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Pankti Mehta Profile picture
@PanktiMehta24
Jun 13 • 11 tweets • 5 min read Twitter logo Read on Twitter
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🔹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
👃👃👃👃
Nasal chondritis
🔹Pain at the root of the nose, but no local inflammation can be seen Image
A good list of DDs again! Image
🫁🫁🫁🫁🫁
Respiratory Chondritis

🔹Larynx
Cervical pain
Dysphonia
Stridor

🔹Trachea
Cough
Chest pain
Respiratory failure
Remember, it begins with chondritis only in 60%!

Other features:

🔹🔥arthritis (relapsing, 🚫 erosive, seroneg, axial/peripheral)

🔹👁️: epi/scleritis

🔹Internal ear: vertigo/hearing loss

🔹🫀: aortitis, myocarditis (♂️, s/o VEXAS)

🔹Skin: neut dermatoses ( s/o VEXAS)
Can be classified into 3️⃣ clusters: Image
Relapsing Polychondritis vs VEXAS ImageImageImage
Investigations fall into three domains:

🔹Confirm diagnosis and rule out mimics

🔹Extent of disease

🔹Rule out an associated disease ImageImageImage
How do we treat??

No RCTs

🔹1st episode of minor chondritis: NSAIDs, short steroids (taper & stop over 10 dyas)
🔹Relapsing: colchicine ⏩ methotrexate/dapsone
🔹Severe organ manifestations: high dose steroids + Cyclophosphamide

• • •

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More from @PanktiMehta24

Pankti Mehta Profile picture
Jun 15
🫁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
Pankti Mehta Profile picture
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 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
Pankti Mehta Profile picture
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
Pankti Mehta Profile picture
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
Pankti Mehta Profile picture
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
Pankti Mehta Profile picture
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

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