Aravind Palraj Profile picture
Aug 16 11 tweets 4 min read Read on X
1/ 🧵 Most people think Sjögren’s disease means dry eyes and mouth—but did you know it can also affect your kidneys? Kidney problems in Sjögren’s are serious but often missed. Here’s everything you need to know. 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @JasmineNephro @arvindcanchi @SarahSchaferMD @NeuroSjogrens @elisa_comer @SjogrensIrl @SjogrensForum @SjogrensOrg @SjogrensCa #MedTwitter #RheumatologyImage
2/ Renal involvement in Sjögren’s can take many forms, from mild lab abnormalities to full-blown kidney disease. Early detection is key to prevent lasting damage. Image
3/ Common kidney-related symptoms and signs include:
•Excess protein or blood in urine
•Excessive thirst and urination
•Muscle weakness due to low potassium
•Fatigue and swelling
•Sometimes no symptoms, only abnormal lab tests Image
4/ The most frequent kidney problem in Sjögren’s is tubulointerstitial nephritis (TIN)—inflammation and scarring around tiny kidney tubes—leading to impaired kidney function. Image
5/ Many patients also develop renal tubular acidosis (RTA), where kidneys fail to maintain acid-base balance, causing low potassium and other metabolic problems. Image
6/ Less commonly, Sjögren’s affects the glomeruli (kidney filters), causing various types of glomerulonephritis—sometimes linked to immune complexes or cryoglobulinemia. Image
7/ Kidney stones and nephrocalcinosis (calcium deposits in kidneys) are also reported in Sjögren’s patients. Image
8/ Renal disease may appear before classic dry eye/mouth symptoms, so screening is essential even for newly diagnosed patients. Image
9/ To catch kidney involvement early, doctors should monitor:
•Urinalysis (for protein, blood)
•Kidney function tests (eGFR, creatinine)
•Electrolytes (especially potassium, bicarbonate) Image
10/ Treatment typically involves immunosuppressants (like steroids), potassium and bicarbonate supplements for RTA, and close follow-up to protect kidney health. Image
11/ If you or someone you know has Sjögren’s—not only watch for dryness but also ask your doctor about kidney screening. Silent kidney damage is more common than you think!

Raising awareness can save lives. Please share this thread to help others understand the full impact of Sjögren’s disease. #Sjogrens #KidneyHealth #AutoimmuneDiseaseImage

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More from @Rheumat_Aravind

Aug 17
🧵 2025 AHA Hypertension Guidelines: Changes & New Updates
1/ The 2025 AHA/ACC hypertension guideline replaces the 2017 version with key, evidence-driven changes. Here are the must-know updates for your clinical practice.
@IhabFathiSulima @DrAkhilX @TrackYourHeart @sumersethi @Mahmoud33986639 @latchumanadhas #MedTwitterImage
2/ PREVENT Risk Equation Now Central
All therapy decisions now use the PREVENT risk score (not pooled cohort equations). The 10-year CVD risk threshold to start medication is now ≥7.5%—so more patients, especially with moderate risk, will get earlier treatment. Image
3/ Initiation of Therapy at Lower Thresholds
Stage 1 hypertension (130–139/80–89 mm Hg):
•If CVD, CKD, diabetes, or PREVENT risk ≥7.5%, start antihypertensive immediately.
•If PREVENT risk <7.5%: start with lifestyle changes for 3–6 months. If BP stays ≥130/80, add medication.
This expands eligibility —more aggressive than 2017.Image
Read 12 tweets
Aug 17
🧵 Hematological Manifestations in Autoimmune Diseases—2025 Clinical Update
1/ Blood disorders are common in autoimmune diseases and may be the first clue. Timely recognition can be lifesaving. Here’s a crisp clinical thread every practitioner should bookmark.
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @HematologyAdv @EHA_Hematology #MedTwitter #RheumatologyImage
2/ 🦋 Lupus (SLE):
•Anemia (iron-deficiency, hemolytic, chronic disease, drug-induced)
•Lymphopenia
•Thrombocytopenia (may be severe)
All correlate with disease activity and need close monitoring. Image
3/ 🤲 Rheumatoid Arthritis (RA):
•Anemia of chronic disease
•Felty’s syndrome: RA + big spleen + neutropenia
•Drug-induced cytopenias (MTX, biologics)
•Blood markers (Hb, NLR) can predict flare/remission. Image
Read 12 tweets
Aug 17
🧵 ANA (Antinuclear Antibody): What Every GP Needs To Know—2025 Guide

1/ What is ANA—and Why Test It?
ANA is a blood test that helps detect autoantibodies against cell nuclei, seen in autoimmune diseases like lupus, Sjögren’s, and more. It’s NOT a screening test for general complaints. Use it when history or exam genuinely points to autoimmune disorders
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @Janetbirdope @SarahSchaferMD @NeuroSjogrens #MedTwitter #RheumatXImage
2/ Who Should Be Tested?
Test ANA only when you see signs such as:
•Unexplained, non-infectious joint pain/swelling
•Persistent rash, especially photosensitive
•Raynaud’s phenomenon
•Sicca symptoms (dry eyes/mouth)
•Multi-system symptoms (e.g., nephritis, serositis) Image
3/ How To Interpret ANA Results
•Negative ANA: Very low likelihood of connective tissue disease, but rarely rules out all autoimmune illness.
•Positive ANA: Means autoantibodies were detected, but CAUTION! Many healthy people, especially elderly and women, can test positive. Image
Read 8 tweets
Aug 16
🧵 Red Flag Symptoms NOT to Miss in Rheumatic Diseases

1/ Systemic (Whole-Body) Red Flags
•Fever, unexplained weight loss, night sweats, loss of appetite, persistent fatigue
•Malaise or feeling generally unwell, lymph node swelling, new pallor
These often signal serious underlying inflammation, infection, or even malignancy.
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @SarahSchaferMD @NeuroSjogrens #MedTwitter #RheumatologyImage
2/ Pain and Swelling Not Acting Like “Usual Arthritis”
•Acute, severe, or rapidly increasing joint pain (especially a single hot, swollen joint)
•Bone pain, deep/throbbing—not just joint tenderness
•Recurrent or migratory joint pain, especially with redness or heat. Image
3/ Night Pains & Persistent Symptoms
•Pain waking you up at night and not eased with usual pain relief
•Stiffness that lasts more than an hour in the morning or after inactivity. Image
Read 8 tweets
Aug 16
🧵 Unlocking Rheumatology: What Every Joint, Patient & Clinician Should know👇

Tweet 1/5: The Anatomy of Arthritis
Ever wondered what sets a healthy joint apart from one with rheumatoid arthritis?
🔹 Healthy knees have smooth cartilage and clean bone architecture.
🔸 RA knees show swelling, inflamed synovium (the joint lining), and bone erosion—key targets for early intervention!
@IhabFathiSulima @DrAkhilX @CelestinoGutirr #MedTwitterImage
Tweet 2/5: Morning Struggles
Stiff, aching joints first thing in the morning? You’re not alone.
For many with RA and similar diseases, getting out of bed is the hardest part. Targeted therapy and gentle movement can really help. Image
Tweet 3/5: Medication, Planning, & Progress
Managing rheumatic disease can feel like a juggling act: pills, injections, calendars, and appointments!
Organization, reminders, and open conversations with your doctor lead to the best outcomes. Image
Read 5 tweets
Aug 14
💡 “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 #MedTwitterImage
Tweet 2:
1️⃣ Fever + Acute Monoarthritis
•Think septic arthritis until proven otherwise
•Don’t start steroids until infection is ruled out Image
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 Image
Read 9 tweets

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