Gelsomina Rozza

MD | Rheumatologist 🩺

[Aravind Palraj @Rheumat_Aravind]

ANCA is a powerful diagnostic tool—but only when used in the right clinical context.

A positive ANCA does not diagnose ANCA-associated vasculitis, and a negative ANCA does not exclude it.

This infographic summarizes when to order ANCA, how to interpret PR3-ANCA and MPO-ANCA, common diagnostic pitfalls, and why clinical phenotype always comes before laboratory results.

Interpret the patient—not just the antibody.

#Rheumatology #ANCA #Vasculitis #MedEd #EvidenceBasedMedicine @IhabFathiSulima @docakx @vasculitisES @anzvasc @IRAeNewsLetter

[Dr sthanu subramanian @drsthanus]

A woman in her 40s presented with a 1-week hx of fatigue and painful, swollen gums.

White-cell count was 225,000 per cubic millimeter.

Likely diagnosis?

[Aravind Palraj @Rheumat_Aravind]

Idiopathic Inflammatory Myopathies made simple 🔥

Autoantibodies are not just diagnostic — they define the disease.

🧵 Key patterns you must know:

• MDA5 → Rapidly progressive ILD (high mortality)
• TIF1-γ → Malignancy (adult DM)
• HMGCR → Statin-associated necrotizing myopathy
• SRP → Severe myopathy + cardiac involvement
• Jo-1 → Classic antisynthetase syndrome

Clinical mapping = exam gold:

ILD dominant → PL-7, PL-12, MDA5
Cancer → TIF1-γ, NXP2
Good prognosis DM → Mi-2

⚠️ ANA can be negative (cytoplasmic staining)

Negative ANA ≠ No myositis

This is precision rheumatology in practice.

#Rheumatology #Myositis #Dermatomyositis #Pulmonology @DrAkhilX @IhabFathiSulima #MedTwitter #NEETPG #INI #MRCP

[Dau⚕️ @daoo100]

Drugs of choice for Patients with Acute Bell’s palsy? #MedX ?

A) Oral Acyclovir alone
B) Oral Prednisolone (started immediately)
C) IV antibiotics + steroids
D) Carbamazepine

[Gelsomina Rozza @GelsominaRozza]

💪🏻waiting

[Gelsomina Rozza @GelsominaRozza]

@Doctors_GUILD C

[Dr. John Cush @RheumNow]

Evaluation of pts w/ muscle weakness and elevated muscle enzymes https://t.co/faTWMscUzz

[Ravi Kumar @RheumattDoc]

🧬 PAPA Syndrome: When Sterile Inflammation Mimics Infection

(Pyogenic Arthritis, Pyoderma gangrenosum, Acne)

•A rare monogenic autoinflammatory disease
•Caused by gain-of-function mutations in PSTPIP1

🧠 Pathophysiology
•Mutant PSTPIP1 → increased interaction with pyrin
•Excess inflammasome activation
•↑ IL-1β → sterile neutrophilic inflammation

👶 Clinical phenotype (classic triad)

1.Pyogenic arthritis
•Childhood onset
•Recurrent, sterile, destructive arthritis
•Often triggered by minor trauma

2.Pyoderma gangrenosum
•Adolescence/adulthood
•Pathergy common

3.Severe cystic acne
•Puberty onward

👉 Phenotype often age-dependent:
arthritis → skin disease later

🧪 Laboratory features
•Elevated CRP / ESR during flares
•No cytopenias
•Normal zinc
•Cultures from joints/skin: sterile

🧬 Genetics
•PSTPIP1 mutations
•Common: A230T, E250Q
•Autosomal dominant (variable penetrance)

💊 Treatment
•IL-1 blockade (best evidence)
•Anakinra
•Canakinumab
•TNF inhibitors – useful for skin disease
•Steroids: short-term control
•Conventional DMARDs: usually ineffective

🧠 Key differentials
•PAMI syndrome
•SAPHO syndrome
•Chronic recurrent multifocal osteomyelitis (CRMO)
•Infective arthritis (ruled out by sterile cultures)

Recurrent sterile arthritis in a child + later severe acne/PG = think PAPA, not infection

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @DrAkhilX @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1 @Urchilla01

[Laurent ARNAUD @Lupusreference]

✅ Today is the world #LUPUS #DAY 🌍🌎🌏 Let's raise AWARENESS about this rare #autoimmune disease impacting ~3.4 million persons worldwide. Lupus is a multifaceted disease, it can be very VISIBLE👀 life-threatening 🔥or on the contrary INVISIBLE with #fatigue or even minimal🦋

[Janet Pope @Janetbirdope]

#Diagnosis in 1 #picture

What is the scar and why?
So
👇
What is the #dx ?

I am ‘sympathetic’ to this #treatment!

#clinicalPearl

#MedX #medEd #rheumX #rheumEd

[Gelsomina Rozza @GelsominaRozza]

❤️

[Darpan Thakare @darpan06T]

🌟IgG4RD: Lessons from the first 20 years🌟by Prof John Stone

⭐️Lesson 1- IgG4RD is a variable vessel vasculitis
✨Can cause small vessel vasculitis of the skin
✨One of few vasculitis causing coronary arteritis in adults

⭐️Lesson 2- IgG4RD is more common and severe in males
✨M/F- 2.2 to 1
✨Males diagnosed 5 years older

⭐️Lesson 3- IgG4RD has no diagnostic histopathology
✨Always remember (do NOT occur in IgG4RD)

⭐️Lesson 4-Serum IgG4 levels is a good biomarker
✨Reflects disease activity
✨Serum IgG4 levels >5 ULN [PPV-75% (69-81%)]

⭐️Lesson 5- Rising IgG4 levels should not be ignored

⭐️Lesson 6- Pancreas in IgG4RD is the analogue of the kidney in AAV

⭐️Lesson 7- B cell therapy is highly effective in IgG4RD

❤️❤️Only person who can make diagnosis of IgG4RD is the CLINICIAN❤️❤️

✨Future therapy- Obexelimab (Bifunctional antibody)✨

#IRACON24 #rheumatology #MedTwitter
@IRACON24Blr @IndianRheum @TheIJR

[Rheuma Doc @LastManStand85]

Frequency of ANCA positivity in different conditions. Atypical ANCAs w/negative PR3 or MPO can be found in a range of nonvasculitic conditions (inflammatory bowel disease, autoimmune disease, malignancy & chronic infection)
[D.Geetha et al]
#Vasculitis #Rheumatology #MedTwitter

[Scientissimum @scientissimum]

Good morning, dear ladies and gentlemen! Today, #Scientissimum would like to present an #anatomy case focusing on the #knee and its joints. The knee connects the thigh to the leg and comprises two joints: one between the femur and tibia known as the tibiofemoral joint, and another between the femur and patella referred to as the patellofemoral joint. Serving as the largest joint in the human body, the knee functions as a modified hinge joint, allowing for flexion and extension, along with subtle internal and external rotation movements.🦵🏼
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¡Buenos días, queridos damas y caballeros! Hoy nos gustaría presentar un caso de #anatomía centrándonos en la #rodilla y sus articulaciones. La rodilla conecta el muslo con la pierna y comprende dos articulaciones: una entre el fémur y la tibia conocida como articulación tibiofemoral, y otra entre el fémur y la rótula denominada articulación femororrotuliana. La rodilla, la articulación más grande del cuerpo humano, funciona como una articulación de bisagra modificada, lo que permite la flexión y extensión, junto con sutiles movimientos de rotación interna y externa.👨🏽‍⚕️
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Bom dia, queridos senhoras e senhores! Hoje gostaríamos de apresentar um caso de anatomia com foco no #joelho e suas articulações. O joelho conecta a coxa à perna e compreende duas articulações: uma entre o fêmur e a tíbia, conhecida como articulação tibiofemoral, e outra entre o fêmur e a patela, conhecida como articulação patelofemoral. Servindo como a maior articulação do corpo humano, o joelho funciona como uma articulação modificada, permitindo flexão e extensão, juntamente com movimentos sutis de rotação interna e externa.🏥
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Video credit to its proper owners.
#Eclipse #medtwitter #medX #meded #fosmed #SolarEclipse

[Journal of Brown Hospital Medicine @BrownJHM]

Causes of abdominal pain by location @medics_AbuSaif #MedX

[Oren Gottfried, MD @OGdukeneurosurg]

abdominal pain by common locations

[TA✨ @DrPharmDMDTh]

Vitamin Deficiencies

A - blindness

B1 - beriberi

B2 - glossitis

B3 - pellagra

B5 - burning foot syndrome

B6 - peripheral neuropathy

B7 - brittle nails, hair loss

B9 - neural tube defects

B12 - megaloblastic anemia

C - scurvy

D - rickets

E - muscle pain / weakness

[NEJM @NEJM]

In the MANDARA randomized trial, benralizumab was noninferior to mepolizumab for the induction of remission in patients with relapsing or refractory eosinophilic granulomatosis with polyangiitis. Read the full trial results and Research Summary: https://t.co/PEh2JB5uwi

[Gelsomina Rozza @GelsominaRozza]

😱

[Oren Gottfried, MD @OGdukeneurosurg]

Provide a name for this hand by Skalski