Dr Nilesh Nolkha Profile picture
Oct 14 5 tweets 1 min read Read on X
🧵 Read this if you have knee pain and are 35–40+ 👇

#KneePain #KneeOsteoarthritis #DrNileshNolkha #NirjaraMultispecialityClinic #FreedomFromPain #NIRJARA



1️⃣ What exactly is Knee Osteoarthritis? 🦵
It’s not just age or “wear & tear.”
Osteoarthritis = cartilage thinning + bone changes + low-grade inflammation + muscle weakness.
🎯 It’s a whole-joint condition—mechanical + metabolic. (Nature Rev Rheumatol 2023)
2️⃣ Why “wear & tear” in knee pain is oversimplified ⚙️?
📊 Studies show obesity doubles the risk (OR ≈ 2.18). (Obesity Reviews 2015)
💪 Weak thigh muscles raise OA risk by ~1.6×. (Arthritis Care Res 2015)
So it’s not age alone—it’s load + inactivity + inflammation.
3️⃣ Why early strengthening helps 💪🦵in knee pain or early knee osteoarthritis?
Stronger quadriceps & glutes act like shock absorbers for your knee.
🏋️ Resistance training improves pain, strength & daily function in knee OA. (PMCID: PMC11676110)
Even 10 min/day → big difference in comfort & mobility.
4️⃣ Your simple daily plan 🧭
✅ Walk 20–30 min/day (pain-guided)
✅ Strength train 2–3×/week
✅ Lose 5–10 % body weight if overweight (AHS White Paper 2021)
✅ Eat higher protein, lower calories + fiber
❌ Avoid over-rest & fear. Motion = medicine
5️⃣ Don’t fear “Wear & Tear.” 🌿
Your knees are meant to move.
🦵 Regular motion nourishes cartilage & keeps fluid circulating.
The real enemies: obesity + weak muscles + inactivity—not age itself.
🌟 Strengthen, move, nourish — and keep living pain-free.
#FreedomFromPain #NIRJARA #DrNileshNolkha

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More from @nileshnolkha

Oct 7
Knee replacement
Indian context

🧵 1/12 — Not every knee pain needs a Knee Replacement… and waiting too long can also be a mistake.

#KneeReplacement #FreedomFromPain #NirjaraMultispecialityClinic #NileshNolkha
2/12 — When Knee Replacement truly helps
✅ Severe knee arthritis with daily pain and progressive decrease in mobility
✅ Pain affecting walking, stairs, sleep, or work
✅ No benefit from medicines, exercises, or injections
At that point, Knee Replacement can restore quality of life.
#KneeReplacement #FreedomFromPain #NirjaraMultispecialityClinic
3/12 — When NOT to go for Knee
❌ inadequate trial of conservative therapy, rehab, exercises
❌ Pain all over the body (like fibromyalgia)
❌ Inflammatory arthritis (RA, PsA) not under control
❌ No trial of structured physiotherapy or diet improvement
❌ No post-surgery rehab plan or family support
❌ Excess weight is an issue

Neither of this may be an absolute contraindication
#KneeReplacement #NileshNolkha #FreedomFromPain
Read 12 tweets
Sep 21
Read if you want to understand the framework of rheumatology / medicine diagnosis and practice

🧵 How to Approach a Patient of Connective Tissue Disease in Real Life – Lessons from a 68-Year-Old Case

1/ A 68F presented with severe hand arthritis, neck & foot pain.
She had failed MTX, HCQ, Leflunomide, Sulfasalazine + Steroids. Being treated for almost 9 months.
USG: Tenosynovitis with vascularity → confirmed inflammation.
But autoantibody profile didn’t match neatly.

#MedTwitter #NileshNolkha #FreedomFromPainImage
Mismatch Between Antibodies & Clinical Phenotype – What Do We Do?

2/
•ANA 2+ positive
•CENP A/B positive (suggesting CREST)
•Anti-CCP negative
•Mild dry eye, no Raynaud’s, no mouth dryness, no skin fibrosis or digital pits or psoriasis

👉 Possible Sjögren’s overlap
👉 Best working label = Undifferentiated CTD with arthritis-predominant disease

#MedTwitter #NileshNolkha #FreedomFromPain
CTD Management is Domain-Driven – Every Patient is Different

3/ In CTD, therapy depends on the dominant manifestation:
•Arthritis → MTX, Leflunomide, JAK inhibitors, Biologics
•ILD → MMF, Cyclophosphamide, Rituximab, Nintedanib
•PH → PDE5i, Endothelin antagonists, Prostacyclins
•Nephritis → MMF, CYC, Rituximab, Belimumab

📌 One label ≠ one treatment.

#MedTwitter #NileshNolkha #FreedomFromPain
Read 6 tweets
Aug 22
🧵 Hydroxychloroquine - HCQ- Masterclass : One Drug, Many Uses – Safe, Practical & Powerful 💊

This can be read by both patients and doctors

1/
💊 Hydroxychloroquine (HCQ) is a cornerstone DMARD in rheumatology.
It’s slow-acting but offers:
✅ Immunomodulation
✅ Steroid-sparing benefit
✅ Metabolic perks
✅ Safety in long-term use

Let’s break down how to use it wisely 🧠
#RheumTwitter #medtwitter
#hydroxychloroquine #hcq
#HCQMasterclass #rheumatoidarthritis #lupus
2/
🔍 Where is HCQ most used in rheumatology?
•🦋 Systemic Lupus Erythematosus (SLE)
•🤲 Rheumatoid Arthritis
•💧 Sjogrens disease
•🧬 Antiphospholipid Syndrome (APS)
•🌞 Cutaneous LE, Dermatomyositis

#RheumTwitter #medtwitter
#hydroxychloroquine #hcq
3/
🌐 niche uses of HCQ:
•Sarcoidosis (skin, joint)
•Lichen planus ?
•Porphyria cutanea tarda
•Post-viral arthritis
•Palindromic rheumatism
•Fatigue-dominant systemic diseases (CTD)
💡 Useful beyond guidelines.
#RheumTwitter #medtwitter
#hydroxychloroquine #hcq
Read 15 tweets
Aug 14
🧵 ANA Testing in Rheumatology — Masterclass for Doctors & MedTwitter

1/ 📢 What’s ANA?
ANA = Anti-Nuclear Antibodies.
It’s a surrogate marker for >50 nuclear antigens (Ro, Sm, dsDNA, La, Scl-70, etc).
✅ Can be positive in many CTDs
❌ Positive ≠ disease
❌ Negative ≠ rule out all CTDs.Image
2/ 🧪 When NOT to order ANA
•No symptoms/signs of CTD
•Only “screening” due to anxiety or family history
•Non-specific aches/fatigue without other red flags
🔑 Always pair ANA with a clinical question.
3/ 📊 Pre-test probability is king!
Low pre-test probability = higher chance of false positives.
30% of healthy people may have positive ANA.
Use clinical context before interpreting.
I Image
Read 20 tweets
Aug 6
🧵 Why do I keep getting gout attacks despite treatment?
Let’s bust the myths and explain the science 👇
#Gout #RheumatologySimplified #RefractoryGout #GPUpdate #UricAcid Image
1️⃣
💥 “Doc, I take meds. I stopped alcohol. I even eat tart cherries & turmeric capsules…
…Then WHY AM I STILL GETTING GOUT ATTACKS?”

📍 This is what we call uncontrolled or refractory gout.
Let’s break down why this happens 👇
2️⃣
🎯 #1: Uric acid target not achieved
Even if you’re on meds like Allopurinol or Febuxostat, you may NOT be at goal.

✅ Target = Uric acid < 6 mg/dl
📉 Not just normal. We want it low enough to stop crystal formation.
#ReachForSix Image
Read 11 tweets
Feb 6
Common Myths & Mistakes About Knee Replacement surgery in India 🇮🇳

Many avoid or delay surgery due to misconceptions. Proper prehab, rehab, and diet are key for the best results!

Let’s bust the myths & share the right approach! 🦵💡
1/12
❌ Myth: Knee replacement is only for the elderly.
✅ Fact: Pain & mobility matter more than age. Many in their 40s & 50s get it due to arthritis or injuries. Early intervention = better results! (2/12)
❌ Myth: Knee replacement Surgery should be the last resort.
✅ Fact: Delaying too long worsens damage & makes surgery harder. If pain affects daily life & non-surgical options fail, consult a specialist ASAP! (3/12)
Read 12 tweets

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