🧵 “Skin Clues in Rheumatology: When the Diagnosis Is Written on the Skin”

Sometimes, you don’t need a biopsy or antibodies.
You just need to look closely.
Skin findings can be the first, only, or most obvious sign of rheumatic disease.
Let’s decode the most important ones. 👇
#Rheumatology #Dermatology #MedTwitter @IhabFathiSulima @Drkhenaizan @DrAkhilX @dermatology 1/
🧠 Why skin matters:
•It’s visible
•It’s diagnostic
•It’s often missed
Mastering skin signs gives you a head start in systemic diagnosis.

🧵 “When the Lungs Whisper Autoimmunity: Pulmonary Clues in Rheumatology”

That cough isn’t always infectious. That dyspnea may not be cardiac.
Pulmonary findings can define diagnosis, severity, or prognosis in autoimmune disease.
Let’s break them down. 👇
#Rheumatology #Pulmonology #MedTwitter @DrAkhilX @IhabFathiSulima 1/
🫁 The lungs are a frequent but often under-recognized site of autoimmune involvement.
In rheumatic diseases, pulmonary signs may indicate:
•Early manifestation
•Disease activity
•Organ-threatening complications
•Need for urgent escalation

🧵 “When Is It Not Just Dry Eyes? Clues to Hidden Sjögren’s Syndrome”

Everyone has “dry eyes” from time to time — screens, ACs, aging.
But sometimes, it’s autoimmune.
Here’s how to tell when dryness needs serologic and systemic workup.
👇 #Rheumatology #Sjögren #MedEd #DryEyes @IhabFathiSulima @DrAkhilX 1/
💧 Sjögren’s Syndrome = Autoimmune attack on exocrine glands
→ Classic features:
•Dry eyes
•Dry mouth
•Parotid swelling
But don’t stop there — systemic disease is often silent.

🧵 “Low-Grade Fever in Rheumatology: When It’s Not Just a Viral Illness”

Patient has fever for weeks. Cultures are negative. Antibiotics don’t help.
Could it be autoimmune?
Here’s your stepwise approach to low-grade fever in rheumatologic diseases.
👇 #Rheumatology #MedEd #Autoimmunity #PUO #MedTwitter @DrAkhilX @IhabFathiSulima /
🌡️ Low-grade fever = Temperature between 99°F and 101°F (37.2–38.3°C)
Common in autoimmune disease — often the first or only symptom.

🧵 “Red Eyes in Rheumatology: Not Always Benign”

A patient with joint pain and eye redness walks in.
Is it dry eyes? Or is it vision-threatening scleritis or uveitis?
Here’s how to differentiate ocular involvement in rheumatology.
👇 #Rheumatology #OphthoRheum #RedEye #MedEd #RheumReady @DrAkhilX @IhabFathiSulima @drgunjand 1/
👁️ Red eyes in rheumatology can signal:
•Keratoconjunctivitis sicca (Sjögren’s)
•Episcleritis (benign)
•Scleritis (vision-threatening)
•Anterior uveitis (SpA, sarcoid, Behçet’s)
•Retinal vasculitis (SLE, Behçet’s)
•Orbital inflammation (IgG4-RD, GPA)

🧵 “Macrophage Activation Syndrome (MAS): The Autoimmune Cytokine Storm”

When your patient with SLE, AOSD, or JIA suddenly worsens — think MAS.
Here’s how to recognize, diagnose, and save a life.
👇 #Rheumatology #MAS #HLH #MedEd #Autoimmunity @DrAkhilX @IhabFathiSulima 1/
🔥 MAS is a form of secondary HLH — a life-threatening cytokine storm
Seen in:
•SLE
•Adult-Onset Still’s Disease (AOSD)
•Systemic JIA
•Vasculitis
•Even dermatomyositis

🧠 Often triggered by infection or flare

🧵 Steroids in Rheumatology: When, How, and How Much

Steroids can save lives—or destroy them.
Used right, they’re essential.
Used wrong, they’re devastating.
Here’s your clinical guide 👇
#Rheumatology #MedTwitter
@IhabFathiSulima @DrAkhilX 1/
📌 When are steroids absolutely essential?
🚨 Life- or organ-threatening autoimmune disease:
✔️ Lupus nephritis
✔️ DAH
✔️ MAS/HLH
✔️ RPGN
✔️ Neuropsychiatric lupus
✔️ Severe myositis
✔️ Active systemic vasculitis

🧵 Autoimmune vs Infection — How to Tell the Difference FAST

Fever, rash, cytopenia, organ dysfunction?
Is it a flare or an infection?
In autoimmune patients, this is life or death.
Here’s how to think clearly under pressure 👇
#Rheumatology #MedTwitter #CriticalCare @IhabFathiSulima @DrAkhilX @Medicalinfo111 @JasmineNephro @Janetbirdope 1/
⚠️ Steroids mask infection symptoms.
💊 If your patient is immunosuppressed, always suspect infection first.

🎯 Rule: Infection is 5x more common than a flare in rheum patients with fever.

🧵 When to Refer to Rheumatology: 10 Red Flags Every Internist Should Know

Some autoimmune conditions need urgent rheumatology input—
Delays can mean organ damage or irreversible disability.

Here are 10 referral red flags you shouldn’t miss 👇
#Rheumatology #MedTwitter #ClinicalPearls @DrAkhilX @IhabFathiSulima 1/
🚩 Young patient with unexplained cytopenias
Anemia, leukopenia, or thrombocytopenia?
📌 Rule out SLE, MAS, HLH
🧪 Do ANA, LDH, retic, ferritin
🎯 Refer if cytopenias persist or recur

🧵 How to Work Up a Suspected Connective Tissue Disease (CTD) in 15 Minutes

CTDs are complex, systemic, and often subtle.
A smart, stepwise approach saves time—and organs.
Let’s simplify the workup 👇
#Rheumatology #MedTwitter #Autoimmune 1/
🧍‍♀️ Step 1: Pattern Recognition
Start with syndromic clues:
🔹 Arthritis + rash → SLE
🔹 Raynaud + skin thickening → SSc
🔹 Sicca + parotid swelling → Sjögren’s
🔹 Proximal weakness + rash → Myositis
🔹 Inflammatory back pain + uveitis → SpA

✅ Clinical suspicion comes before antibody panels.

🧵 SLE Mimics — When ANA Misleads You

SLE is called “the great imitator”…
But sometimes, it’s the mimics that fool you.
Let’s break down 10 conditions that can look like lupus 👇
#Rheumatology #MedTwitter #SLE @IhabFathiSulima @DrAkhilX 1/
🎭 Drug-induced lupus (DIL)
💊 Hydralazine, INH, procainamide, minocycline
📌 +ANA, +anti-histone
🧠 Usually lacks nephritis/CNS features
⚠️ Resolves after stopping the drug

🧵 “The Art of Classifying Vasculitis: A Clinical Cheat Code”

Vasculitis is vast — but with the right system, it becomes manageable.
Here’s how to clinically break down and recognize vasculitis by vessel size, key features, and red flags.
👇 #Rheumatology #Vasculitis #MedEd #RheumReady @DrAkhilX @IhabFathiSulima 1/
🎯 The key to vasculitis is vessel size.
Think of it like plumbing:
•Large = highways
•Medium = main roads
•Small = alleyways & capillaries

Size tells you symptoms. Symptoms guide the test.

🧵 Top 10 Labs in Rheumatology — And How to Interpret Them

Ordering is easy.
Interpreting in context is where clinical medicine begins 👇
#Rheumatology #MedTwitter
@IhabFathiSulima @DrAkhilX 1/
🔬 ANA (Antinuclear Antibody)
✅ Best screening test for CTDs
🧠 Significant = ≥1:160
⚠️ False positives common (up to 15% in healthy adults)
🔍 Pattern helps:
•Homogeneous → SLE
•Speckled → Sjögren’s, MCTD
•Centromere → Limited SSc
•Nucleolar → Diffuse SSc

🧵 Rheumatology Drugs: 10 Clinical Tips You Won’t Find in Textbooks

Prescribing is easy. Monitoring is where the art lies.
Here are high-yield real-world tips to use rheum drugs wisely 👇
#Rheumatology #MedTwitter #ClinicalTips @IhabFathiSulima @DrAkhilX 1/
💊 Methotrexate
📌 Give once weekly, not daily — #1 source of iatrogenic toxicity
💡 Folic acid 5 mg once or twice weekly (next day after MTX) prevents ulcers, cytopenias

🧵 10 Clinical Signs That Should Make You Think: “Is This Autoimmune?”

Autoimmune diseases don’t shout.
They whisper.
Here are 10 subtle signs that often go missed 👇
#Rheumatology #MedTwitter #ClinicalMedicine @DrAkhilX @IhabFathiSulima 1/
🔸 Fatigue + Joint Pain + Normal Labs
Don’t dismiss it.
This is classic early SLE or Sjogren’s
📌 Ask about dryness, photosensitivity, oral ulcers

🧵 Rheumatology Emergencies You Should Never Miss!

Rheum isn’t slow and benign always.
Some cases need ICU, not OPD.

Here are the top life-threatening rheumatologic emergencies clinicians must recognize early 👇
#MedTwitter #Rheumatology #ICUMedicine @IhabFathiSulima @DrAkhilX 1/
🔥 Macrophage Activation Syndrome (MAS) / HLH
Pancytopenia, high ferritin (>10,000!), liver dysfunction
Occurs in AOSD, SLE, JIA
Treat fast with steroids, cyclosporine, biologics
Delay = fatal

🧵 General Medicine in Rheumatology: What Every Internist Should Know

1/
Rheumatology isn’t just joints & ANA!
It’s a multisystem puzzle that needs internal medicine mastery.
Here’s how general medicine and rheumatology intertwine 👇

#MedTwitter #Rheumatology #InternalMedicine @IhabFathiSulima @DrAkhilX @nileshnolkha 2/
🫁 Pulmonology
ILD in RA, SLE, systemic sclerosis
🔹 Crackles ≠ always infection
🔹 Think NSIP, UIP, DAH
🔹 PFT + HRCT = must-do
@pulmonology101 @LungAssociation

🧵 “ANA Positive ≠ Lupus: The Art of Interpreting Autoantibodies”

ANA positivity is one of the most misunderstood findings in medicine.
Here’s how to approach an ANA report systematically, clinically, and with confidence.
👇 #Rheumatology #ANA #Autoimmunity #MedEd @DrAkhilX @IhabFathiSulima #MedTwitter 1/
🔬 The ANA (antinuclear antibody) test is highly sensitive, but not specific.
A positive result ≠ lupus.
Let’s walk through how to interpret ANA wisely, not fear it blindly.

🧵 “What Rheumatologists Should Know About TB Reactivation in India”

🧵 1/
Tuberculosis (TB) reactivation is a major concern for patients on biologic DMARDs in TB-endemic regions like India.
This thread outlines what rheumatologists must know before starting biologics.
🔎 #Rheumatology #TB #bDMARDs #MedEd @Lupusreference @Janetbirdope @IhabFathiSulima @DrAkhilX @DurgaPrasannaM1 @eular_org @ACR_Journals @APLAR_org 2/
🔴 Why this matters in India:
•India accounts for ~26% of global TB burden
•Latent TB reactivation is a real risk with TNF-α inhibitors
•Reactivation risk is highest in the first 6–12 months after biologic initiation

Lupus Podocytopathy:

A rare form of kidney involvement in systemic lupus erythematosus (SLE) characterized by nephrotic syndrome in the absence of traditional immune complex-mediated glomerular lesions.🧵Thread👇
@12VRavindran @Renalpathsoc @ISNkidneycare @goKDIGO @Amansharmapgi #MedTwitter @DurgaPrasannaM1 @DrAkhilX @IhabFathiSulima @JasmineNephro @thisis_drgsp @arvindcanchi @Lupusreference @RheumNow @Janetbirdope - Light Microscopy in Lupus Podocytopathy: Normal glomeruli, minimal change disease (MCD)-like lesions, mesangial proliferation, or focal segmental glomerulosclerosis (FSGS) without endocapillary proliferation or thickening of the glomerular basement membrane.🧵👇