Pankti Mehta Profile picture
Jun 6 12 tweets 5 min read Twitter logo Read on Twitter
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
Chronic >6 weeks

🔹Rheumatoid arthritis
🔹Lupus, Sjogren's, other systemic rheumatic diseases
🔹Still's disease
🔹CPPD/ sometimes polyarticular gout
🔹Psoriatic arthritis
🔹Osteoarthritis

(4/12)
3️⃣Temporal pattern
📈📉📊
(5/12) Image
4️⃣ What is the nature of the pain?

🔹Inflammatory: pain worse at rest, relieved with activity, with early morning stiffness>30min

🔹Non-inflammatory: pain worse with activity, relieved with rest

This is important to figure out the plausible etiologies!

(6/12) Image
5️⃣ Next, what is the joint distribution??

This 📷 has the classic bilateral symmetrical polyarthritis seen in

🔹Rheumatoid arthritis
🔹Lupus
🔹Sjogrens & other systemic rheumatic diseases
(7/12) Image
📷 is showing asymmetric polyarthritis seen in

🔹Polyarticular psoriatic arthritis (note the 'ray' sign with involvement of MCPs, PIPs DIPs in a line & asymmetric sacroiliitis)

(8/12) Image
🔹 Osteoarthritis pattern with knee, hip, 1st MTP, 1st CMC, PIP, DIP involvement

(9/12) Image
6️⃣ Extra articular features

🔹Fever 💭 of infection, lupus, still's disease, autoinflammation

🔹Nodules 💭 of RA, gout, rheumatic fever

🔹Rash 💭 lupus, dermatomyositis, sjogren, still's disease, viral infection, psoriasis

(10/12) Image
🔹 Raynaud's 💭 of Scleroderma spectrum, lupus, Sjogren

🔹 Others: sicca, skin thickening, weight loss, anorexia, organ specific symptoms 🫁🫘🫀

(11/12) Image
And always remember,

History & clinical examination will give you the diagnosis in most cases.

An arthritis panel will only confuse you & make the lab owner richer 😏

(12/12) Image

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More from @PanktiMehta24

Jun 5
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
Jun 3
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
Read 6 tweets
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

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