AI can detect shadows on a scan.
But it can’t see how a patient moves, hesitates, or hides pain.
Before MRI. Before algorithms. There was Hutchison — and the art of touch.
Here are 100 timeless MSK pearls every real clinician should know 👇
@12VRavindran @Amansharmapgi @DurgaPrasannaM1 @IndianRheum @IJRheum @ACRheum @DrAkhilX @IhabFathiSulima @Janetbirdope @RheumNow #MedTwitter #RheumatX
💬 Tweet 1 – General Principles
1️⃣ The musculoskeletal exam begins before touch.
Watch how they move, sit, breathe, hesitate.
“Look, feel, move” — Hutchison’s eternal rhythm of bedside medicine.
1/ What if one mutation causes vasculitis, strokes, immune deficiency & cytopenias — all in one patient?
That’s DADA2 (Deficiency of Adenosine Deaminase 2).
@DrAkhilX @IhabFathiSulima #MedTwitter #RheumTwitter
2/ 🔍 What is DADA2?
•Rare, autosomal recessive disease
•Mutations in ADA2 gene → enzyme deficiency
•Impacts vessels, immune system, bone marrow
🧵 Management of Scleroderma (Systemic Sclerosis) – 2025 Update
1/ Scleroderma (Systemic Sclerosis, SSc) is a chronic autoimmune connective tissue disease with fibrosis, vasculopathy, and autoimmunity at its core.
Management is organ-specific and evolving with new evidence. Let’s break it down. 👇
@DrAkhilX @IhabFathiSulima #MedTwitter
2/ 🔹 General Principles
•No single “cure” exists.
•Approach is multidisciplinary: rheumatology, pulmonology, cardiology, nephrology, dermatology.
•Early recognition of organ involvement = better outcomes.
3/ 🌿 Lifestyle & Supportive Care
•Smoking cessation
•Physical therapy & hand exercises
•Skin care (moisturizers, avoid cold exposure)
•Vaccinations (flu, pneumococcal, COVID)
•Patient education + psychosocial support
Tweet 1:
Proteinuria isn’t always just nephrology.
Sometimes, it’s the first clue to systemic disease.
Here’s how to approach proteinuria with an internal medicine + rheumatology lens 👇 @DrAkhilX @IhabFathiSulima #MedTwitter #RheumTwitter #NephroTwitter
Tweet 2:
🔍 Step 1: Confirm proteinuria
•Dipstick vs. spot UPr/Cr ratio vs. 24h collection
•Rule out false positives (alkaline urine, hematuria, concentrated sample)
Tweet 3:
📊 Step 2: Quantify
•<500 mg/day → often tubular or overflow causes
•0.5–3.5 g/day → non-nephrotic, think secondary causes
•3.5 g/day → nephrotic, raises red flags for glomerular pathology