Aravind Palraj Profile picture
Sep 14 10 tweets 4 min read Read on X
🧵 Key Terms in Rheumatology — Simplified & Explained ⬇️

Rheumatology is full of terms like synovitis, enthesitis, tenosynovitis, dactylitis.
Let’s break them down in a clear way

1️⃣ Synovitis
= Inflammation of the synovial lining of a joint.
Signs: swelling, warmth, tenderness, ↓ ROM.
Seen in: RA, lupus arthritis, JIA.
Think: “the joint lining is angry.”
@DrAkhilX @IhabFathiSulima #MedTwitter #RheumatTwitterImage
2️⃣ Enthesitis
= Inflammation at the enthesis (where tendons/ligaments insert into bone).
Common in: Spondyloarthritis (PsA, AS, IBD-arthritis).
Typical sites: Achilles tendon, plantar fascia, costochondral junctions.
Pain is deep, localized, worse with stress.Image
3️⃣ Tenosynovitis
= Inflammation of the tendon sheath.
Classic example: de Quervain’s at wrist.
Also in RA, lupus, spondyloarthritis, infections (TB).
Feels like “painful sausage around the tendon.”Image
4️⃣ Dactylitis
= “Sausage digit” → uniform swelling of entire finger/toe.
Due to synovitis + tenosynovitis + enthesitis together.
Seen in: Psoriatic arthritis, reactive arthritis, sarcoidosis, sickle cell disease.Image
5️⃣ Bursitis
= Inflammation of a bursa (fluid-filled sac cushioning bone/tendon/joint).
Examples:
•Olecranon bursitis (“student’s elbow”)
•Prepatellar bursitis (“housemaid’s knee”)
Can be inflammatory (RA, gout) or infectious.Image
6️⃣ Myositis
= Inflammation of skeletal muscle fibers.
Manifestation: proximal muscle weakness ± pain.
Seen in: Dermatomyositis, Polymyositis, overlap syndromes.
Clue: ↑ CK, MRI edema, muscle biopsy changes.Image
7️⃣ Vasculitis
= Inflammation of blood vessel wall → ischemia, organ damage.
Small, medium, large vessel types.
Seen in: ANCA vasculitis, PAN, GCA, Takayasu’s.
Clue: purpura, ulcers, hematuria, neuropathy.Image
8️⃣ Sicca
= “Dryness” of eyes (keratoconjunctivitis sicca) & mouth (xerostomia).
Seen in: Sjögren’s, lupus, systemic sclerosis.
Clues: sandy eyes, difficulty swallowing dry food, rampant dental caries.Image
9️⃣ Raynaud’s Phenomenon
= Reversible color changes of fingers/toes on cold exposure or stress:
White → Blue → Red
Primary (benign) or Secondary (SSc, MCTD, lupus).Image
🔟 Takeaway
These terms aren’t just jargon.
They describe specific clinical patterns that point directly to diagnosis.
Mastering them = thinking like a rheumatologist 🔎

Share to spread knowledge.Image

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More from @Rheumat_Aravind

Sep 14
🧵 Urinalysis in Clinical Medicine:

1️⃣ Why it matters
Urinalysis = bedside, cheap, high-yield test.
Helps in:
•AKI & CKD workup
•Nephritis & nephrotic syndrome
•Infections & metabolic disorders
•Drug monitoring in rheumatology (cyclophosphamide, NSAIDs)
@IhabFathiSulima @DrAkhilX @CelestinoGutirr #MedTwitter #nephrology #rheumatologyImage
2️⃣ Components of urinalysis
1.Physical exam – color, clarity, odor, volume
2.Chemical (dipstick) – protein, blood, glucose, ketones, pH, nitrite, leukocyte esterase, SG
3.Microscopy – cells, casts, crystals, organisms Image
3️⃣ Physical exam – color & clues
•Red/brown → hematuria, hemoglobin, myoglobin
•Dark brown/tea → bilirubin (hepatic/AIH overlap in rheum)
•Milky → pyuria, chyluria
•Foamy → proteinuria (nephrotic in lupus/Sjogren’s) Image
Read 10 tweets
Sep 13
🧵 Hypercalcemia – A Clinical Approach plus Rheumatological causes:

1/
Hypercalcemia isn’t just “high calcium.”
It can cause kidney stones, bone pain, abdominal symptoms, psychiatric changes – and even cardiac arrest.
Here’s a structured approach 👇
@IhabFathiSulima @DrAkhilX #MedTwitterImage
2/
🔎 Step 1 – Confirm
•Correct serum Ca for albumin OR check ionized Ca.
•Rule out lab error.
•Always assess severity & symptoms.

Mild: 10.5–12
Moderate: 12–14
Severe: >14 or symptomatic Image
3/
🫀 Step 2 – Assess Clinical Features
•“Stones, bones, groans, psychiatric overtones”
•Nephrolithiasis, bone pain/fractures, constipation, abdominal pain, depression, confusion, arrhythmias. Image
Read 10 tweets
Sep 11
1/🧵 Acute Kidney Injury (AKI) is a common but critical problem in Internal Medicine.
Early recognition & classification into Prerenal, Intrinsic, Postrenal is essential for patient outcomes.
Here’s a stepwise approach
@IhabFathiSulima @DrAkhilX #MedTwitter #RheumTwitter #NephroTwitterImage
2/
🔹 Definition (KDIGO):
•↑ Serum Creatinine by ≥0.3 mg/dL within 48 hrs OR
•↑ Serum Creatinine to ≥1.5× baseline within 7 days OR
•Urine output <0.5 mL/kg/hr for 6 hrs Image
3/
Step 1: Clinical Context
•Recent illness? (diarrhea, vomiting, bleeding → Prerenal)
•Drug history? (NSAIDs, ACEi, aminoglycosides → Intrinsic)
•Obstructive symptoms? (anuria, flank pain → Postrenal) Image
Read 12 tweets
Sep 11
1/
Chest pain in rheumatology patients?
Don’t forget Pericarditis — one of the most frequent cardiac manifestations of autoimmune disease.
Here’s a stepwise approach. 🧵
@ihabFathiSulima @DrAkhilX #MedTwitter #RheumTwitterImage
2/
🔹 Autoimmune causes of pericarditis:

Connective Tissue Diseases (CTD):
•SLE (most common), RA (long-standing, nodular), Scleroderma/systemic sclerosis, Sjögren’s disease, MCTD, Overlap syndromes

Systemic Vasculitis:
•PAN, ANCA vasculitis, Takayasu arteritis, Giant cell arteritis (rare),Behçet’s disease

Other Rheumatic Conditions:
•Adult-onset Still’s disease, Sarcoidosis, IgG4-related disease, Autoinflammatory syndromes (TRAPS, FMF)Image
3/
💡 Clinical features
•Sharp, pleuritic chest pain → relieved on sitting forward
•Pericardial rub (scratchy sound at LSB)
•Dyspnea if effusion present
•Fever with active inflammation Image
Read 8 tweets
Sep 11
Renal Tubular Acidosis (RTA) in Autoimmune Diseases:🧵

1/ Not every metabolic acidosis is due to sepsis or renal failure.
In rheumatology, think Renal Tubular Acidosis (RTA) — a subtle but important clue to underlying autoimmune disease. @IhabFathiSulima @DrAkhilX #MedTwitter #RheumTwitter #NephroTwitterImage
2/
🔹 What is RTA?
A defect in renal acid handling → normal anion gap metabolic acidosis with preserved GFR.
Types:
•Type 1 (Distal)
•Type 2 (Proximal)
•Type 4 (Hypoaldosteronism-related) Image
3/
💡 Rheumatology associations
•Type 1 RTA: Sjögren’s (classic), SLE, RA
•Type 2 RTA: Sjögren’s, SLE (rare)
•Type 4 RTA: SLE, lupus nephritis, sometimes drugs (ACEi, ARBs, heparin, calcineurin inhibitors) Image
Read 8 tweets
Sep 11
🧵 Liver & Autoimmune Diseases (AIH, PBC and PSC):
1/
When the immune system attacks the liver or bile ducts, 3 classic conditions come to mind:
•Autoimmune Hepatitis (AIH)
•Primary Biliary Cholangitis (PBC)
•Primary Sclerosing Cholangitis (PSC)

Let’s walk through them 👇 @IhabFathiSulima @DrAkhilX @Janetbirdope @theliverdr @drkeithsiau @Gastronaut___ @NatRevGastroHep #MedTwitter #Hepatology #GastroTwitterImage
2/
📌 Autoimmune Hepatitis (AIH)
•Mostly affects young women
•Symptoms: fatigue, jaundice
•Labs: very high AST/ALT, ↑IgG
•Autoantibodies: ANA, SMA, anti-LKM

Untreated → cirrhosis in a few years. Image
3/
💊 AIH Treatment
•Start with steroids
•Add azathioprine for long-term control
•Budesonide in select non-cirrhotic patients
•Monitor enzymes + IgG
Relapse is common if stopped early. Image
Read 18 tweets

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