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Aravind Palraj Profile picture
@Rheumat_Aravind
Sep 5 • 6 tweets • 2 min read • Read on X
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🧵 Serum ACE in Rheumatology:

One of the most debated biomarkers.
Ordered often, misinterpreted even more.
Let’s clear the confusion 👇
#Rheumatology #Sarcoidosis #Biomarkers @IhabFathiSulima @DrAkhilX @CelestinoGutirrImage
1/
 🔬 Serum ACE is produced by epithelioid cells in granulomas.
Hence, levels may be elevated in granulomatous diseases — especially sarcoidosis. Image
2/
 📊 When is ACE useful?
•Supporting diagnosis of sarcoidosis (not diagnostic alone)
•Monitoring disease activity (trend > absolute value)
•May fall with treatment response Image
3/
 ⚠️ Limitations:
•Low sensitivity (40–60%)
•Low specificity — elevated in TB, leprosy, silicosis, berylliosis, histoplasmosis, even hyperthyroidism
•Normal ACE does not exclude sarcoidosis Image
4/
 🧪 Practical notes:
•Always correlate with clinical + imaging (esp. CXR/HRCT)
•Repeatable for follow-up but avoid over-reliance
•Genetic ACE polymorphisms can affect baseline levels Image
5/
 ✅ Take-home:
Serum ACE is a supportive biomarker, not a stand-alone test.
Use it for trends in known sarcoidosis, not as a universal screening tool. Image

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More from @Rheumat_Aravind

Aravind Palraj Profile picture
Sep 6
🧵 Thread: Ultrasound in Arthritis — A Rheumatologist’s Tool:

Tweet 1
🖤🤍In Rheumatology, USG is becoming an extension of clinical exam.
Let’s decode why and how we use it in arthritis 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @Janetbirdope @Lupusreference #MedTwitter #RheumatologyImage
Tweet 2
🔍 What USG shows in arthritis:
• Synovial hypertrophy
•Joint effusion
•Power Doppler (blood flow = inflammation)
•Bone erosions

👉 Real-time look at inflammation.Image
Tweet 3
✨ Advantages of USG in Rheumatology:
1. Bedside, no radiation
2. Dynamic — see movement
3. Guides aspiration & injections
4. Detects subclinical synovitis (before X-ray/clinical exam)Image
Read 6 tweets
Aravind Palraj Profile picture
Sep 6
🧵 Lactate Dehydrogenase (LDH) in Rheumatology

A common enzyme test, but often overlooked.
LDH is a tissue damage marker with key roles in autoimmune disease.
Let’s decode its value 👇
1/
 🔬 What is LDH?
•Enzyme in glycolysis (pyruvate ↔ lactate)
•Present in almost every tissue
•Released with cell damage → hence very non-specific
#Rheumatology #MedTwitter #Myositis @IhabFathiSulima @DrAkhilX @CelestinoGutirrImage
2/
 📊 Clinical contexts in Rheumatology:
•Myositis (esp. when CK is normal)
•MAS/HLH → marker of hyperinflammation
•Interstitial lung disease (ILD in DM/MCTD/SSC)
•Hemolysis (esp. autoimmune hemolytic anemia) Image
3/
 💡 Why is LDH important in Myositis?
•CK is most sensitive, but some subtypes (e.g. anti-MDA5 DM, amyopathic DM) may have normal CK
•LDH, AST, ALT, aldolase help detect occult muscle injury Image
Read 6 tweets
Aravind Palraj Profile picture
Sep 5
🧵 Vitamin D in Rheumatology:

A lab we all order. A deficiency we often find.
But what does it really mean in autoimmune disease?
Let’s clear the confusion 👇
#Rheumatology #VitaminD
@IhabFathiSulima @DrAkhilX @CelestinoGutirrImage
1/
 💡 Vitamin D is not just about bones.
It’s an immunomodulator: affects T cells, B cells, and dendritic cells.
Deficiency is linked to ↑ autoimmunity risk (RA, SLE, MS, etc.). Image
2/
 🔍 Testing:
•Serum 25(OH)D is the correct test (not 1,25(OH)₂D).
•Deficiency: <20 ng/mL
•Insufficiency: 20–30 ng/mL
•Sufficiency: >30 ng/mL Image
Read 6 tweets
Aravind Palraj Profile picture
Sep 5
🧵 Serum Uric Acid in Rheumatology:

Tweet 1:
Serum uric acid — one of the most over-ordered and misinterpreted tests in medicine.
Here’s how to understand it in rheumatology 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr #MedTwitter #RheumatologyImage
Tweet 2 (Basics):
•Uric acid = end product of purine metabolism
•Normal range: ~3.5–7 mg/dL (varies by lab/sex)
•Excreted mainly by kidneys (~70%) + gut (~30%)Image
Tweet 3 (Hyperuricemia ≠ Gout):
•Many people with high uric acid never develop gout
•Risk rises as uric acid >9 mg/dL
•Gout diagnosis = clinical + crystals, not just lab valueImage
Read 7 tweets
Aravind Palraj Profile picture
Sep 4
🧵 Anti-Phospholipid Antibodies (aPL) in Rheumatology:
Tweet 1:
Anti-Phospholipid Antibodies — a small blood test with big consequences.
From clots to pregnancy complications, they guide APS diagnosis and management.
Here’s what every clinician should know 👇@IhabFathiSulima @DrAkhilX @CelestinoGutirr #MedTwitter #RheumatologyImage
Tweet 2 (What are aPL?):
•Autoantibodies against phospholipid-binding proteins
•Main types tested:
• Lupus anticoagulant (LA)
• Anticardiolipin (aCL) IgG/IgM
• Anti-β2 glycoprotein I (β2GPI) IgG/IgM Image
Tweet 3 (Why they matter):
•Central to Antiphospholipid Syndrome (APS) diagnosis
•Predict thrombotic events (arterial & venous)
•Predict pregnancy morbidity (recurrent miscarriage, fetal loss) Image
Read 9 tweets
Aravind Palraj Profile picture
Sep 4
🧵 ANCA in Rheumatology:

Tweet 1:
ANCA — one antibody, many confusions.
From GPA to drug-induced vasculitis, it’s powerful when used right…
and misleading when used wrong.
Here’s a quick guide 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr #MedTwitter #RheumatologyImage
Tweet 2 (What is ANCA?):
•Anti-Neutrophil Cytoplasmic Antibodies
•Autoantibodies targeting neutrophil granule proteins
•Tested by:
🔬 Immunofluorescence (IFA)
🧪 Antigen-specific assays (ELISA, CLIA) Image
Tweet 3 (Patterns):
•c-ANCA → cytoplasmic glow → usually PR3
•p-ANCA → perinuclear halo → usually MPO
•Atypical ANCA → seen in IBD, drugs, infections Image
Read 7 tweets

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