Pankti Mehta Profile picture
Nov 3, 2022 8 tweets 7 min read Read on X
💭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

@MedTweetorials

(1/8) Image
🪜The first step is early diagnosis, do not wait until the deformities to form!

💬Think of RA when a patient presents with

🔸Peripheral
🔸Symmetric
🔸Arthritis
🔸Morning stiffness>30 minutes

#MedTwitter

(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 👑

(3/8)
In cases of seronegative RA, don't miss these!

🔸 #Psoriatic #arthritis
🔸 Crystal arthropathies
🔸 Polymyalgia rheumatica
🔸 Generalized #osteoarthritis
🔸 Hansen's disease
🔸#Lupus, sjogren's and other CTDs

#MedTwitter

(4/8)
Now the drug of choice for RA is the good old methotrexate 💊
But before that a few more things need to be checked ☑️

🔸CBC
🔸LFT
🔸RFT
🔸Chest radiograph
🔸HbsAg & anti- HCV
🔸Screen for other comorbidities, hypothyroidism, osteoporosis when appropriate

#MedTwitter

(5/8)
If all okay✅, then start with

😧😧Symptom control- NSAIDs, +/- steroids

💊DMARDs- Methotrexate. Start with 10-15mg weekly

⏫Step it up 4-6 weekly to a maximum of 25mg.

🚫🚫You don't want to start a cocktail 🍸 of inappropriately dosed DMARDs🚫🚫

#MedTwitter

(6/8) Image
A good way to add on therapy 👇 by using the treat to target🎯 approach (EULAR 2019 recommendations)

ard.bmj.com/content/79/6/6…

#MedTwitter

(7/8) Image
And hopefully in a few years, we'll have patients with Rheumatoid #Arthritis on treatment coming like this👇😀

Again, all cases may not be straightforward! A tweetorial on #rheumatoidarthritis in special situations is coming up soon!

(8/8) Image

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More from @PanktiMehta24

Jul 10
How to approach a patient with #angioedema? 🧐 🧵

#MedTwitter

(1/7) Image
♦️There are two broad mechanisms of angioedema

1️⃣ Histamine mediated or #allergy 🤧
2️⃣ Bradykinin mediated 🥵

The management depends on the underlying mechanism !

Also before anything, secure the AIRWAY if needed 🫁

(2/7)
Image
Image
✏️What are the possible etiologies ?
🔹Allergic 🤧
🔹Drugs 💊
🔹Hereditary 🧬
🔹Acquired
- lymphoproliferative disease➡️ excess C1
-autoimmune diseases ➡️ antibodies against C1inh

(3/7)
Read 7 tweets
Jul 4
Facial rashes that look like lupus but are not ! 🧵🦋

1. Rosacea 🥵
🔹Look for telangiectasia
🔹Involvement of the nasolabial folds 🔹Flushing with spicy foods, heat, & sun exposure

#MedTwitter #RheumTwitter
Image
Image
2. Seborrheic dermatitis

🔹Yellowish scales
🔹 Involvement of the nasolabial folds, eyebrows & scalp Image
3. Dermatomyositis

🔹Involvement of the nasolabial folds
🔹Other rashes like heliotrope, gottron's etc
🔹Systemic features Image
Read 5 tweets
Jun 15, 2023
🫁How to interpret pulmonary function tests ??🫁

I'm not a pulmonologist but have to deal with a fair share ILDs,
here's a simple approach useful in the clinic especially for non pulmonary specialists

(1/7)

#MedTwitter #RheumTwitter #MedEd Image
1️⃣Is the test valid?

You need to check for three things

🌬️ Effort
✅The time volume curve forms a plateau in 1-2 seconds
✅ sustained expiration for 6 seconds!

(2/7) Image
➰Flow loops

✅ for artefacts/abnormalities 📷⤵️

(3/7) Image
Read 8 tweets
Jun 13, 2023
🔹Relapsing Polychondritis🔹

Important takeaways from an excellent presentation by @Lupusreference @eular_org #EULAR2023

#MedTwitter #RheumTwitter
🔹Rare disease
🔹Middle aged adults
🔹No♀️ predominance

👂👂👂👂
It's typically characterized by:
🥵Red/swollen
👂Spares the lobule
🤕Painful
⏳lasts >48 hrs
❌ ear discharge (infection)
❌ necrosis/purpura (CAPS)

📷⤵️Prone to erroneous diagnosis!! ImageImage
Once 👂chondritis is confirmed, rule out mimics! Image
Read 11 tweets
Jun 6, 2023
Doctor: Where is the pain?

Patient: Pain pain everywhere!

❔How do we approach a patient with multiple joint pains❔

(1/12)
#polyarthritis #MedTwitter #MedEd #RheumTwitter Image
1️⃣ Is it polyarthritis?

First, you want to make sure it's polyarthritis - multiple (>4 joints) pain WITH SWELLING

& NOT 🚫

🔹Polyarthralgia⏩ pain WITHOUT swelling
🔹Widespread pain
🔹Myalgia
🔹Bone pain
🔹Neuropathic pain

Let's deal with polyarthritis ⏬

(2/12)
2️⃣ Is it acute or chronic??

Acute<6 weeks

🔹 Infections- gonococcal, infective endocarditis, rheumatic fever, lyme disease, viral

🔹Elderly RA, ANCA vasculitis, paraneoplastic

(3/12)

#MedTwitter
Read 12 tweets
Jun 5, 2023
It's #WorldEnvironmentDay2023 & I thought why not discuss the influence of air pollution🏭 on various rheumatic diseases

The association of 🏭 is obvious with lung diseases, malignancies & skin problems

But, we have to understand that the effects are deeper than that😦
Particulate matter (PM10) is inhaled & affects the upper bronchi ⏩ local inflammation

Fine & ultrafine PM reach the alveoli & circulation ⏩ systemic effects

Levels of inflammatory markers ∝ exposure to 🏭

pubmed.ncbi.nlm.nih.gov/19687019/

pubmed.ncbi.nlm.nih.gov/33470401/ ImageImage
Does it increase the risk of disease development?

Yes!

In a study from Italy, exposure to PM 10 increased the risk of RA & other immune mediated diseases

pubmed.ncbi.nlm.nih.gov/35292563/aa Image
Read 6 tweets

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