Pankti Mehta Profile picture
Apr 21 10 tweets 5 min read Twitter logo Read on Twitter
😣Patient: "All my joints are painful & swollen!"😣

👩‍⚕️But when you examine the patient, you don't find any joint swelling

How to approach this scenario? 🤷

#MedTwitter #RheumTwitter #MedEd 🧵🧵🧵

(1/10) Image
Now there are two possibilities

1️⃣ There was a joint swelling which is no longer there


2️⃣ There was no joint swelling to begin with

Let's start with the first one– there was indeed joint swelling which is no longer there

That means we are dealing with

☝️ An episodic inflammatory disease
✌️ Drug modified disease

☝️Episodic inflammatory diseases

💭 Of

🔹Palindromic #rheumatoid arthritis
🔹Autoinflammatory syndromes
🔹Spondyloarthritis (especially reactive)

✌️ Drug-modified disease

Any inflammatory arthritis can be modified by the use of

🔹Steorids 👿
🔹Complementary & alternative drugs 👿👿👿! (Very important)

So take that history well and check all records !

Now, let's move to scenario no.
2️⃣ There was no joint swelling to begin with

This raises 2 questions

☝️are we dealing with #arthritis?
✌️or is it something else?

☝️ So, what kinds of arthritis may not have joint swelling?

Simple- The ones that are non inflammatory!

💭 of


✌️is it even arthritis or something else?

Confirm if the pain is restricted to the joints or not?

Regional/diffuse pain could be related to

🔹Hypermobility disorders
🔹Bone pains
🔹Neurologic pain
🔹Soft tissue rheumatism

Also, some diseases may only have polyarthralgia

🔹Post Viral syndromes

In summary,

✅Joint pain without ❎swelling

💭 of
🔹Episodic #arthritis
🔹Drug modified arthritis
🔹Non inflammatory arthritis
🔹Regional/widespread #pain syndromes
🔹Systemic diseases with polyarthralgia!


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More from @PanktiMehta24

Apr 18
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
Jan 18
It's 🥶 & we're coming across many cases of peripheral ischemia/gangrene

🔢The semiology of seizures is what we are all taught, but gangrene is another condition where history is the king 👑

🔁It's essentially a demand≠supply mismatch

#MedEd #MedTwitter #RheumTwitter
The 📝 goes on & so that we can save ⏳ & 💰 on the tests, I like to broadly divide the pathology into:

1️⃣Luminal: atherothrombosis, thrombosis (APLA, DIC), cryofibrinogenemia

2️⃣Vessel wall: vasculitis (ANCA, PAN, SLE),vasculopathy (scleroderma spectrum)

3️⃣External compression
Q1️⃣: How was the onset?

🐌Insidious onset, gradual progression is the most common

➡️peripheral vascular disease

➡️most vasculitides


#MedEd #MedTwitter
Read 12 tweets
Nov 23, 2022
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
Nov 23, 2022
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
Nov 18, 2022
Autoinflammatory syndromes by Dr Dan Kastner at #ACR22 !


🧬AR, pyrin mutation, evolutionary resistance to Y pestis

🌡️Fever 1-3 days
😣Peritonitis (severe)
🫁Pleurisy unilateral
✊Mono or oligoarthritis


⚕️ colchicine, anti IL1 💉

#MedTwitter #MedEd

No ethnic predisposition

🧬AD, TNGRSF1A- p55

🌡️Fever 4-6 weeks
♨️Migratory rash proximal -->distal
👁️ conjunctivitis, periorbital edema

Amyloidosis occasionally

❌response to colchicine
⚕️Steorids ✅ anti IL1✅

Northern europeans

🌡️3-7 days
😣 Serositis
♨️Diffuse MP rash
Cervical adenopathy
Aphthous ulcers

Read 5 tweets
Nov 5, 2022
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

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