Pankti Mehta Profile picture
Jun 3 6 tweets 3 min read Twitter logo Read on Twitter
Hey #MedTwitter !

1. What does the image show?
2. Possible etiologies?

#RheumTwitter Image
It's a purpuric rash. The two most important DDs are:

🔹Small vessel vasculitis (lupus, ANCA, cryoglobulinemia etc) ♨️

🔹Infective endocarditis (janeway lesions) ❣️

Bleeding disorders often affect areas where the skin is soft and loose rather than the soles
Other causes of palmoplantar rash

1️⃣Infections- maculopapular, blanching

🔹Viral eg parvovirus, coxsackie, measles
🔹Bacterial- menigococcimia (purpuric, non blanching), syphilis (2°)
🔹Rickettsia- RMSF

#MedTwitter #MedEd Image
2️⃣ Erythema Multiforme

Macular targetoid lesions- immune phenomenon secondary to infections (herpes simplex, mycoplasma) or drugs Image
3️⃣ Psoriasiform

Scaly erythematous plaques

🔹 Palmoplantar psoriasis
🔹Keratoderma blenorrhagicum

Both are clinically indistinguishable

🔹Other cause of a nodular scaly rash is arsenic keratosis ImageImageImage
4️⃣ Palmar Erythema

Kawasaki's disease, CLD, pregnancy etc Image

• • •

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More from @PanktiMehta24

May 3
☘️Antinuclear Antibodies (ANA)☘️

Here's a 🧵 on another #rheumatology test which can confuse>help if ordered without a 💭 (part 1)

Let's peek into the #immunology lab to learn more about the lab aspect of ANA 🥼🧪👀

(1/12)

#MedTwitter #LupusAwarenessMonth #MedEd Image
🤔 What do we mean by ANA??

🔹As the name suggests, they are antibodies to various nuclear components

🔹These Antigens(Ag) can be related to

1. DNA🧬: DNA, histones, nucleosomes

2. RNA: Smith, RNP, Ro, La

3. Others: ribosomal P, Ku etc

(2/12)
Which one of the following is the oldest test to detect ANA? 📜

(3/12)
Read 12 tweets
Apr 21
😣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

OR

2️⃣ There was no joint swelling to begin with

(2/10)
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

(3/10)
Read 10 tweets
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
onlinelibrary.wiley.com/doi/10.1111/j.…

(3/15)
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

➡️vasculopathy

#MedEd #MedTwitter
Read 12 tweets
Nov 23, 2022
Learning mycobacterial rheumatism from the best @anupamwakhlu !!

#IRACON22
@IndianRheum
#Hansen's disease

✊ Arthritis in 1-78%🙀🙀🙀

Cause?

🧪Reactionary
🔥Direct inflammation
🧠neuropathic joints

#MedTwitter Image
😵confusing conundrums😵

Hansen's disease may present like

👉Rheumatoid arthritis
👉Carpal Tunnel Syndrome
👉Reactive Arthritis
👉Relapsing Polychondritis (YES!)
👉Sarcoidosis
👉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
#RheumTwitter

@IndianRheum
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)

👌immunity

🚫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

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