Eufrates Hdez Nuñez

Apasionado por la reuma, intenso como internista. Amo a mis hijos, con mi pelusa

[Updates in Medicine @medic_updates]

New Universal Definition & Classification of Heart Failure

[Daniel Zovatto @Zovatto55]

Vuelvo a recomendar este estupendo sitio, qué diariamente nos ofrece sugerencias muy valiosas de lectura, acompañadas de versiones virtuales gratuitas de las mismas. Gracias @lectocratas

[Keith Siau @drkeithsiau]

You are replaceable at work, but you are NOT replaceable at home. A beautiful and poignant reflection that applies to all clinicians.

[The Lancet Rheumatology @TheLancetRheum]

NEW REVIEW—Glucocorticoid treatment in patients with inflammatory rheumatic diseases: current practice and open questions https://t.co/UdWg2TGyja @FraButtgereit @LaiShanTam3

[Mithu Maheswaranathan, MD @MithuRheum]

🆕 AAO 2026 Guidelines for #Hydroxychloroquine Retinopathy Screening

OCT + FAF (wide-pattern Fundus Autofluorescence) are the primary screening tests for HCQ Retinopathy

Why no longer VF? FAF has better recognition of pericentral retinopathy.

#RheumX #RheumTwitter #OphthoX

[Jesús Martín Mendoza Arriola @JesusMartinMx]

A ver tú ¿cómo te llamas? ¿Hugo? @HugoAguilarOrti Al primer ministro holandés se le cayó el café y el mismo limpió el suelo. Y tú dejaste que una mujer te limpiara los zapatos. Opiniones libres para este pequeño sujeto. @HugoAguilarOrti @SCJN
https://t.co/yllaQXYeef

[Dr. Isaac Chávez Díaz @DrChavezDiaz]

Los médicos residentes solo podrán estar un máximo de 24 horas continuas en el hospital.

[Dr.Mukesh , MD , DM @dr_immuno29]

🦴 Stopping antiresorptives in osteoporosis —
🔹 Bisphosphonates
• Bind bone → residual effect after stop
• BMD gain plateaus ~3–5 yrs
• Drug holiday OK if LOW–MOD risk
• Continue if: age ≥70, T-score ≤−2.5, prior fracture
• Tail effect: Zoledronate > Alendronate > Risedronate
• Long use ↑ AFF & ONJ (rare, risk ↓ fast after stop)
• Holiday too long (>2 yrs) → ↑ hip & vertebral fractures

🔹 Denosumab
• No holiday concept ❌
• Stop = rebound CTX ↑↑
• BMD loss 1–2 yrs
• Multiple vertebral fractures 10–15% in 1st year
• Risk ↑ if: long use, prior vertebral Fx, CKD
• Exit mandatory → Zoledronate / Alendronate
• Timing matters: give antiresorptive ~6 months after last dose
• BTMs guide re-dosing better than BMD alone

🔹 Monitoring
• DXA: ↓ >3% = significant
• CTX rise >30% = loss of control
• Dental & thigh pain screening essential

🔹 Bottom line
✔ Osteoporosis = chronic
✔ Bisphosphonates → planned pause
✔ Denosumab → planned transition
✔ Unplanned stopping = fractures

#Osteoporosis #Denosumab #Bisphosphonates #DrugHoliday #BoneTurnover #FracturePrevention #Rheumatology #Endocrinology #EvidenceBased

📄 DOI: 10.1002/art.43179

[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

[CRUZ AZUL @CruzAzul]

GRACIAS POR TODO, NACHO 💙🚂

[Dr. John Cush @RheumNow]

Novartis announced top line results of its ianalumab (VAY736;B cell inhibitor) in primary Sjögren’s dz. 2 RCTs, NEPTUNUS-1 and NEPTUNUS-2, met met primary endpoints w/ statistically significant improvements in disease activity in Sjögren’s patients. https://t.co/cIBhF3YJh3

[Dr. John Cush @RheumNow]

Nerandomilast FDA Approved for Progressive Pulmonary Fibrosis

The FDA has approved nerandomilast (Jascayd), a PDE4b inhibitor, to treat adults with progressive pulmonary fibrosis (PPF). Nerandomilast was approved to treat idiopathic pulmonary fibrosis (IFP) in October 2025.

https://t.co/QqZpyQSrWn

[ILLIASUL IBAD @IlliasulK]

Nobody saw the one finger dropping… unable to extend while others move perfectly?

That’s not weakness — this is extensor tendon rupture.

Meet Vaughan–Jackson Syndrome 🚨

A rare but classic pattern in Rheumatoid Arthritis where extensor tendons rupture sequentially from ulnar → radial side.

🟣 Little finger stops extending first

🟣 Then ring → middle → index

🟣 Caused by dorsally subluxed ulnar head mechanically sawing the tendons

🟣 RA tenosynovitis accelerates the damage

🟣 Prevention = early screening + tenosynovectomy

🟣 Once ruptured → surgical repair, but full ROM may not return

Spot the “dropped finger” early. Save the hand. ✋

#MedTwitter #RheumTwitter #OrthoTwitter #HandSurgery #RheumatoidArthritis #ClinicalPearls #SpotDiagnosis #VaughanJacksonSyndrome #Tweetorial @DrAkhilX @IhabFathiSulima @CelestinoGutirr @Urchilla01

[Jonathan Chávez @JonathanNefro]

Llama la atención que ante albuminuria, se consideran las comorbilidades adicionales para decidir el tratamiento adecuado.

Desde mi perspectiva, la evidencia justifica que en todas las mencionadas, los iSGLT2 deberían ser los primeros elegibles

BMJ 2025
https://t.co/Lh8h4jVL6W

[CardioTeca @cardioteca]

🆕 Estudio MIRO-CKD: Balcinrenona (nuevo ARM no esteroideo) + dapagliflozina en nefropatía crónica albuminúrica.

📕 Lancet
📁 Resumen del artículo en https://t.co/df0MQPdnCV

Balcinrenone + dapagliflozina en enfermedad renal crónica (MIRO-CKD) 👀
En 12 semanas, la combinación logró una reducción adicional de la albuminuria frente a dapagliflozina sola, con pocos casos de hiperpotasemia y cambios discretos en la función renal y la tensión arterial.

Mensaje práctico: consolidar siempre RAS + iSGLT2 en ERC albuminúrica y seguir de cerca la llegada de nuevos MRA no esteroideos que permitan un verdadero triple bloqueo cardiorrenal con riesgo de potasio más manejable.

#cardio #nefro #ERC #albuminuria #iSGLT2 #MRA #cardiorrenal

[ILLIASUL IBAD @IlliasulK]

Anti-RNAP III in SSc = not just antibodies, it’s a cancer siren

A meta-analysis of 22 studies (1980–2023) shows:

• Anti-RNAP III+ SSc pts → RR 1.48 (95% CI 1.16–1.80) → ~48% higher cancer risk than negative pts

• ACA+ SSc pts → RR 0.78 (95% CI 0.60–0.96) → lower cancer risk, mostly limited SSc

• Anti-Scl70 → no major cancer signal, more ILD/fibrosis valve than malignancy flag

Take-home:

👩‍⚕️ If RNAP III is positive → screen aggressively for malignancy (age + family hx appropriate)

✅ If ACA is positive → think limited SSc, less cancer fear but still monitor

Early diagnosis is good.

Early cancer screening in RNAP III+ SSc is better.

#Rheumatology #SSc #SystemicSclerosis #CancerScreening #Autoantibodies #MedTwitter #SclerodermaAwareness @DrAkhilX @IhabFathiSulima @CelestinoGutirr @Urchilla01 @DurgaPrasannaM1

[Ravi Kumar @RheumattDoc]

🦋 Thrombocytopenia: The Early Whisper of Lupus

Isolated thrombocytopenia (ITP-like presentation) is one of the most common hematologic clues that can appear months to years before a formal diagnosis of systemic lupus erythematosus (SLE).

🔍 Why Thrombocytopenia Can Precede SLE

1️⃣ Immune Attack on Platelets

🛡️ Autoantibodies target and destroy platelets → ITP-like picture.

2️⃣ Early Immune Dysregulation

⚠️ Gradual accumulation of ANA and other autoantibodies → evolves into full SLE.

3️⃣ Genetic Predisposition

🧬 Familial or genetic susceptibility may manifest first as isolated thrombocytopenia.

📊 How Common Is Progression?
•2–5% of patients initially diagnosed with isolated ITP eventually develop SLE.

⏱ Progression Timeline
•May occur anytime from 6 months to 5+ years.
•Median: 1–3 years after thrombocytopenia onset.

🔺 Risk Factors for Progression to SLE
•👩 Female sex – significantly higher risk
•🕒 Younger age (<40 years)
•🧪 High-titer ANA (≥1:160) – strongest predictor
•🧬 Presence of additional autoantibodies
•Anti-dsDNA
•Anticardiolipin etc

Clinical features
•Photosensitivity, rash, oral ulcers
•Arthralgia/arthritis
•Hair loss
•Raynaud phenomenon
•Mild leukopenia or lymphopenia

💊 General Management Approach
•💊 Steroids for acute platelet drops
•🌿 Hydroxychloroquine – cornerstone in SLE and beneficial even in early autoimmune phases
•💉 Immunosuppressants (AZA, MMF, etc.) when organ involvement develops

🧭 Prognosis
•Majority do not progress to severe SLE.
•When progression occurs, hematologic and mucocutaneous signs are typically the first SLE features.
•Early identification and monitoring improve long-term outcomes.

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

[Scholarship for PhD @ScholarshipfPhd]

7 Sci-Hub Alternative Websites

Paper you need to ask for payment &amp; can't use sci-hub?

You don't have to pay to read academic papers.

These are 7 sci-hub alternative websites to download papers for free.

[Walter Suárez Carmona @a_fisiolog57853]

ESPECIAL DE LANCET SOBRE ALIMENTOS ULTRAPROCESADOS

¡¡¡A leer, zagales!!!

https://t.co/mPOuS20aQS

Entrada: todos las publicaciones de noviembre

[Aravind Palraj @Rheumat_Aravind]

Ozempic vs Mounjaro — the REAL 2025 comparison.
🧵Thread🔥👇
Everyone is talking about weight-loss drugs. But the REAL showdown is Ozempic vs Mounjaro — and the winner is clear.
Ozempic and Mounjaro should be prescribed ONLY after medical assessment — never self-started.

@DrAkhilX @IhabFathiSulima #MedTwitter #ozempic #mounjaro #weightloss #diabetes