🧵 SAPHO Syndrome: The Skin–Bone Connection

1/
Ever seen acne + arthritis + osteitis in the same patient?
That strange cluster could be SAPHO syndrome — a rare, under-recognised autoinflammatory disorder.

Let’s break it down 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr #MedTwitter #RheumatX 2/
🔤 SAPHO = Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis
It’s not just an acronym.
It’s a unifying concept linking skin lesions + bone/joint inflammation.

🧵 Tweet 1:
🔥 High spiking fevers.
🩸 Sky-high ferritin.
🌸 A fleeting salmon-pink rash.
A diagnostic puzzle every rheumatologist must know:
Adult-Onset Still’s Disease (AOSD) 👇 @IhabFathiSulima @DrAkhilX @CelestinoGutirr @RACC_UK @RheumNow
#Rheumatology #MedTwitter Tweet 2 (Basics)
🔑 What is AOSD?
•Rare systemic autoinflammatory disease.
•Triad: high fevers, evanescent rash, arthritis.
•Shares features with infections, malignancy, and autoimmune disease → often misdiagnosed.

🔥 🧵 Thread: “When Vasculitis Wears a Disguise”

Vasculitis is a shapeshifter.
It never walks into clinic saying, “Hello, I am vasculitis.”
Instead, it hides behind everyday symptoms.
Here are the common masks it wears 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr #MedTwitter #RheumatX 1. Just a rash?
Palpable purpura on the legs may look like “allergy.”
But when it’s non-blanching, raised, and painful → small-vessel vasculitis should be suspected.

🧬 🧵 Myositis profile demystified!
Tweet 1:
Polymyositis? Dermatomyositis? Overlap?
The myositis antibody panel helps us classify, predict prognosis & even guide therapy.
Here’s a breakdown #Rheumatology #MedTwitter @IhabFathiSulima @DrAkhilX @CelestinoGutirr @Janetbirdope @Myositis_India Tweet 2 (What is a Myositis Profile?)

🔎 What is a myositis profile?
👉 A panel of autoantibodies associated with idiopathic inflammatory myopathies (IIM).
👉 Includes myositis-specific antibodies (MSA) + myositis-associated antibodies (MAA).

🦋🌸ANA profile demystified!
Tweet 1:
ANA positivity is just the entry gate.
The ANA profile (a panel of extractable nuclear antigens) gives the real diagnostic clues.
Here’s the breakdown 👇
#Rheumatology #MedTwitter
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @Janetbirdope @IJRheum Tweet 2
🧪 What is ANA profile?
👉 A panel of disease-specific autoantibodies, tested after ANA positivity.
👉 Methods: ELISA, immunoblot, or line assay.
👉 Helps distinguish between lupus, Sjögren’s, SSc, MCTD, myositis.

Here’s a thread on 10 general medicine lessons reinforced in rheumatology 🧵
Tweet 1:
Rheumatology isn’t “super-specialised.”
It’s general medicine… but deeper.
Every principle we learnt in MBBS comes back in rheumatology.
#MedTwitter #Rheumatology @IhabFathiSulima @DrAkhilX @CelestinoGutirr @Janetbirdope @docchennai Tweet 2
🌡️ Fever of unknown origin
Clues to think beyond infection:
• Rash that comes & goes
• Cytopenias
• Very high ferritin
• Hepatosplenomegaly
• Serositis

Sometimes, fever is inflammation wearing a disguise.

🧵: The Eye & Rheum: A Clinician’s Guide to Ocular Manifestations
Tweet 1:
1/10 👁️ The eye isn’t just the window to the soul—in medicine, it’s a window to systemic disease. Many rheumatic conditions write their first, or most severe, chapters on the ocular surface. A thread for clinicians on the critical link between Rheumatology & Ophthalmology. #RheumTwitter #OphthoTwitter #MedEd @IhabFathiSulima @Janetbirdope @DrAkhilX @ACRheum @RheumNow Tweet 2: Anatomy Primer
2/10 Before we dive in, let’s map the battlefield. Key structures where rheumatology makes its mark:
•Uvea: The pigmented middle layer (iris, ciliary body, choroid).
•Sclera: The tough, white outer layer.
•Cornea: The transparent front.
•Lacrimal Glands: The tear producers.

🧵 Drug vs Disease — When Side Effects Mimic the Diagnosis👇
Is it the disease—or the drug? Many “flares” are actually medication effects. Here’s a clinic-ready guide to the most common drug–disease confusions, what to check, and how to pivot fast. Save and share. #MedTwitter #RheumTwitter #FOAMed #IMTwitter #PrimaryCare #PatientSafety @IhabFathiSulima @DrAkhilX @Janetbirdope Post 1
Big idea
Before escalating therapy, ask: could the medication be causing or unmasking the symptom? Use this checklist: timing vs start/dose change, dose–response, dechallenge/rechallenge, and alternative explanations.

🧵 Steroid Stewardship & Safe Tapering: A Practical Playbook👇
For clinicians across primary care, rheumatology, IM, EM, and dermatology
Steroids help fast—but harm fast without a plan. Here’s a concise, clinic-ready playbook: when to start, how to taper, who needs bone/GI/infection protection, and when to escalate. Save this thread, share with teams, and use it tomorrow. #RheumTwitter #MedTwitter #FOAMed #PatientSafety #PrimaryCare #IMTwitter
@IhabFathiSulima @DrAkhilX @ACRheum @IRAeNewsLetter @DurgaPrasannaM1 @CelestinoGutirr @NeuroSjogrens @nirmalregency @Janetbirdope @Lupusreference #MedTwitter #Rheumatology #RheumTwitter #PrimaryCare #GP #IMTwitter Post 1
Steroids help fast—but harm fast if misused. Goals: shortest duration, lowest dose, clear taper, bone protection, and an exit plan. Save for clinic.
#MedTwitter #RheumTwitter #FOAMed #GP #PrimaryCare

Clinical Rheumatology Thread for Busy GPs:
Post 1
Early inflammatory arthritis(IA): the 3–3–3 rule
•Onset ≤3 months
•Morning stiffness ≥30–60 minutes
•≥3 swollen joints (MCP/MTP common)
If present, manage as IA: urgent rheum referral; NSAIDs if no contraindications.
@IhabFathiSulima @DrAkhilX @DurgaPrasannaM1 @Janetbirdope @ACRheum @RheumNow @Amansharmapgi @12VRavindran #MedTwitter #Rheumatology Post 2
Red flags over patterns
Screen for: systemic (fever, weight loss, night sweats), vascular (new headache >50y, jaw/limb claudication), neuro/renal (hematuria, neuropathy).
Any present → same-week labs (CBC, ESR/CRP, creatinine, urinalysis) and escalate.

🧵 2025 AHA Hypertension Guidelines: Changes & New Updates
1/ The 2025 AHA/ACC hypertension guideline replaces the 2017 version with key, evidence-driven changes. Here are the must-know updates for your clinical practice.
@IhabFathiSulima @DrAkhilX @TrackYourHeart @sumersethi @Mahmoud33986639 @latchumanadhas #MedTwitter 2/ PREVENT Risk Equation Now Central
All therapy decisions now use the PREVENT risk score (not pooled cohort equations). The 10-year CVD risk threshold to start medication is now ≥7.5%—so more patients, especially with moderate risk, will get earlier treatment.

🧵 Hematological Manifestations in Autoimmune Diseases—2025 Clinical Update
1/ Blood disorders are common in autoimmune diseases and may be the first clue. Timely recognition can be lifesaving. Here’s a crisp clinical thread every practitioner should bookmark.
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @HematologyAdv @EHA_Hematology #MedTwitter #Rheumatology 2/ 🦋 Lupus (SLE):
•Anemia (iron-deficiency, hemolytic, chronic disease, drug-induced)
•Lymphopenia
•Thrombocytopenia (may be severe)
All correlate with disease activity and need close monitoring.

🧵 ANA (Antinuclear Antibody): What Every GP Needs To Know—2025 Guide

1/ What is ANA—and Why Test It?
ANA is a blood test that helps detect autoantibodies against cell nuclei, seen in autoimmune diseases like lupus, Sjögren’s, and more. It’s NOT a screening test for general complaints. Use it when history or exam genuinely points to autoimmune disorders
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @Janetbirdope @SarahSchaferMD @NeuroSjogrens #MedTwitter #RheumatX 2/ Who Should Be Tested?
Test ANA only when you see signs such as:
•Unexplained, non-infectious joint pain/swelling
•Persistent rash, especially photosensitive
•Raynaud’s phenomenon
•Sicca symptoms (dry eyes/mouth)
•Multi-system symptoms (e.g., nephritis, serositis)

🧵 Red Flag Symptoms NOT to Miss in Rheumatic Diseases

1/ Systemic (Whole-Body) Red Flags
•Fever, unexplained weight loss, night sweats, loss of appetite, persistent fatigue
•Malaise or feeling generally unwell, lymph node swelling, new pallor
These often signal serious underlying inflammation, infection, or even malignancy.
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @SarahSchaferMD @NeuroSjogrens #MedTwitter #Rheumatology 2/ Pain and Swelling Not Acting Like “Usual Arthritis”
•Acute, severe, or rapidly increasing joint pain (especially a single hot, swollen joint)
•Bone pain, deep/throbbing—not just joint tenderness
•Recurrent or migratory joint pain, especially with redness or heat.

1/ 🧵 Most people think Sjögren’s disease means dry eyes and mouth—but did you know it can also affect your kidneys? Kidney problems in Sjögren’s are serious but often missed. Here’s everything you need to know. 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @JasmineNephro @arvindcanchi @SarahSchaferMD @NeuroSjogrens @elisa_comer @SjogrensIrl @SjogrensForum @SjogrensOrg @SjogrensCa #MedTwitter #Rheumatology 2/ Renal involvement in Sjögren’s can take many forms, from mild lab abnormalities to full-blown kidney disease. Early detection is key to prevent lasting damage.

🧵 Unlocking Rheumatology: What Every Joint, Patient & Clinician Should know👇

Tweet 1/5: The Anatomy of Arthritis
Ever wondered what sets a healthy joint apart from one with rheumatoid arthritis?
🔹 Healthy knees have smooth cartilage and clean bone architecture.
🔸 RA knees show swelling, inflamed synovium (the joint lining), and bone erosion—key targets for early intervention!
@IhabFathiSulima @DrAkhilX @CelestinoGutirr #MedTwitter Tweet 2/5: Morning Struggles
Stiff, aching joints first thing in the morning? You’re not alone.
For many with RA and similar diseases, getting out of bed is the hardest part. Targeted therapy and gentle movement can really help.

💡 “When Joint Pain Is NOT Arthritis” — The 7 Red Flags Every Doctor Should Know

Tweet 1:
“Not every swollen or painful joint is arthritis. Missing the real cause can delay life-saving treatment.
Here are 7 red flags that should make you think beyond rheumatology 👇”
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @SarahSchaferMD @NeuroSjogrens #MedTwitter Tweet 2:
1️⃣ Fever + Acute Monoarthritis
•Think septic arthritis until proven otherwise
•Don’t start steroids until infection is ruled out

🧵 The Gut–Joint Connection: How Your Microbiome Influences Arthritis

🦠🤔 Could your gut bacteria be making your arthritis worse?
Emerging science says YES.
Your gut microbiome can shape your immune system… and may even trigger autoimmune joint disease.
Let’s connect the gut to the joints 👇
#MedTwitter #guthealthmatters @DurgaPrasannaM1 @nileshnolkha @IhabFathiSulima @DrAkhilX @CelestinoGutirr @drkeithsiau @SarahSchaferMD The microbiome’s hidden role
Your gut hosts trillions of microbes.
When balanced → they help digestion & immunity.
When imbalanced (“dysbiosis”) → they can mis-train the immune system, sparking inflammation far beyond the gut.

🧵🤰💊 Managing Rheumatoid Arthritis during pregnancy & breastfeeding isn’t just about the right meds — it’s about timing, planning, and protecting both mum & baby.
Here’s your evidence-based, easy-to-follow guide 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @DurgaPrasannaM1 @RA_information #MedTwitter #Rheumatology 1️⃣ Planning is key
RA and pregnancy can coexist safely with the right plan.
Pre-pregnancy counselling is essential — discuss disease control, medication safety, and timing of conception.

🧵 HBV Reactivation — How to Avoid Triggering a Silent Killer Before Steroids or Biologics

Every day, we start steroids, methotrexate, rituximab, TNF-inhibitors.
If you miss hepatitis B status → you can cause fulminant hepatitis.

Before you start immunosuppression — read this 👇
@IhabFathiSulima @DrAkhilX @drkeithsiau #MedTwitter 1️⃣ First principle
Before ANY immunosuppression — from high-dose steroids to biologics — always check hepatitis B serology:
•HBsAg (surface antigen)
•anti-HBc (core antibody)
•anti-HBs (surface antibody)

🧵 Back pain that gets better when you move and worse when you rest?
That’s your body waving a red flag — and it’s not mechanical.
Here’s how to spot Inflammatory Back Pain (IBP) and catch axial spondyloarthritis before it hides for years 👇
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @SarahSchaferMD @DurgaPrasannaM1 #MedTwitter #RheumatX The 5 IBP Clues (ASAS) — 4 or more = high likelihood:
🔹 Onset <40 years
🔹 Slow, insidious start
🔹 Improves with exercise
🔹 No better with rest
🔹 Wakes at night, eases on getting up