNFi's, ARVs, CTx) in the differential diagnosis. Image
Read 10 tweets
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

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