🧵 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 #RheumatTwitter
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.
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.”
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.
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.
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).
🔟 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.
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Gout is the most common inflammatory arthritis, yet nearly 80% of patients are suboptimally managed, leading to preventable flares, tophi, and joint damage.
Forget the old myths of “kings and diet.”
Here is the modern, evidence-based approach to gout management, aligned with ACR guidelines, for the busy clinician. 🧵
MYTH: Gout is purely a “lifestyle disease” fixed by diet.
FACT: Diet typically alters serum urate by ~1 mg/dL at most.
Gout is primarily a genetically determined disorder of renal urate under-excretion.
You cannot “diet away” established gout. Medication is usually required.
Tweet 3 - The Goal (Treat-to-Target)
The goal of therapy isn’t just stopping flares - it’s dissolving monosodium urate crystals.
That requires a Treat-to-Target strategy:
• Target serum urate < 6.0 mg/dL for all gout patients
• If tophi are present: < 5.0 mg/dL for faster crystal clearance
The Clinical Approach to a Positive Antinuclear Antibody (ANA):
A positive ANA is one of the most common consults in Internal Medicine, yet it is widely misunderstood.
Positive ANA ≠ Lupus.
It causes significant patient anxiety and unnecessary referrals.
Here is the evidence-based approach to interpreting a positive ANA for the busy clinician. 🧵
#MedEd #Rheumatology #MedTwitter @DrAkhilX @IhabFathiSulima #InternalMedicine #Lupus #MedicalEducation
First, understand the pre-test probability.
ANA is not a screening test for fatigue or nonspecific pain.
Why? Up to 20–30% of the healthy population has a positive ANA at 1:40 titer. Even at 1:160, ~5% of healthy individuals are positive.
#Diagnostics #ClinicalPearls #PrimaryCare
The Titer is the key to specificity.
• 1:40 to 1:80: Low positive. Low clinical significance in isolation.
• 1:160: Intermediate.
• ≥ 1:320: High positive. Higher specificity for autoimmune disease, but still requires clinical correlation.
Treat the patient, not the number.
Ozempic vs Mounjaro — the REAL 2025 comparison.
🧵Thread🔥👇
Everyone is talking about weight-loss drugs. But the REAL showdown is Ozempic vs Mounjaro — and the winner is clear.
Ozempic and Mounjaro should be prescribed ONLY after medical assessment — never self-started.
🧵 5 Lab Traps That Delay Lupus Diagnosis (with one example)
I’ve seen lupus hide behind “normal” labs more times than I can count.
Here are 5 lab traps that delay the diagnosis — with one real case that’ll stick with you. 🧵👇
@DrAkhilX @IhabFathiSulima @DrNikhilMD @Janetbirdope @DurgaPrasannaM1 #MedTwitter #RheumTwitter #Autoimmunity
1️⃣ “ANA is negative, so it’s not lupus.”
Wrong.
Early SLE can have low-titer or even transiently negative ANA.
🧠 If your gut says lupus, repeat it after a few weeks.
2️⃣ “CRP is high, so it must be infection.”
Not always.
Lupus flares often have normal CRP.
High CRP just means: check if there’s serositis, arthritis… or yes, infection.