💡 “When Joint Pain Is NOT Arthritis” — The 7 Red Flags Every Doctor Should Know
Tweet 1:
“Not every swollen or painful joint is arthritis. Missing the real cause can delay life-saving treatment.
Here are 7 red flags that should make you think beyond rheumatology 👇”
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @SarahSchaferMD @NeuroSjogrens #MedTwitter
Tweet 2:
1️⃣ Fever + Acute Monoarthritis
•Think septic arthritis until proven otherwise
•Don’t start steroids until infection is ruled out
Tweet 3:
2️⃣ Joint Pain + Rash + Low Platelets
•Could be dengue or other viral fevers
•ESR/CRP may be high but steroids can be dangerous
Tweet 4:
3️⃣ Back Pain + Weight Loss + Night Sweats
•Rule out spinal TB, lymphoma, metastatic cancer
•Don’t rush to label as spondyloarthritis
Tweet 5:
4️⃣ Sudden Swelling + Travel History
•Think viral arthritis (Chikungunya, Parvovirus)
•Usually self-limiting, but steroids may prolong symptoms
Tweet 6:
5️⃣ Polyarthritis + New Heart Murmur
•Consider infective endocarditis
•Early antibiotics can save lives
Tweet 7:
6️⃣ Joint Pain + Neurological Symptoms
•Could be multiple sclerosis, stroke, vasculitis
•Don’t miss CNS involvement
Tweet 8:
7️⃣ Bone Pain + Swelling Without Inflammation Markers
•Think primary bone tumor or metastasis
•X-ray can be diagnostic
Tweet 9:
Joint pain is common. Arthritis is just one possibility.
Spot the red flags → order the right tests → save a life.
Share this so more doctors think beyond arthritis.
#MedTwitter #Rheumatology #MedEd
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🧵 The Gut–Joint Connection: How Your Microbiome Influences Arthritis
🦠🤔 Could your gut bacteria be making your arthritis worse?
Emerging science says YES.
Your gut microbiome can shape your immune system… and may even trigger autoimmune joint disease.
Let’s connect the gut to the joints 👇
#MedTwitter #guthealthmatters @DurgaPrasannaM1 @nileshnolkha @IhabFathiSulima @DrAkhilX @CelestinoGutirr @drkeithsiau @SarahSchaferMD
The microbiome’s hidden role
Your gut hosts trillions of microbes.
When balanced → they help digestion & immunity.
When imbalanced (“dysbiosis”) → they can mis-train the immune system, sparking inflammation far beyond the gut.
RA and specific bacteria
🔍 Studies show Prevotella copri is more common in new RA patients.
It’s thought to activate immune pathways that attack joints.
A 2023 study found Eggerthella lenta may cause autoantibodies YEARS before symptoms.
🧵🤰💊 Managing Rheumatoid Arthritis during pregnancy & breastfeeding isn’t just about the right meds — it’s about timing, planning, and protecting both mum & baby.
Here’s your evidence-based, easy-to-follow guide 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @DurgaPrasannaM1 @RA_information #MedTwitter #Rheumatology
1️⃣ Planning is key
RA and pregnancy can coexist safely with the right plan.
Pre-pregnancy counselling is essential — discuss disease control, medication safety, and timing of conception.
2️⃣ Disease activity matters
Best pregnancy outcomes happen when RA is in remission or low activity for ≥3–6 months before conception.
Active disease → ↑ risk of miscarriage, preterm birth, and growth restriction.
🧵 HBV Reactivation — How to Avoid Triggering a Silent Killer Before Steroids or Biologics
Every day, we start steroids, methotrexate, rituximab, TNF-inhibitors.
If you miss hepatitis B status → you can cause fulminant hepatitis.
Before you start immunosuppression — read this 👇
@IhabFathiSulima @DrAkhilX @drkeithsiau #MedTwitter
1️⃣ First principle
Before ANY immunosuppression — from high-dose steroids to biologics — always check hepatitis B serology:
•HBsAg (surface antigen)
•anti-HBc (core antibody)
•anti-HBs (surface antibody)
2️⃣ Why it matters
HBV can hide in hepatocytes for years.
Immunosuppression → virus wakes up → hepatitis flare → liver failure.
Mortality? Up to 25–40% in severe reactivation.
🧵 Back pain that gets better when you move and worse when you rest?
That’s your body waving a red flag — and it’s not mechanical.
Here’s how to spot Inflammatory Back Pain (IBP) and catch axial spondyloarthritis before it hides for years 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @SarahSchaferMD @DurgaPrasannaM1 #MedTwitter #RheumatX
The 5 IBP Clues (ASAS) — 4 or more = high likelihood:
🔹 Onset <40 years
🔹 Slow, insidious start
🔹 Improves with exercise
🔹 No better with rest
🔹 Wakes at night, eases on getting up
Who needs a rheumatology referral?
Chronic back pain >3 months, onset before 45 + ANY SpA feature.
Think: uveitis, psoriasis, IBD, enthesitis, dactylitis, great NSAID response, ↑CRP.
Cold hands turn white/blue/red.
Sometimes it’s harmless.
Sometimes it’s systemic sclerosis knocking.
Here’s how to tell—fast. 👇
@Amansharmapgi @DurgaPrasannaM1 @IhabFathiSulima @DrAkhilX @CelestinoGutirr @SarahSchaferMD @NeuroSjogrens #MedTwitter #RheumX
1) What counts as Raynaud’s?
Recurrent, cold- or stress-triggered color change in digits: white → blue → red (can be biphasic).
Tingling/pain on rewarming is common.
2) Primary vs Secondary (the fork in the road)
Primary = young, mild, symmetric, no ulcers, normal exam.
Secondary = red flags below → think rheumatology disease.
🧵 Red Eye in Rheumatology — When It’s Not “Just Conjunctivitis”
In rheumatology, a red eye can mean systemic inflammation, vasculitis, or a vision-threatening flare.
Here’s how to tell benign from dangerous — fast. 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr #MedTwitter #NEETPG
1️⃣ First, ask 3 rapid questions
•Pain? mild vs deep/boring
•Vision? normal or blurred
•Photophobia? none, mild, or severe
If severe pain, blurred vision, or marked photophobia → think ocular inflammation from systemic disease.
2️⃣ Episcleritis — Often Harmless, Sometimes a Clue
•Pain: mild discomfort
•Redness: sectoral, bright red
•Blanches with phenylephrine
•Vision: normal
•Rheum link: RA, IBD, lupus — can be first manifestation
•Treat underlying disease; topical lubricants often enough