Hydroxychloroquine (Plaquenil)

⭐️why do we use an anti-malaria medication for autoimmune conditions?

⭐️how did geography impact the use of synthetic anti-malarials vs natural quinine (tree bark)

⭐️how WW2 gave a big clue to it's use in autoimmune conditions

a thread

#Meded Let's start with Malaria and World War 2 (Pacific theater) from America's perspective

a little background:

⭐️in 1942 Army medical personnel treated 47,663 cases of malaria

⭐️rate of infection calculated at almost 251 cases per 1,000 troops

so it was bad

Sensory Ganglionopathy & Sjogren Syndrome

⚡️what is it?

⚡️how to recognize/diagnose it

⚡️what's the underling cause?

latest @HRheuminations is up with link at the end of this ripping 🧶

a thread

#neurology #sjogren #rheumatology Let's review anatomy 1st

Sensory nerves: travel from skin to the nerve cell body in the Dorsal Root Ganglion (DRG) then⬆️dorsal column of spine to the brain

DRG- ‼️cell body of sensory nerves‼️

Motor nerves: travel from brain and exit ventral (anterior) spinal cord ➡️muscle

INFLAMMATORY ARTHRITIS

it's a word we throw around a lot

What does it mean? How can you tell the different causes from one another?

a🧵

#meded #rheumatology #rheumtwitter #arthritis @VuMedi Inflammatory arthritis just refers to:

🌟immune cell (typically innate) invading the joint space
🌟 typically neutrophils are the 1st to the scene of the crime

INTRAVENOUS IMMUNOGLOBULIN

Or IVIG as the 😎 cool kids call it

⭐️ What is it?

⭐️How did we first start using it?

⭐️How was it accidentally found to treat autoimmune conditions?

A thread 🧵

#meded #rheumtwitter @HRheuminations #immunodeficiency Immunoglobulin is another way of saying antibodies (Abs)

Abs are what your immune system produces after being exposed to an infection or what you produce in response to a vaccine to protect you long term

METHOTREXATE

Considered a cornerstone of Rheumatoid Arthritis treatment among other autoimmune conditions

FDA approved in 1988 for the treatment of #rheumatoidarthritis but DISCOVERED in the 1940s

⁉️ why the delay ⁉️

here is the (short)story 🧵

#meded #rheumtwitter Dr Sidney Farber, pediatric pathologist, considered a founder of chemotherapy

recognized folic acid is important for DNA synthesis

🌟cancer needs more DNA synthesis

🌟Aminopterin developed to BLOCK folic acid and decrease cancer cell growth

🌟Used to treat childhood Leukemia

Cancer and mycobacterium Tuberculosis, both ancient foes of humans

How did we get to the point of fighting cancer WITH a form of mycobacterium?

and what does this have to do with Rheumatology?

let's investigate! 🧵

#meded #cancer #urology @LCalabreseDO @HRheuminations Let's start with a little background on BCG vaccine

Calmette and Guerin (the C and G), worked on a vaccine to protect people from the scourge that was/is mycobacterium tuberculosis

how to do this?

Step 1

Isolate a similar bacterium off a cow (M. bovis)

thanks cow

⛄️Winter is coming, time for a 2nd 🧵 on cryoglobulins!

❄️What's a cryoglobulin?

❄️What causes cryos to form?

❄️When to suspect cryos are the culprit?

#medtwitter #meded @HRheuminations #immunology #vasculitis Cryoglobulins are antibodies that:

❄️precipitate at temps less than 37 degrees C
🌟dissolve after rewarming

(the last 🧵 demonstrates, it's not just temps that cause precipitation, but also changes in concentration, salinity and ph)

Why do they do this? We're not sure!

Cryoglobulinemic Vasculitis

The #vasculitis where antibodies fall out of serum at ❄️ temps and cause all sorts of badness

follow this 🧵to learn the history of these strange proteins

#medtwitter #meded @HRheuminations @LCalabreseDO #rheumatology it starts in 1933

Dr. Wintrobe is studying the blood of a woman who would later be found to have multiple myeloma

Her WBCs were very low

YET....the buffy coat (where WBCs like to live) was very large.

if her WBCs were low, what was accounting for the large buffy coat?