🧵 Read this if you have knee pain and are 35–40+ 👇

#KneePain #KneeOsteoarthritis #DrNileshNolkha #NirjaraMultispecialityClinic #FreedomFromPain #NIRJARA

⸻

1️⃣ What exactly is Knee Osteoarthritis? 🦵
It’s not just age or “wear & tear.”
Osteoarthritis = cartilage thinning + bone changes + low-grade inflammation + muscle weakness.
🎯 It’s a whole-joint condition—mechanical + metabolic. (Nature Rev Rheumatol 2023) 2️⃣ Why “wear & tear” in knee pain is oversimplified ⚙️?
📊 Studies show obesity doubles the risk (OR ≈ 2.18). (Obesity Reviews 2015)
💪 Weak thigh muscles raise OA risk by ~1.6×. (Arthritis Care Res 2015)
So it’s not age alone—it’s load + inactivity + inflammation.

Knee replacement
Indian context

🧵 1/12 — Not every knee pain needs a Knee Replacement… and waiting too long can also be a mistake.

#KneeReplacement #FreedomFromPain #NirjaraMultispecialityClinic #NileshNolkha 2/12 — When Knee Replacement truly helps
✅ Severe knee arthritis with daily pain and progressive decrease in mobility
✅ Pain affecting walking, stairs, sleep, or work
✅ No benefit from medicines, exercises, or injections
At that point, Knee Replacement can restore quality of life.
#KneeReplacement #FreedomFromPain #NirjaraMultispecialityClinic

Read if you want to understand the framework of rheumatology / medicine diagnosis and practice

🧵 How to Approach a Patient of Connective Tissue Disease in Real Life – Lessons from a 68-Year-Old Case

1/ A 68F presented with severe hand arthritis, neck & foot pain.
She had failed MTX, HCQ, Leflunomide, Sulfasalazine + Steroids. Being treated for almost 9 months.
USG: Tenosynovitis with vascularity → confirmed inflammation.
But autoantibody profile didn’t match neatly.

#MedTwitter #NileshNolkha #FreedomFromPain Mismatch Between Antibodies & Clinical Phenotype – What Do We Do?

2/
•ANA 2+ positive
•CENP A/B positive (suggesting CREST)
•Anti-CCP negative
•Mild dry eye, no Raynaud’s, no mouth dryness, no skin fibrosis or digital pits or psoriasis

👉 Possible Sjögren’s overlap
👉 Best working label = Undifferentiated CTD with arthritis-predominant disease

#MedTwitter #NileshNolkha #FreedomFromPain

🧵 Hydroxychloroquine - HCQ- Masterclass : One Drug, Many Uses – Safe, Practical & Powerful 💊

This can be read by both patients and doctors

1/
💊 Hydroxychloroquine (HCQ) is a cornerstone DMARD in rheumatology.
It’s slow-acting but offers:
✅ Immunomodulation
✅ Steroid-sparing benefit
✅ Metabolic perks
✅ Safety in long-term use

Let’s break down how to use it wisely 🧠
#RheumTwitter #medtwitter
#hydroxychloroquine #hcq
#HCQMasterclass #rheumatoidarthritis #lupus 2/
🔍 Where is HCQ most used in rheumatology?
•🦋 Systemic Lupus Erythematosus (SLE)
•🤲 Rheumatoid Arthritis
•💧 Sjogrens disease
•🧬 Antiphospholipid Syndrome (APS)
•🌞 Cutaneous LE, Dermatomyositis

#RheumTwitter #medtwitter
#hydroxychloroquine #hcq

🧵 ANA Testing in Rheumatology — Masterclass for Doctors & MedTwitter

1/ 📢 What’s ANA?
ANA = Anti-Nuclear Antibodies.
It’s a surrogate marker for >50 nuclear antigens (Ro, Sm, dsDNA, La, Scl-70, etc).
✅ Can be positive in many CTDs
❌ Positive ≠ disease
❌ Negative ≠ rule out all CTDs. 2/ 🧪 When NOT to order ANA
•No symptoms/signs of CTD
•Only “screening” due to anxiety or family history
•Non-specific aches/fatigue without other red flags
🔑 Always pair ANA with a clinical question.

🧵 Why do I keep getting gout attacks despite treatment?
Let’s bust the myths and explain the science 👇
#Gout #RheumatologySimplified #RefractoryGout #GPUpdate #UricAcid 1️⃣
💥 “Doc, I take meds. I stopped alcohol. I even eat tart cherries & turmeric capsules…
…Then WHY AM I STILL GETTING GOUT ATTACKS?”

📍 This is what we call uncontrolled or refractory gout.
Let’s break down why this happens 👇

Common Myths & Mistakes About Knee Replacement surgery in India 🇮🇳

Many avoid or delay surgery due to misconceptions. Proper prehab, rehab, and diet are key for the best results!

Let’s bust the myths & share the right approach! 🦵💡
1/12 ❌ Myth: Knee replacement is only for the elderly.
✅ Fact: Pain & mobility matter more than age. Many in their 40s & 50s get it due to arthritis or injuries. Early intervention = better results! (2/12)

Are you seeing a lot of patients with Chickungunya or post viral arthritis ?

Here’s a primer on how to treat same (feel free to post queries and please retweet for awareness)

..1 #MedTwitter How does Chickungunya or post viral arthritis present ?

Acute fever going upto 102 degree Celsius

Severe joint pains (overnight) with or without joint swelling. May have diffuse maculopapular rash. These usually happens on 2-3 day after fever…2

Ok i am a modern medicine doctor & will try to answer. First understand that modern medicine talks of healthy lifestyle for almost every disease - everyone should eat healthy, exercise, meditate etc. Lets also first rs understand the problem with these questions (Qs).1

https://twitter.com/yogrishiramdev/status/1396809666529619974

Modern medicine does of healthy lifestyle to reverse atleast some of above diseases in early stages. Unfortunately for severe diseases, we have to give some form of medicine. Baba has smartly tried to frame Qs in a way which makes people think that we give meds for everything.2

So, as per news, two treatments will be launched in near future in India for covid
1 is favipravir, so called 'allopathy' drug. 2nd is 'coronil' a ? herbal drug by patanjali. I have serious problems with both. Plz read thread to understand the major issues
..1 Favipravir is supposedly approved for restricted use, in mild to moderate covid patients, based on research which is not published or not in public domain. Any research should be out in open so that doctors and scientists can critically review it..2