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Pankti Mehta

@PanktiMehta24

Jun 5 • 6 tweets • 4 min read Twitter logo

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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/

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

What about RA flares?

Contrasting data here but logically speaking it could definitely be associated with flares 😦

60 day average exposure to 🏭 associated with flares✅
pubmed.ncbi.nlm.nih.gov/33470401/

Whereas short term (1-2 wk) exposure ❌ associated

pubmed.ncbi.nlm.nih.gov/34444236/

An increased risk of lupus was observed in a community exposed to petroleum pollution due to pristane ! pubmed.ncbi.nlm.nih.gov/17316448/

And it may even trigger #lupus flares !
ncbi.nlm.nih.gov/pmc/articles/P…

Similar risks for other autoimmune diseases with an especially strong association of silica dust with GPA and sarcoidosis.

So,
🔹Ask for a good residential & occupational history

🔹👀 for travel to pollution hotspots for unexplained flares

More work in this area needed!!

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More from @PanktiMehta24

Pankti Mehta

@PanktiMehta24

Jun 6

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

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

Pankti Mehta

@PanktiMehta24

Jun 3

Hey #MedTwitter !

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

#RheumTwitter

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

Read 6 tweets

Pankti Mehta

@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

🤔 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

Pankti Mehta

@PanktiMehta24

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)

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

Pankti Mehta

@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)

1️⃣ what is RF actually?🤷‍♀️

They are antibodies directed against the Fc fragment of IgG antibody

(2/15)

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

Pankti Mehta

@PanktiMehta24

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