Aravind Palraj Profile picture
Aug 30 8 tweets 3 min read Read on X
🔥 🧵 Thread: “When Vasculitis Wears a Disguise”

Vasculitis is a shapeshifter.
It never walks into clinic saying, “Hello, I am vasculitis.”
Instead, it hides behind everyday symptoms.
Here are the common masks it wears 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr #MedTwitter #RheumatXImage
1. Just a rash?
Palpable purpura on the legs may look like “allergy.”
But when it’s non-blanching, raised, and painful → small-vessel vasculitis should be suspected. Image
2. Just sinusitis?
Recurrent sinusitis, ear infections, or epistaxis might be ENT’s problem.
But add hematuria or lung shadows, and GPA (Granulomatosis with polyangiitis) enters the picture. Image
3. Just asthma?
Late-onset, steroid-dependent asthma with eosinophilia may not be “just asthma.”
It could be EGPA (Eosinophilic granulomatosis with polyangiitis). Image
4. Just neuropathy?
Sudden foot drop or wrist drop without trauma often signals vasculitic neuropathy (mononeuritis multiplex). Image
5. Just kidney disease?
Rapidly progressive renal failure with RBC casts in urine = a red flag for ANCA-associated vasculitis. Image
6. Just stroke in the young?
Infarcts in multiple territories or with systemic features → think primary angiitis of CNS or systemic vasculitis. Image
💡 Clinical pearl:
Vasculitis rarely appears in isolation.
It leaves a trail across multiple systems — skin, lungs, kidneys, nerves.
The key is to connect the dots before irreversible damage. Image

• • •

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More from @Rheumat_Aravind

Aug 28
🧬 🧵 Myositis profile demystified!
Tweet 1:
Polymyositis? Dermatomyositis? Overlap?
The myositis antibody panel helps us classify, predict prognosis & even guide therapy.
Here’s a breakdown #Rheumatology #MedTwitter @IhabFathiSulima @DrAkhilX @CelestinoGutirr @Janetbirdope @Myositis_IndiaImage
Tweet 2 (What is a Myositis Profile?)

🔎 What is a myositis profile?
👉 A panel of autoantibodies associated with idiopathic inflammatory myopathies (IIM).
👉 Includes myositis-specific antibodies (MSA) + myositis-associated antibodies (MAA).Image
Tweet 3 (MSA List)

🎯 Myositis-Specific Antibodies (MSA):
Found almost only in myositis.
Examples: Jo-1, Mi-2, SRP, MDA5, TIF1γ, NXP2.Image
Read 9 tweets
Aug 27
🦋🌸ANA profile demystified!
Tweet 1:
ANA positivity is just the entry gate.
The ANA profile (a panel of extractable nuclear antigens) gives the real diagnostic clues.
Here’s the breakdown 👇
#Rheumatology #MedTwitter
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @Janetbirdope @IJRheumImage
Tweet 2
🧪 What is ANA profile?
👉 A panel of disease-specific autoantibodies, tested after ANA positivity.
👉 Methods: ELISA, immunoblot, or line assay.
👉 Helps distinguish between lupus, Sjögren’s, SSc, MCTD, myositis. Image
Tweet 3
🔎 SLE-related antibodies
•dsDNA → hallmark of lupus, correlates with nephritis
•Sm (Smith) → highly specific for SLE (though not very sensitive)
•RNP → MCTD, overlap syndromes Image
Read 8 tweets
Aug 27
Here’s a thread on 10 general medicine lessons reinforced in rheumatology 🧵
Tweet 1:
Rheumatology isn’t “super-specialised.”
It’s general medicine… but deeper.
Every principle we learnt in MBBS comes back in rheumatology.
#MedTwitter #Rheumatology @IhabFathiSulima @DrAkhilX @CelestinoGutirr @Janetbirdope @docchennaiImage
Tweet 2
🌡️ Fever of unknown origin
Clues to think beyond infection:
• Rash that comes & goes
• Cytopenias
• Very high ferritin
• Hepatosplenomegaly
• Serositis

Sometimes, fever is inflammation wearing a disguise. Image
Tweet 3
🫀 Severe hypertension in a 20-something?
Always feel the pulses.
Bruits, unequal BP in arms → large vessel vasculitis.
Sudden crisis in systemic sclerosis → renal emergency.

Not all BP rises are “essential.” Image
Read 16 tweets
Aug 23
🧵: The Eye & Rheum: A Clinician’s Guide to Ocular Manifestations
Tweet 1:
1/10 👁️ The eye isn’t just the window to the soul—in medicine, it’s a window to systemic disease. Many rheumatic conditions write their first, or most severe, chapters on the ocular surface. A thread for clinicians on the critical link between Rheumatology & Ophthalmology. #RheumTwitter #OphthoTwitter #MedEd @IhabFathiSulima @Janetbirdope @DrAkhilX @ACRheum @RheumNowImage
Tweet 2: Anatomy Primer
2/10 Before we dive in, let’s map the battlefield. Key structures where rheumatology makes its mark:
•Uvea: The pigmented middle layer (iris, ciliary body, choroid).
•Sclera: The tough, white outer layer.
•Cornea: The transparent front.
•Lacrimal Glands: The tear producers.Image
Tweet 3: Anterior Uveitis & Spondyloarthritis
3/10 The Classic Duo: Anterior Uveitis & Spondyloarthritis (SpA). A patient with acute, unilateral eye pain, redness, & photophobia? Think SpA, especially if they are HLA-B27+. This is often the first clue leading to an AxSpA diagnosis. #Uveitis #AnkylosingSpondylitisImage
Read 10 tweets
Aug 22
🧵 Drug vs Disease — When Side Effects Mimic the Diagnosis👇
Is it the disease—or the drug? Many “flares” are actually medication effects. Here’s a clinic-ready guide to the most common drug–disease confusions, what to check, and how to pivot fast. Save and share. #MedTwitter #RheumTwitter #FOAMed #IMTwitter #PrimaryCare #PatientSafety @IhabFathiSulima @DrAkhilX @JanetbirdopeImage
Post 1
Big idea
Before escalating therapy, ask: could the medication be causing or unmasking the symptom? Use this checklist: timing vs start/dose change, dose–response, dechallenge/rechallenge, and alternative explanations. Image
Post 2
NSAIDs vs kidney/pressure
•Looks like: edema, rising creatinine, “worsening gout/OA pain”
•Could be: NSAID nephrotoxicity or hypertension
•Check: creatinine/eGFR, BP, volume status; step down NSAID, switch to topical or COX-2 cautiously; renal-safe analgesia plan. Image
Read 16 tweets
Aug 20
🧵 Steroid Stewardship & Safe Tapering: A Practical Playbook👇
For clinicians across primary care, rheumatology, IM, EM, and dermatology
Steroids help fast—but harm fast without a plan. Here’s a concise, clinic-ready playbook: when to start, how to taper, who needs bone/GI/infection protection, and when to escalate. Save this thread, share with teams, and use it tomorrow. #RheumTwitter #MedTwitter #FOAMed #PatientSafety #PrimaryCare #IMTwitter
@IhabFathiSulima @DrAkhilX @ACRheum @IRAeNewsLetter @DurgaPrasannaM1 @CelestinoGutirr @NeuroSjogrens @nirmalregency @Janetbirdope @Lupusreference #MedTwitter #Rheumatology #RheumTwitter #PrimaryCare #GP #IMTwitterImage
Post 1
Steroids help fast—but harm fast if misused. Goals: shortest duration, lowest dose, clear taper, bone protection, and an exit plan. Save for clinic.
#MedTwitter #RheumTwitter #FOAMed #GP #PrimaryCare Image
Post 2
Before starting prednisone:
•Confirm inflammatory indication (not purely mechanical pain)
•Baseline: BP, weight, glucose, ±lipids; vaccine status
•Agree on dose, duration, taper, monitoring, rescue plan
#PatientSafety #ClinicalTips #IMTwitter Image
Read 15 tweets

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