Manikandan G

Rheumatologist and Immunologist @CMC vellore.

MD Internal Medicine@PGI chandigarh

[Rheuma Doc @LastManStand85]

A Good Read👇📖 #Fibromyalgia #ChronicPain
https://t.co/IaEYhUium0

[NEJM @NEJM]

Among patients with multivessel coronary artery disease who were in stable condition 1 year after stenting, an additional year of DAPT led to a lower risk of ischemic events than aspirin alone, without increased bleeding. Full DAPT-MVD trial results: https://t.co/iHRM4Gv3ND

Editorial: Balancing the Scales — Extended DAPT in Coronary Artery Disease https://t.co/Nxqwkd4Trr

[jpedrokessner @KessnerJp]

Pulmonary Hypertension associated with Interstitial Lung Disease.
@ERSpublications a state-of-the-art review.
🫁😨❤️‍🩹🫀✍️🏻📚
@EuroRespSoc @ALATorax @SeparRespira @NeumoMadrid @Neumosur @socapnet @pneumosbpt @neumoparatodos @HUReinaSofia
https://t.co/LiIkKlG9RD

[Dr Abhilasha Manwatkar (AIIMS Nagpur) @Abhilasha21822]

Clues:
🖤 Urine darkens on standing
👂 Bluish-black ear cartilage
👁️ Scleral pigmentation
🦴 Early degenerative arthropathy

Dark urine. Black cartilage. Early joint replacement.

Alkaptonuria is rare but easy to pick if you see d clues…

[Dr. John Cush @RheumNow]

SELECT-Axis 2 trial and Withdrawal of Upadacitinib - Of 734 pts, 194 were in remission at wk104--> UPA w/d & 22% maintained drug-free remission for >48wks. Rest flared, median time to flare: 3.1 mos (89% regained LDA by wk24 w/ restart) #EULAR2026 #axSpA POS1350

[Abhishek G P @Abhishek_joints]

🚨 New Publication Alert!

Our 30-year cohort study on SSc Renal Crisis.

Takeaways:
✔️ Prior steroid exposure was strongly associated with SRC
✔️ Older age & pitting scars identify patients at risk
✔️ Immunosuppressants may reduce SRC risk

[NEJM @NEJM]

Presented at #EULAR2026:

Among patients with relapsed polymyalgia rheumatica, treatment with secukinumab plus a 24-week glucocorticoid taper resulted in a higher percentage of patients with remission than a glucocorticoid taper alone. Full phase 3 REPLENISH trial results: https://t.co/w1oD5ug1kJ

Editorial: Emerging Era for Polymyalgia Rheumatica and GCA — Interleukin-17A Targeting https://t.co/I13JtK01EA

Original Article in @NEJMEvidence: Secukinumab for Giant Cell Arteritis (phase 3 GCAptAIN trial) https://t.co/0dWjwDaEHs

@eular_org

[NatRevRheumatol @NatRevRheumatol]

New content online: Type I interferon mediates autoimmune photosensitivity https://t.co/DiiGFmS55D

[Dr Abhilasha Manwatkar (AIIMS Nagpur) @Abhilasha21822]

“ROPE sign” in RA?

Why is a head-to-toe examination important in rheumatoid arthritis?

Patient presented with:
• Erythematous to violaceous papules or plaques
• Truncal and proximal limb involvement

Histology :
CD68+ macrophage-rich interstitial infiltrates surrounding degenerated collagen bundles without vasculitis or mucin deposition.

imp: Interstitial granulomatous dermatitis (IGD).

But where is the Rope ??
Linear subcutaneous “rope sign” lesions ,,,seen in only around 10% of cases •
Occasionally, perforation with extrusion of necrobiotic collagen

But here is the important part:
IGD is NOT exclusive to RA.

It can also be associated with:
• Other autoimmune diseases
• Arthralgia syndromes
• Drug reactions
• Even underlying malignancy

Important differentials include:
• Granuloma annulare
• Necrobiosis lipoidica
• Granulomatous slack skin
• Interstitial granulomatous drug reaction

[Durga Prasanna Misra @DurgaPrasannaM1]

I am delighted to present to all of you the June 2026 issue of the Indian Journal of Rheumatology. Request you all to read and circulate the issue amongst your peers, and to please cite relevant articles from the journal in your own papers. @IJRheum @IndianRheum @abledoc @Amansharmapgi @kunalchandwar @drssjagtap @UpendraRathore_ @DrPradeepta @jainavinash
The issue is available at https://t.co/Cg0J6vN71B

[NatRevRheumatol @NatRevRheumatol]

New content online: Treatment strategies in giant cell arteritis and polymyalgia rheumatica: beyond glucocorticoids https://t.co/b73BXXezcS

[Dr. John Cush @RheumNow]

Another IL-17A inhibitor (Vunakizumab) for active Ankylosing Spondylitis

Vunakizumab, a novel anti–interleukin (IL) 17A monoclonal antibody, was studied in patients with active radiographic axial spondyloarthritis [r-axSpA] and found to be effective and tolerable.

https://t.co/6sobyIgrei

[The Lancet Rheumatology @TheLancetRheum]

NEW RESEARCH—Efficacy and safety of enpatoran, a Toll-like receptor 7/8 inhibitor, in patients with skin manifestations of cutaneous lupus erythematosus or systemic lupus erythematosus: findings from Cohort A of a phase 2 trial https://t.co/kcBDWH0vuc #WorldLupusDay

[Dr. John Cush @RheumNow]

24 systemic amyloidosis pts (AA type 46%, AL 29%); 62% joint pain & AM stiff, axial 37.5%, macroglossia (4 pts, 17%), carpal tunnel (12%), proteinuria > 1 gm 50%, CKD 21%, Cardiac amyloid 29%. Amyloid was secondary to Rheum Dx in 11/24. Better survival w/ AA than AL (91% vs 14.3%) https://t.co/B87zmXc1u7

[Anant Bhan @AnantBhan]

The Lancet in its latest issue (02 May 2026) profiled Dr Amita Aggarwal, who has been an inspiring clinician, academic, and researcher in the field of autoimmune rheumatic diseases- through her stellar work @SGPGI & in her current role as Executive Director @AiimsBibinagar

[Dr Abhilasha Manwatkar (AIIMS Nagpur) @Abhilasha21822]

Interphalangeal (IP) joint injections .

A valuable office-based procedure in rheumatology for rapid relief of pain, swelling, and stiffness in inflammatory arthritis.

Key technical points:
• Identify the joint line by gentle flexion–extension
• Use a superolateral approach to avoid the neurovascular bundle
• Confirm intra-articular placement — patient often feels joint distension
• Never inject against resistance
• Small volume, precise placement matters more than force

Pearls:
✔️ Know the anatomy before the needle enters
✔️ Stabilize the finger well
✔️ Use fine-gauge needles for comfort and precision
✔️ Ultrasound guidance can improve accuracy in difficult joints

[Manikandan G @GmkTkmc]

@Amansharmapgi @pgichd @dpgi_chandigarh @raja_1980 @drsuniltaneja @drvishal82 @DurgaPrasannaM1 @VasculitisUK @dada2foundation @IndianRheum @vascuk Congratulations 🎊 sir

[Manikandan G @GmkTkmc]

Don’t ignore the signs.
Early diagnosis by a Rheumatologist can change everything — there are over 100 types!

[ACR_Journals @ACR_Journals]

Whole-exome seq study of 174 patients with SLE treated with glucocorticoids identified heterozygous variants in ANK1 and EPB41, associated with higher risk of steroid-induced osteonecrosis of the femoral head

Arthritis & Rheumatology
https://t.co/AJNfDkKywS

[ACR_Journals @ACR_Journals]

Editorial in A&R: Interferon with Still Disease and the Treatment Conundrum

By exploring the role for IFN-I in SD and SD-LD, Ombrello and colleagues have advanced the science/knowledge for this rare condition. While many of the correlations were made using a single timepoint analysis of ISG-28 scores in largely refractory SD patients, the genetic underpinnings support a role for IFN-I in a subset of SD individuals

https://t.co/L4gYSxev8L