Antonio Torres Gómez

Médico especialista en Medicina Interna
Enfermedades Autoinmunes Sistémicas
Hospital Universitario San Cecilio de Granada

[Abdelhamed Hamdy @Abdelhamed6261]

CNIs

[Abdelhamed Hamdy @Abdelhamed6261]

lupus nephritis

[Abdelhamed Hamdy @Abdelhamed6261]

Targeted Therapy for ANCA Associated Vasculitis: Where Have We Been?

[Franklin Loachamin @FranLoachamin]

Excelente imagen de Nefrótico y nefrítico.
Créditos a quien corresponda.

[Ravi Kumar @RheumattDoc]

🚨 Infliximab vs Cyclophosphamide in Severe Behçet’s Syndrome

This multicenter phase 2 Bayesian randomized controlled trial compared infliximab with cyclophosphamide in patients with severe Behçet’s syndrome.

🧪 Study Design

• 52 patients with severe Behçet’s syndrome
• Major vascular involvement: 71%
• Neuro-Behçet’s syndrome: 29%

Patients were randomized to receive:

🔹 Infliximab 5 mg/kg at weeks 0, 2, 6, 12, and 18
OR
🔹 Cyclophosphamide IV pulses every 4 weeks

All patients received glucocorticoids.

🎯 Primary Outcome

Complete response at week 22 defined as:
✅ Clinical remission
✅ Biological remission
✅ Radiological remission
✅ Prednisone dose ≤0.1 mg/kg/day

📊 Results

✅ Complete response achieved in:
• 81% with infliximab
• 56% with cyclophosphamide

📉 Overall adverse events:
• 29.6% with infliximab
• 64% with cyclophosphamide

⚠️ Serious adverse events were similar between groups.

💡 Key Takeaway

Infliximab demonstrated superior efficacy with fewer adverse events compared with cyclophosphamide, supporting TNF inhibition as a preferred induction strategy in severe Behçet’s syndrome with vascular or CNS involvement.

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[Aravind Palraj @Rheumat_Aravind]

👁️ Uveitis can be the first clue to an underlying rheumatic disease.

Anterior → HLA-B27 SpA, JIA, PsA, Reactive arthritis
Intermediate → Sarcoidosis, TINU
Posterior → Sarcoidosis, Behçet disease
Panuveitis → Behçet disease, VKH, Blau syndrome

Clinical pearl:
Acute recurrent alternating anterior uveitis → Think HLA-B27–associated spondyloarthritis.

#Rheumatology #Uveitis @docakx @IhabFathiSulima #Spondyloarthritis #BehcetDisease #MedTwitter

[GEAS | Enfermedades Autoinmunes SEMI @GEAS_SEMI_]

Muy relevante caso presentando por @MAS_Clinic de respuesta a voclosporina en #Lupuspodocytopathy refractaria (open access).

[NDT @NDTsocial]

Comparative Analysis of Lupus Nephritis Guidelines:

ACR 2025, EULAR 2025, and KDIGO 2024

🆓https://t.co/bUkps0GzvD

@goKDIGO @ERAkidney

[ACR_Journals @ACR_Journals]

Case report presents a 56-year-old woman presenting with otologic manifestations of IgG4-related disease. She showed improvement following prednisone and treatment with inebilizumab

ACR Open Rheumatology
https://t.co/KFguNMXInT

Figure: (A) H&E showing dense lymphoplasmacytic infiltrate; (B) and (C) IgG-stained plasma cells infiltrate of the fibrous tissue

[Nature Reviews Nephrology @NatRevNeph]

Anti-neutrophil cytoplasmic antibody-associated vasculitis: biological insights and biomarker-guided disease management https://t.co/qmGOtMstYA

[ReumaJoven @ReumaJoven]

*ALLEGORY Fase III: Obinutuzumab arrasa en LES* 🧬

RCT 52 sem vs placebo + estándar:

*SRI-4: 76.7% vs 53.5%*
*LLDAS: 67.6% vs 25%* 🔥
*Remisión DORIS: 35.1% vs 13.8%*
*↓ Flares HR ∼0.6*

*Superior en todos los endpoints.*

#LES #Lupus #Obinutuzumab #ALLEGORY #ReumaJoven

[vasculitides @vasculitides]

Access our new review on diagnosis, classification, and prognosis of ANCA-associated vasculitis in Nat Rev Rheum for free at https://t.co/t9dmuJRr9b

[vasculitides @vasculitides]

Large Vessel Vasculitis: Recent Advances in Pathophysiology and Targeted Therapies https://t.co/HqhLmRKkPZ

[Ahmed Bennis MD 🫀 @drbennisahmed]

Association of SGLT2 inhibitors and new-onset dementia in non-diabetic patients with heart failure

In this large, real-world patient with HF without diabetes, SGLT2i therapy was associated with a significantly lower risk of new-onset dementia and all-cause mortality.
@ESC_Journals @DrMarthaGulati @hvanspall @ShelleyZieroth @BiykemB @Hragy @cardioceptor
https://t.co/0Cy0MQQzUH

[NEJM @NEJM]

Inflammatory myopathies are typically associated with a myositis-specific autoantibody that determines the diagnosis and prognosis. Myositis subgroups have distinct pathomechanisms that now allow for targeted therapies.

Learn more in the Review Article “Inflammatory Myopathies” by Yves Allenbach, MD, PhD, and Olivier Benveniste, MD, PhD: https://t.co/ZeCKdNe87v

[Salvador Casado @DoctorCasado]

1⃣Los internistas son los generalistas hospitalarios.

2⃣Fundamentales para mantener una visión amplia sobre el paciente.

3⃣Hermanados con los médicos de familia, que somos los generalistas de Atención Primaria.

👉Crear puentes es fundamental.

[AntonioZapatero @ZapateroAntonio]

Primer día de elecciones MIR 2026, agotadas Dermatología y Cirugía Plástica, solo se han elegido 7 plazas de Medicina de Familia, 1 de Geriatría, 11 de Psiquiatría y pocas de Pediatría y de Medicina Interna, ninguna de Medicina de Urgencias….que cada uno saque sus conclusiones

[Juan Carlos Gimenez @Infomedicos]

Alguna vez la incertidumbre puede llevar al médico a sentir miedo, pero frente al paciente debe aprender a disimularlo.

"No hay nada que asuste más a un paciente que un médico asustado". Henry Marsh, neurocirujano.

[Cristina Macía @reumacia]

Si te interesan los JAKinibs 💊 aquí tienes la súper revisión ✍️

Acceso abierto 🔑 https://t.co/jbGd8kzjmQ

[Dr.Mukesh , MD , DM @dr_immuno29]

🧬 VEXAS Syndrome — The Game-Changer in Adult Autoinflammation

• 🔥 First described in 2020 → bridges rheumatology + hematology + genetics
• 🧬 Caused by somatic UBA1 mutations (hematopoietic stem cells)
• ⚙️ Defective ubiquitination → proteotoxic stress + systemic inflammation

👤 Who to suspect?
• 👴 Men >50 yrs (predominant)
• 💊 Steroid-dependent inflammation
• 🩸 Macrocytic anemia + cytopenias
• 🦠 Recurrent fevers, skin lesions, chondritis, lung involvement

🔬 Hallmark clues
• 🧫 Bone marrow vacuoles (erythroid + myeloid precursors)
• 🧬 Confirm with UBA1 mutation testing

⚠️ Clinical spectrum
• 🧴 Neutrophilic dermatoses (≈80%)
• 🌬️ Lung involvement (>60%)
• 🦴 Arthritis/chondritis
• 🧠 Vasculitis mimic
• 🩸 MDS in ~30–60%

📊 Epidemiology pearls
• ~1 in 4,000 men >50
• Rare in women (often with X monosomy)

💀 Prognosis
• ⚠️ <50% 10-year survival
• High risk: infections, thrombosis, marrow failure

💊 Treatment (still evolving)
• 🥇 Steroids = rapid control (but dependence common)
• ➕ JAK inhibitors / IL-6 / IL-1 blockers (partial benefit)
• 🧬 Azacitidine → ↓ clone + inflammation
• 🧫 Allogeneic HSCT = only potential cure

💡 Key concept
👉 First adult-onset disease driven by somatic mutation → paradigm shift in inflammatory diseases

📌 Think VEXAS in:
“Unexplained inflammation + cytopenia + steroid dependence in elderly”

🔗 DOI: 10.1038/s41572-026-00695-w

#VEXAS #Rheumatology #Hematology #Autoinflammatory #PrecisionMedicine #MDS #MedTwitter