Aravind Palraj Profile picture
Aug 17 8 tweets 3 min read Read on X
🧵 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
4/ Clinical Context is Everything
A positive ANA doesn’t make the diagnosis. Look at titer (strength) and pattern, but always match results to clinical findings.
•Low titer (≤1:80): Often non-specific, can occur in healthy people.
•High titer (≥1:160): More likely significant, especially with typical symptoms.Image
5/ Common Pitfalls
•Do NOT order ANA for general fatigue, back pain, or isolated arthralgia.
•Do NOT treat ANA positivity alone—diagnose and manage based on the whole clinical picture, not just the lab. Image
6/ Next Steps After Positive ANA
If clinical suspicion remains, GP should consider further antibody tests:
•Anti-dsDNA, anti-Smith (SLE)
•Anti-Ro, anti-La (Sjögren’s, SLE)
•Anti-centromere, anti-Scl70 (Scleroderma)
Work with a rheumatologist if unclear, especially for moderate/high titers or multi-system complaints.Image
7/ Pearls for GPs
•ANA positivity alone rarely equals disease.
•High-titer or active patterns (homogenous, speckled, centromere, nucleolar) deserve attention if symptoms fit.
•Always interpret ANA alongside CBC, renal, and liver panels, complement levels, and urinalysis to spot multi-organ involvement.Image
8/ Summary for General Practice
ANA is a valuable tool—used in the right context. Avoid indiscriminate ordering. Use clinical suspicion, interpret results carefully, confirm with further antibody tests, and refer to rheumatology when in doubt.

Share to help general practitioners use ANA wisely—and avoid common clinical pitfalls in 2025. #Rheumatology #GPs #AutoimmuneTestingImage

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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 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
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
Read 11 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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