Deepak Malgutte

Autoimmune Sherlock | Rheumy | Med Educator
Busting myths around joint pain, autoimmune disease & steroids.

[Deepak Malgutte @DMalgutte]

The Man Who Never Got a Nobel, But Gave the World Methotrexate
— A story of forgotten genius, cancer, arthritis, psoriasis… and hope. 💊💔🧬

[Abhishek G P @Abhishek_joints]

Had the privilege to listen to some of the stories in person, now the whole world will read the path of this GOAT.. Congratulations to Lancet! Many more to come. #padmashri @IndianRheum @nileshnolkha @DurgaPrasannaM1 @Rheumat_Aravind @IlliasulK

[Dr Nilesh Nolkha @nileshnolkha]

@DrDeepakKrishn1 👆

[Deepak Malgutte @DMalgutte]

@nihardesai89 @PanktiMehta24 @UHN @UofT @nileshnolkha Congratulations @PanktiMehta24

[𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 MD, DM @nihardesai89]

🎉 Congratulations, @PanktiMehta24 and the phenomenal Lupus team at @UHN 💪🏽

https://t.co/rx59dZo6xq

[Ravi Kumar @RheumattDoc]

🫁 Tofacitinib vs Calcineurin inhibitors in MDA5+ Dermatomyositis-ILD

📌 Large multicentre retrospective cohort (China, 2014–2023)

Key Findings
🧪 Adults with newly diagnosed MDA5+ dermatomyositis–ILD (course <3 months)
👥 Tofacitinib: 290 patients
👥 Calcineurin inhibitors (CNI): 225 patients

🟢 Primary outcome: 1-year lung-transplant–free survival
•⚰️/🫁 Tofacitinib: 32.4% died or underwent transplant
•⚰️/🫁 CNI: 46.7% died or underwent transplant
•📈 After IPTW adjustment → Significantly higher survival with tofacitinib
•HR 0.72 (95% CI 0.56–0.94; p=0.013)
•Absolute survival benefit: +9.3%

Who benefited most?
👶 Age <60 years
⏱️ Not rapidly progressive ILD
🌬️ PaO₂/FiO₂ ≥300 mmHg

Safety
🦠 Opportunistic infections = major AE
📊 Incidence similar: 42.4% vs 45.3%

Conclusion
💊 Tofacitinib offered significantly better 1-year survival than CNIs in MDA5+ DM-ILD with comparable safety.

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

[Deepak Malgutte @DMalgutte]

"Yes, the list is correctcorrect.

Only thing I usually keep in mind is that this ‘100% ANA positivity’ is more on paper. In real practice it depends a lot on the lab — the assay used, substrate, cut-off, and even how the pattern is read.
So sometimes you may see a false negative or a lower titre just because of technical issues.
Otherwise your list covers the classical conditions well."@nileshnolkha @IlliasulK @PanktiMehta24

[𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 MD, DM @nihardesai89]

Same one, different seasons ❤️

[Deepak Malgutte @DMalgutte]

@DrPyaricetamoI Its feeling with chakali, shakkarpara that make it amrit😜

[Pankti Mehta @PanktiMehta24]

Great work!
🔴 Importantly, 1/3rd of patients had a catastrophic health expenditure
of &gt;20% of family income🔴

#ChronicIllness #Lupus

[Deepak Malgutte @DMalgutte]

Had one of those exhausting weeks — endless work, stress piling up, and no space to breathe.
So I randomly clicked on Re-Tripling again — maybe the 3rd or 4th time.

But this time, it hit differently.
Chandan’s calm, Chanchal’s courage, and Chitvan’s carefree madness — all just synced with me.
Somehow it felt like life’s reminder: even chaos can be beautiful when you pause and feel it.

It didn’t just entertain me — it expanded my horizon, made me feel lighter, alive again.
Sometimes we all need that gentle push — a story that resets your mood, your mind.

What’s that one series or movie that does it for you?
#ReTripling #WeekendVibes #StressBuster #FeelGoodSeries

[Deepak Malgutte @DMalgutte]

@DrAkhilX Surprised no one mentioned ORS (Oral Rehydration Solution) — one of the simplest yet most life-saving medical innovations in history.

Invented in the 1960s, this humble mix of salt, sugar, and water has saved over 70 million lives worldwide — more than any antibiotic or vaccine.

[Dr Nilesh Nolkha @nileshnolkha]

💉 I’m pro-vaccine and I don’t want to get into this twitter war…

But let’s clear a few things about this “pharma lobby” nonsense.

Doctors don’t lose business because of vaccines or medicines.

If anything, post-COVID we’re busier and richer because people refuse preventive care, skip vaccines, and experiment with “alternative” nonsense.

Take rheumatoid arthritis for example 👇

🦴 Early on, it’s treatable with simple, affordable drugs and a rheumatologist’s guidance.
But many patients waste months or years on home remedies, oils, or “natural detox.”

When they finally come:
•Their joints are already deformed,
•Muscles wasted,
•Need multi-drug therapy, rehab, sometimes joint replacement,
•And lifelong disability that could’ve been avoided.

💸 The irony?
They end up spending 10–20× more than what early treatment would’ve cost, all because someone told them “medicines are poison.”

So no, we aren’t in a pharma lobby.
We’re just fixing the mess that pseudoscience and poor judgment create.

And trust me, ‘business’ (you call it business, we call it medical care or healing) isn’t going down because of anti-vaxxers / herbal treatments / ayurveda / homeopathy or alternative therapies, it’s booming because of them. 😅

[Dr.Mukesh , MD , DM @dr_immuno29]

#ACR25 Must-Read 🔥 | “Secrets & Pearls of Rheumatology in CTD” – Janet Pope MD

🔹 SLE Pearls
•Not all lupus rashes are equal!
• Malar → almost always SLE
• Subacute cutaneous → 50% SLE
• Discoid → 5–10% risk
•Lupus vs DM rash → Between vs on knuckles.
•“Lupus pernio” = Sarcoidosis mimic.
👉 Always biopsy if uncertain.

⸻

🔹 Lupus Nephritis (LN)
•Always biopsy first renal episode — defines activity, class, prognosis.
•Combo Rx: MMF/CYCLO + GC + HCQ + another IS (Belimumab/Voclosporin/Tacrolimus).
•Manage BP, lipids, proteinuria (ACEi/ARB/SGLT2i).
•SGLT2i & GLP1-RA → ↓ renal progression, ↓ MACE.
•Taper IST only after 5 yrs remission (WIN-Lupus trial: early stop ↑ relapse).

⸻

🔹 Myositis Pearls
•No need for universal cancer screen.
• High-risk: TIF1-γ, NXP2, >45 yrs, dysphagia, wt loss.
•Skin biopsy findings mimic SLE — interface dermatitis, mucin, vacuolar change.

⸻

🔹 Lab Wisdom 🧪
•Don’t order ANA without suspicion — false + freaks out patients.
•Never repeat a positive ANA.
•ENA only matters if ANA+.
•Negative ANA → ignore dsDNA, unless anti-Ro52.
•Stop serial dsDNA/C3/C4 if stable — waste of ₹💰.

⸻

🔹 Systemic Sclerosis (SSc)
•Primary RP <40 yrs → no workup.
•Red flags: late onset RP, +centromere Ab, abnormal nailfolds → “Prescleroderma”.
→ 30–40% progress to CTD within 5 yrs.
•ILD can develop anytime — even late lcSSc!
•Continue screening; 2/3 progress over 5 yrs.
•PAH: screen early, confirm with RHC; dual therapy = better survival.

⸻

🔹 Sjögren’s Syndrome
•Don’t screen every patient for lymphoma!
• High risk if ≥3 of 7 factors: persistent parotid swelling, LAD, ↓C4, cryoglobulins, MG, RF+, SSA/SSB+.

⸻

🔹 Take-Home Truths 💡
•Believe labs only when they fit the clinical picture.
•Many mimics exist — biopsy, think wide, act smart.

⸻

#ACR25 #RheumTwitter #MedEd #JanetPope #ClinicalPearls #SLE #SSc #Sjogrens #Myositis #LupusNephritis

[Rheuma Doc @LastManStand85]

Azathioprine in Pregnancy: friend or foe? [Evelyne Vinet] #ACR2025
[Crohn’s Colitis 2024] ➡️ 25% of pregnancies show shunting
🚩Use lowest effective dose
🚩Monitor metabolites if available
🚩Monitor for rising bile acids, pruritus,or ⬆️ LFTs
🚩Switch to tacrolimus if shunting/IC

[Dr.Mukesh , MD , DM @dr_immuno29]

🧩 #ACR25 Highlight | Skin in the Game: Cutaneous Clues in Rheumatic Disease
By Dr. Katharina S. Shaw, Penn Medicine

🧵 Post 3 | Dermatomyositis & Localized Scleroderma
• 💪 IMACS 2023: Cancer screening now risk-tiered (High > Intermediate > Low)
• 🎯 Paraneoplastic DM ~5%, mostly High-Risk, cancers → within 2 yrs
• 🧬 Non-paraneoplastic DM: >50% still High/Intermediate risk
• 👶 Linear Morphea (En coup de sabre) → MTX + IV steroids (CARRA) = standard
• ⚠️ Craniofacial Morphea → CNS/eye/TMJ risk → MRI + ophtho + dental eval
• 🧠 Early aggressive therapy prevents irreversible deformity

#Dermatomyositis #Morphea #JuvenileScleroderma #ACR25 #ACRAmbassador #RheumDerm

[Deepak Malgutte @DMalgutte]

@Ishuu_kun “Firecracker-on-face is your argument? you just live-streamed your IQ — zero logic, full noise; exactly why India has pollution and people like you are its brand ambassadors.”

[Pankti Mehta @PanktiMehta24]

Thank you for the feature!
Honoured to be a part of this brilliant team ❤️

#learnandgrow

@nihardesai89

[ILLIASUL IBAD @IlliasulK]

Tweet 10/10

Here’s the simplest way to understand it 👇

💡 Concept:

In absence of obstruction —
👉 RVSP ≈ PASP (Pulmonary Artery Systolic Pressure)

1️⃣ Find RAP from IVC:
•≤2.1 cm & collapse > 50% → 3 mmHg
•2.1 cm & collapse < 50% → 15 mmHg

2️⃣ Measure TR velocity (Vₜᵣ)

PASP = 4(V_{TR})^2 + RAP

👉 TR > 2.8 m/s or PASP > 40 mmHg → suspicious for PH

3️⃣ Estimate mean pressure:

mPAP = 0.61 × PASP + 2

👉 mPAP > 20 mmHg = Pulmonary Hypertension

🔹AcT < 80 ms → severe

🔹PVR > 2 WU → abnormal

Echo gives you the answer if you know where to look.

#Echo #MedTwitter #RheumTwitter #CardioTwitter #PulmonaryHypertension @IhabFathiSulima @CelestinoGutirr

[Deepak Malgutte @DMalgutte]

@IlliasulK @DrAkhilX @IhabFathiSulima @CelestinoGutirr Pinna chondritis with lobule sparing — a hallmark clinical sign pointing to Relapsing Polychondritis (cartilaginous inflammation sparing fatty lobule)

[Deepak Malgutte @DMalgutte]

@drgunjand We form an emotional bond with those songs. It's not that the current music is boring; in fact, our taste in music has evolved for the better.

[Deepak Malgutte @DMalgutte]

Went with wife for dinner last night.

New Bollywood & Punjabi songs were playing — nice, but nothing special.
Then the DJ switched to a 90s track… and the whole restaurant transformed.
People stood up, shouting lyrics, dancing like nobody was watching.
One old song changed the entire energy of 40��50 strangers in seconds.

And a thought hit me —
Those singers, writers, composers probably have no idea that their work is still creating joy decades later.

That’s the thing about good work —
You don’t always see its impact, but it travels far in time.

To all young people building careers —
Work with ethics, skill and sincerity.
You may not get instant applause.
You may not even witness the results.
But someday, because of your work,
a moment, a smile, a life will change —
exactly like that song did last night.

Keep going. The world is silently storing your efforts.