🧵 Don’t Miss These 10 Mimics of Vasculitis
Not all that looks like vasculitis is vasculitis.
Misdiagnosis can lead to harmful immunosuppression—or missed infections.

Here are 10 must-know vasculitis mimics every clinician should recognize 👇
#Rheumatology #Vasculitis #MedTwitter #Autoimmune @IhabFathiSulima @COREIMpodcast 1️⃣ Infective Endocarditis (IE)
• Fever + new murmur + embolic signs
• Can mimic small or medium vessel vasculitis
🔍 Look for:
 ◾ Janeway lesions, Osler nodes
 ◾ Splinter hemorrhages
 ◾ +Blood cultures, echo findings
⚠️ Mistaking IE for ANCA vasculitis can be fatal!

🧵 Sarcoidosis: The Great Imitator

Let’s decode this multisystem granulomatous mystery that baffles physicians across specialties.
#MedTwitter #Rheumatology #Pulmonology #Sarcoidosis #MedEd #InternalMedicine @IhabFathiSulima 1️⃣
🔍 What is Sarcoidosis?
A chronic, multisystem disorder marked by non-caseating granulomas, often affecting the lungs, skin, eyes, and lymph nodes.
🔹 Likely immune-mediated, exact cause still unclear.
#Sarcoidosis #Autoimmunity

🧵 Lymphadenopathy in Rheumatology: Don’t Miss These Clues

Lymph node enlargement can be a subtle herald of systemic autoimmune disease.

Here’s a complete guide to LAD in rheumatology – causes, patterns, and when to biopsy👇
#Rheumatology #MedTwitter #Autoimmune #ClinicalPearls @IhabFathiSulima 1️⃣ When should LAD point to autoimmunity?
Look beyond infections & malignancy when:
✅ LAD persists >4 weeks
✅ Involves >2 regions (generalized)
✅ Accompanied by systemic symptoms (fever, rash, cytopenias)
✅ Nodes are rubbery, mobile, non-tender

🌟 Why are patients with autoimmune diseases so exhausted?

Fatigue isn’t “just being tired.” It’s inflammation, cytokines, anemia & more.

A 🧵 on Autoimmune Fatigue: Why it happens + what helps.

#MedTwitter #Rheumatology #ChronicIllness @IhabFathiSulima 1️⃣
🔥 Cytokine Storm

Chronic inflammation = IL-1, IL-6, TNF-α flooding the system.

✅ Disrupt sleep-wake cycles
✅ Lower pain threshold
✅ Trigger “sickness behavior”

Result: Crushing fatigue + brain fog.

#AutoimmuneDisease

🧵 “Axial Spondyloarthritis: 10 Updated Guideline Pearls (ASAS–EULAR 2022–2023)”

Treatment keeps evolving—here are the most important evidence-based recommendations 👇
#Rheumatology #MedTwitter #ClinicalPearls #Spondyloarthritis @IhabFathiSulima 1️⃣ Early Diagnosis is Crucial
✅ Chronic back pain >3 months, age <45.
✅ MRI sacroiliitis or HLA-B27 positivity confirms early disease.
🎯 Early diagnosis improves long-term function and prevents damage.

🧵 “10 Rheumatology Radiology Clues Every Clinician Should Recognize”

Imaging can make or break the diagnosis.
Here are 10 classic radiologic findings in rheumatology to know 👇
#Rheumatology #MedTwitter #ClinicalPearls #Radiology @DrAkhilX @IhabFathiSulima @Janetbirdope @Lupusreference @RheumNow 1️⃣ Erosions at MCP and PIP Joints
✅ Marginal erosions + periarticular osteopenia.
🎯 Classic of rheumatoid arthritis.

🧵 “10 Hidden Causes of Fatigue Every Doctor Should Consider”

Not all fatigue is “just stress.”
Here are 10 often-missed causes of chronic fatigue with autoimmune clues 👇
#Rheumatology #MedTwitter #ClinicalPearls #Autoimmune @DrAkhilX @IhabFathiSulima 1️⃣ Early Systemic Lupus (SLE)
✅ Fatigue + arthralgia + mild anemia + positive ANA.
✅ Many cases present this way before organ involvement is obvious.

🧵 “10 Things Every Clinician Should Know About Lymphadenopathy in Autoimmune Disease”

Not all lymph nodes are lymphoma.
Here are 10 practical clues to help you interpret lymphadenopathy in rheumatology 👇
#Rheumatology #MedTwitter #ClinicalPearls #Autoimmune @DrAkhilX @IhabFathiSulima 1️⃣ It’s Common in Autoimmunity
✅ Many systemic autoimmune diseases can cause reactive lymphadenopathy.
✅ SLE, rheumatoid arthritis, Sjögren’s, Still’s disease, and vasculitis are frequent culprits.

🧵 “10 Things Every Clinician Should Know About Autoinflammatory Syndromes”

When fever isn’t infection or autoimmunity—it’s autoinflammation.
Here are 10 key points to help you recognize these syndromes early 👇
#Rheumatology #MedTwitter #ClinicalPearls #Autoinflammatory @IhabFathiSulima @DrAkhilX @pash22 1️⃣ What Are Autoinflammatory Syndromes?
✅ Disorders of innate immunity.
✅ Recurrent inflammation without autoantibodies or autoreactive T cells.
📌 Think of them as cytokine-driven diseases.

🧵 “10 Things Every Clinician Should Know About Paraneoplastic Rheumatic Syndromes”

Sometimes arthritis isn’t autoimmune—it’s a clue to hidden cancer.
Here are 10 patterns you should never ignore 👇
#Rheumatology #MedTwitter #ClinicalPearls #Paraneoplastic @DrAkhilX @IhabFathiSulima 1️⃣ Explosive Onset of Polyarthritis
Rapid, severe, symmetric arthritis—especially in older adults.
✅ Always think paraneoplastic arthritis if accompanied by weight loss or systemic symptoms.

🧵 “10 Skin Clues That Should Make You Suspect Vasculitis”

Skin findings are often the first window into systemic vasculitis.
Here are 10 patterns you can’t afford to ignore 👇
#Rheumatology #MedTwitter #ClinicalPearls #Vasculitis @DrAkhilX @IhabFathiSulima @VasculitisFound @vascuk @vasculitides @Janetbirdope 1️⃣ Palpable Purpura
The classic small-vessel vasculitis lesion.
✅ Non-blanching, raised spots, usually on the lower legs.
📌 Think leukocytoclastic vasculitis, cryoglobulinemia, IgA vasculitis.

🧵 “10 Clues Your Patient’s ‘Fibromyalgia’ Might Be Hiding Another Diagnosis”

Not all widespread pain is fibromyalgia.
Here are 10 red flags that mean you need to look deeper 👇
#Rheumatology #MedTwitter #ClinicalPearls #Autoimmune @DrAkhilX @IhabFathiSulima @teamfibro 1️⃣ Persistently Elevated Inflammatory Markers
Fibromyalgia doesn’t raise ESR or CRP.
📌 If they stay high, think inflammatory or infectious causes.

🧵 “10 Things Every Clinician Should Know About Muscle Enzymes in Rheumatology”

Muscle pain and weakness? Labs hold the clues.
Here are 10 essentials to interpret muscle enzymes accurately in autoimmune disease 👇
#Rheumatology #MedTwitter #ClinicalPearls #Myositis @IhabFathiSulima @DrAkhilX 1️⃣ CK is the cornerstone enzyme
✅ Creatine kinase (CK): Most sensitive marker of muscle damage.
📌 In polymyositis and dermatomyositis, CK often 5–50× the upper limit of normal.

🧵 “10 Things Every Clinician Should Know About PFTs in Rheumatology”

Lungs are a silent target in many rheumatic diseases.
Here are 10 essentials to interpret and use PFTs wisely in autoimmune disease 👇
#Rheumatology #MedTwitter #ClinicalPearls #Autoimmune @DrAkhilX @IhabFathiSulima 1️⃣ Why do PFTs matter in rheumatology?
✅ Interstitial lung disease (ILD) is common in:
•Systemic sclerosis (up to 50%)
•RA (10–20%)
•Myositis (~70%)
•Sjögren’s, MCTD
✅ Early detection prevents irreversible fibrosis.

🧵 “10 Things Every Clinician Should Know About DEXA Scans in Rheumatology”

Osteoporosis is silent—until a fracture happens.
Here are 10 essentials for using DEXA scans wisely in rheumatology 👇
#Rheumatology #MedTwitter #ClinicalPearls #Osteoporosis @IhabFathiSulima @DrAkhilX 1️⃣ What does a DEXA scan measure?
✅ Bone mineral density (BMD) at the lumbar spine, total hip, and femoral neck.
📌 Results reported as T-scores and Z-scores.

🧵 “10 Things Every Clinician Should Know About Cryoglobulinemia”

From rash to renal failure, cryoglobulins can wreak havoc.
Here are 10 essential facts to diagnose and manage cryoglobulinemia 👇
#Rheumatology #MedTwitter #ClinicalPearls #Autoimmune @IhabFathiSulima @DrAkhilX 1️⃣ What are cryoglobulins?
✅ Immunoglobulins that precipitate below 37°C and redissolve on warming.
📌 They can form immune complexes that drive systemic vasculitis.

🧵 “10 Myths in Rheumatology That Still Mislead Clinicians”

From diagnosis to treatment, misconceptions are everywhere.
Here are 10 myths in rheumatology you should stop believing right now 👇
#Rheumatology #MedTwitter #ClinicalPearls #Autoimmune @DrAkhilX @IhabFathiSulima 1️⃣ “A negative ANA rules out lupus.”
✅ False.
📌 Up to 5% of SLE patients are ANA-negative (especially in longstanding disease).

🧵 “10 Causes of Unexplained Fever Every Clinician Should Think About”

When infection workup is negative, don’t assume it’s “just viral.”
Here are 10 real causes of fever of unknown origin (FUO) that can be autoimmune or rheumatologic 👇
#Rheumatology #InfectiousDisease #MedTwitter #ClinicalPearls @IhabFathiSulima 1️⃣ Adult-Onset Still’s Disease (AOSD)
✅ Daily spiking fevers, salmon-colored rash, arthralgia.
📌 Ferritin often >3,000.

🧵 “10 Rheumatology Diagnoses That Are Often Missed (Until It’s Too Late)”

Some autoimmune diseases hide in plain sight.
Here are 10 real-world diagnoses clinicians overlook—until disaster strikes 👇
#Rheumatology #MedTwitter @DrAkhilX @IhabFathiSulima 1️⃣ Antiphospholipid Syndrome (APS)
✅ Clue: Young patient with unprovoked DVT or stroke.
📌 Don’t call it “just a clot.”
→ Look for recurrent miscarriages, livedo, aPL antibodies.

🧵 Scleroderma Renal Crisis (SRC): 2025 Update—A Rheumatology Emergency

⸻

1️⃣
What is SRC?
A life-threatening complication of systemic sclerosis marked by:
✅ Sudden severe hypertension (often malignant)
✅ Acute kidney injury
± Microangiopathic hemolytic anemia (MAHA) & thrombocytopenia

#Rheumatology #MedTwitter @IhabFathiSulima @DrAkhilX 2️⃣
When & Who?
🔹 Typically in the first 5 years of diffuse cutaneous systemic sclerosis
🔹 Strongly associated with anti-RNA polymerase III antibodies
🔹 Risk factors:
– Rapid skin thickening
– Recent high-dose steroids (>15 mg pred/day)
– Anemia, thrombocytopenia
– Cardiac involvement

🧠 Nomogram models now integrate these to improve prediction.

🧵 “Ferritin 300–1,000? 10 Causes of Mild–Moderate Elevation (And When to Worry)”

Ferritin isn’t just an iron marker—it’s an acute phase reactant, an inflammation signal, and sometimes a danger sign.
Here’s how to approach ferritin in the 300–1,000 ng/mL range 👇
#Rheumatology #LabMedicine #MedTwitter #ClinicalPearls @IhabFathiSulima 1️⃣ Early Iron Overload
Hereditary hemochromatosis often starts here before progressing.
📌 Clue: Transferrin saturation >45%—if normal, iron overload unlikely.
✅ Consider HFE gene testing if strong suspicion.