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More from @Rheumat_Aravind

Aravind Palraj

@Rheumat_Aravind

Aug 10

🧵 Giant Cell Arteritis — Save a Sight in 5 Minutes

The vision loss is often permanent—and preventable.
A zero-fluff checklist: who to treat before tests, when ultrasound beats biopsy, steroid start & taper, and the traps (normal ESR/CRP, “PMR only,” jaw pain without headache).
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @Janetbirdope @vascuk #MedTwitter #NEETPG

Why this matters
•GCA is the most common primary vasculitis >50 years
•~15–20% develop vision loss — often before diagnosis
•Half lose the other eye within days if untreated
•Risk drops almost to zero with prompt steroids

Classic presentation
•Age ≥50
•New headache (often temporal)
•Jaw claudication (highly specific)
•Visual blurring / loss
•Scalp tenderness (pain on combing hair)
•± Polymyalgia rheumatica symptoms

Read 10 tweets

Aravind Palraj

@Rheumat_Aravind

Aug 10

🧵 C3 vs C4 — What the Pattern Really Means (in 30 seconds)

We order complements all the time.
But the pattern is the diagnosis.
Here’s the fast way to read C3/C4 without overthinking. 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @DurgaPrasannaM1 @SarahSchaferMD @EMJNephrology #MedTwitter #Rheumatology

1) Quick primer
•C3 = shared hub (alternative + classical).
•C4 = classical pathway marker (C1q → C4).
Pattern > any single value.

2) Both C3 ↓ and C4 ↓ → immune-complex “classical burn”
Think: active SLE, infective endocarditis, serum-sickness/drug IC, mixed cryoglobulinemia.
Next: CH50, anti-dsDNA, C1q binding/anti-C1q, blood cultures if febrile.

Read 9 tweets

Aravind Palraj

@Rheumat_Aravind

Aug 10

🧵 CK Can Lie — Catching Myositis When Creatine Kinase Is Normal

Myalgia + weakness.
CK is normal.
Everyone relaxes.
That’s how dangerous myositis gets missed. Let’s fix it. 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr #MedTwitter

1) First principle
Normal CK ≠ no muscle disease. CK reflects muscle necrosis, not strength. Patchy disease, low muscle mass, or perimysial-predominant injury can keep CK normal.

2) When CK is often normal (or only mildly ↑)
•Dermatomyositis (esp. MDA5 phenotype)
•Steroid myopathy (treatment complication, not inflammation)
•Inclusion body myositis (>50 yrs; finger flexors/quads)
•Early/patchy disease, chronic burnt-out myositis

Read 12 tweets

Aravind Palraj

@Rheumat_Aravind

Aug 9

🧵 Drug Combinations That Can Kill — Interactions You Must Never Miss

We prescribe these daily.
Get the combination wrong → bleeding, rhabdomyolysis, bone marrow suppression, cardiac arrest.

Here are the 10 combinations you must always check for 👇
@DrAkhilX @IhabFathiSulima @CelestinoGutirr @Janetbirdope @DurgaPrasannaM1 @SarahSchaferMD @NeuroSjogrens #MedTwitter #RheumTwitter

1) Allopurinol or Febuxostat + Azathioprine or 6-Mercaptopurine
❌ Severe bone marrow suppression (xanthine oxidase inhibition).
✅ Avoid the combination; if unavoidable, drastically reduce azathioprine dose and monitor blood counts closely — but switching is safer.

2) Methotrexate + Trimethoprim–Sulfamethoxazole (Co-trimoxazole)
❌ Pancytopenia, mucositis, acute kidney injury.
✅ Use alternatives such as nitrofurantoin or fosfomycin for urinary tract infections.

Read 12 tweets

Aravind Palraj

@Rheumat_Aravind

Aug 9

🧵 When It’s Not Sepsis – Clues That It’s Actually Autoimmunity

Fever.
Tachycardia.
High CRP.
Looks like sepsis—but cultures stay negative, and antibiotics don’t work.

Let’s break down how to catch autoimmune mimicry of infection—before it’s too late. 👇
@IhabFathiSulima @DrIanWeissman @DrAkhilX @CelestinoGutirr @NeuroSjogrens @SarahSchaferMD @drkeithsiau #MedTwitter #RheumTwitter

1. The classic setup:

Patient has:
✅ Fever
✅ High CRP
✅ High neutrophils
✅ Looks toxic

But…
🧪 Cultures are negative
🧫 Antibiotics fail
🧠 Something’s not adding up

2. When you should pause:

🚩 No response to antibiotics after 48–72 hrs
🚩 Blood cultures negative
🚩 No source on imaging
🚩 Worsening cytopenias
🚩 Rising liver enzymes or ferritin
🚩 Mental status changes

Read 10 tweets

Aravind Palraj

@Rheumat_Aravind

Aug 8

🧵 Thrombocytopenia – Not Always ITP

Low platelets aren’t always immune.
Sometimes they bleed.
Sometimes they clot.
Sometimes they’re screaming for help.

Let’s break down how to approach thrombocytopenia with clarity 👇
@IhabFathiSulima @DrAkhilX @drkeithsiau #MedTwitter #Hematology

1. First: Is it even real?

Some low counts are lab errors—not pathology.
Check for:
– Platelet clumps in EDTA
– Smear confirmation
– Citrate sample if unsure

2. Bleeding? Clotting? Or neither?

🩸 Bleeding → ITP, marrow failure, DIC
🧱 Clotting + low platelets → APS, TMA, HIT
🧪 No symptoms? Still needs evaluation.

Read 9 tweets

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