How to approach a patient with #angioedema? 🧐 🧵

#MedTwitter

(1/7) ♦️There are two broad mechanisms of angioedema

1️⃣ Histamine mediated or #allergy 🤧
2️⃣ Bradykinin mediated 🥵

The management depends on the underlying mechanism !

Also before anything, secure the AIRWAY if needed 🫁

(2/7)

Facial rashes that look like lupus but are not ! 🧵🦋

1. Rosacea 🥵
🔹Look for telangiectasia
🔹Involvement of the nasolabial folds 🔹Flushing with spicy foods, heat, & sun exposure

#MedTwitter #RheumTwitter

2. Seborrheic dermatitis

🔹Yellowish scales
🔹 Involvement of the nasolabial folds, eyebrows & scalp

🫁How to interpret pulmonary function tests ??🫁

I'm not a pulmonologist but have to deal with a fair share ILDs,
here's a simple approach useful in the clinic especially for non pulmonary specialists

(1/7)

#MedTwitter #RheumTwitter #MedEd 1️⃣Is the test valid?

You need to check for three things

🌬️ Effort
✅The time volume curve forms a plateau in 1-2 seconds
✅ sustained expiration for 6 seconds!

(2/7)

🔹Relapsing Polychondritis🔹

Important takeaways from an excellent presentation by @Lupusreference @eular_org #EULAR2023

#MedTwitter #RheumTwitter 🔹Rare disease
🔹Middle aged adults
🔹No♀️ predominance

👂👂👂👂
It's typically characterized by:
🥵Red/swollen
👂Spares the lobule
🤕Painful
⏳lasts >48 hrs
❌ ear discharge (infection)
❌ necrosis/purpura (CAPS)

📷⤵️Prone to erroneous diagnosis!!

Doctor: Where is the pain?

Patient: Pain pain everywhere!

❔How do we approach a patient with multiple joint pains❔

(1/12)
#polyarthritis #MedTwitter #MedEd #RheumTwitter 1️⃣ Is it polyarthritis?

First, you want to make sure it's polyarthritis - multiple (>4 joints) pain WITH SWELLING

& NOT 🚫

🔹Polyarthralgia⏩ pain WITHOUT swelling
🔹Widespread pain
🔹Myalgia
🔹Bone pain
🔹Neuropathic pain

Let's deal with polyarthritis ⏬

(2/12)

It's #WorldEnvironmentDay2023 & I thought why not discuss the influence of air pollution🏭 on various rheumatic diseases

The association of 🏭 is obvious with lung diseases, malignancies & skin problems

But, we have to understand that the effects are deeper than that😦 Particulate matter (PM10) is inhaled & affects the upper bronchi ⏩ local inflammation

Fine & ultrafine PM reach the alveoli & circulation ⏩ systemic effects

Levels of inflammatory markers ∝ exposure to 🏭

pubmed.ncbi.nlm.nih.gov/19687019/

pubmed.ncbi.nlm.nih.gov/33470401/

Hey #MedTwitter !

1. What does the image show?
2. Possible etiologies?

#RheumTwitter It's a purpuric rash. The two most important DDs are:

🔹Small vessel vasculitis (lupus, ANCA, cryoglobulinemia etc) ♨️

🔹Infective endocarditis (janeway lesions) ❣️

Bleeding disorders often affect areas where the skin is soft and loose rather than the soles

☘️Antinuclear Antibodies (ANA)☘️ -Part ✌️

We learnt about the history and lab methods in part ☝️


Let's continue the story!!

#RheumTwitter #MedEd #MedTwitter #rheumatology

(1/24)

https://twitter.com/PanktiMehta24/status/1653772269053968386?t=8DP_f0iKMnXPQkyI0D373Q&s=19

The biggest advantage of indirect immunofluorescence is the ability to gauge antibody specificity from the staining pattern

Prerequisites

🔹An experienced professional
🔹+ & - controls

(2/24)

☘️Antinuclear Antibodies (ANA)☘️

Here's a 🧵 on another #rheumatology test which can confuse>help if ordered without a 💭 (part 1)

Let's peek into the #immunology lab to learn more about the lab aspect of ANA 🥼🧪👀

(1/12)

#MedTwitter #LupusAwarenessMonth #MedEd 🤔 What do we mean by ANA??

🔹As the name suggests, they are antibodies to various nuclear components

🔹These Antigens(Ag) can be related to

1. DNA🧬: DNA, histones, nucleosomes

2. RNA: Smith, RNP, Ro, La

3. Others: ribosomal P, Ku etc

(2/12)

😣Patient: "All my joints are painful & swollen!"😣

👩‍⚕️But when you examine the patient, you don't find any joint swelling

How to approach this scenario? 🤷

#MedTwitter #RheumTwitter #MedEd 🧵🧵🧵

(1/10) Now there are two possibilities

1️⃣ There was a joint swelling which is no longer there

OR

2️⃣ There was no joint swelling to begin with

(2/10)

Rheumatoid factor

One of the most used & abused tests in #rheumatology

Let's learn a bit about its origin & utility!

#MedEd #MedTwitter #RheumTwitter

(1/15) 1️⃣ what is RF actually?🤷‍♀️

They are antibodies directed against the Fc fragment of IgG antibody

(2/15)

It's 🥶 & we're coming across many cases of peripheral ischemia/gangrene

🔢The semiology of seizures is what we are all taught, but gangrene is another condition where history is the king 👑

🔁It's essentially a demand≠supply mismatch

#MedEd #MedTwitter #RheumTwitter The 📝 goes on & so that we can save ⏳ & 💰 on the tests, I like to broadly divide the pathology into:

1️⃣Luminal: atherothrombosis, thrombosis (APLA, DIC), cryofibrinogenemia

2️⃣Vessel wall: vasculitis (ANCA, PAN, SLE),vasculopathy (scleroderma spectrum)

3️⃣External compression

Learning mycobacterial rheumatism from the best @anupamwakhlu !!

#IRACON22
@IndianRheum #Hansen's disease

✊ Arthritis in 1-78%🙀🙀🙀

Cause?

🧪Reactionary
🔥Direct inflammation
🧠neuropathic joints

#MedTwitter

Discussing problems unique to our region 🌍

🔘Kick-starting the South Asian Rheumatology Symposium with Prof. Syed Atiqul Haq joining us in spirit !

Vaccination in ##Rheumatology

#IRACON22 #vaccine
#RheumTwitter

@IndianRheum Pneumococcal 'prime and boost'

🕜PCV13⏩ 8 ⏩ weeks PSV23

🕜PSV23⏩1 year ⏩PCV13

🔁Repeat PSV23 at 5 years and once after 65 years!

Autoinflammatory syndromes by Dr Dan Kastner at #ACR22 !

1️⃣FMF🏖️

🧬AR, pyrin mutation, evolutionary resistance to Y pestis

🌡️Fever 1-3 days
😣Peritonitis (severe)
🫁Pleurisy unilateral
✊Mono or oligoarthritis

2%-->Amyloidosis

⚕️ colchicine, anti IL1 💉

#MedTwitter #MedEd 2️⃣TRAPS

No ethnic predisposition

🧬AD, TNGRSF1A- p55

🌡️Fever 4-6 weeks
😣Serositis
♨️Migratory rash proximal -->distal
💪fasciitis
👁️ conjunctivitis, periorbital edema

Amyloidosis occasionally

❌response to colchicine
⚕️Steorids ✅ anti IL1✅

The prevalence of #rheumatoidarthritis 🌍 ~1%

🙀 So ~14 million suffer from RA!

So we 👩‍⚕️ have to deal with special situations while managing this fairly common disease!

#MedTwitter #MedEd #rheumatology #RheumTwitter

@MedTweetorials @nihardesai7

(1/9) Let's begin with one of the most beautiful miracles of life ☺️

#pregnancy in #rheumatoidarthritis

(2/9)

💭When we think of #Rheumatoid #Arthritis , a mental image of this comes up 👇

But does it have to get to this🤔???

🙅NO! Definitely, NO! 🙅

#MedTwitter #MedEd #RheumTwitter #Rheumatology

@MedTweetorials

(1/8) 🪜The first step is early diagnosis, do not wait until the deformities to form!

💬Think of RA when a patient presents with

🔸Peripheral
🔸Symmetric
🔸Arthritis
🔸Morning stiffness>30 minutes

#MedTwitter

(2/8)

"Your diagnosis is elevated uric acid. You need to stop eating 🍅🥗🥦🥪🥩🫘, basically everything"

Beware of these!!

Elevated uric acid doesn't always 🟰 gout

#MedEd #MedTwitter #gout #Uricacid Gout is a form of arthritis due to deposition of excess uric acid in joints and it usually has (not always) high serum uric acid levels.

My experience: #Covid_19 ICU rotation at #SGPGI #Lucknow

1. All patients were >35 years of age with majority being males

2. Apart from the usual comorbidities, central #obesity without over #diabetes or #hypertension also predisposed to #SARI 3. #Lymphopenia was a great marker of severity and a rising trend predicted clinical recovery

4. #recoverytrial further reiterated the use of steroids for patients with severe disease which many centers including ours was already practising