Gurveen soin

Rheumatologist and consultant physician @stellenboschUni, @UCT. interest in ILD complicating CTD/Arthritis. Hockey, rally fan- WRC

[Gurveen soin @guvzsoin]

@0DonaldTrumpJr1 93

[Dr.Mukesh , MD , DM @dr_immuno29]

RA in 2026: inflammation begins before joints swell—but outcomes are often decided in the first 3 months

Pathogenesis
Genetic susceptibility—especially HLA-DRB1—interacts with smoking, periodontitis, lung/gut mucosal inflammation and microbial triggers → protein citrullination → activation of T cells, B cells and plasma cells → ACPA/RF–immune complexes.

Complement and macrophage activation releases TNF, IL-1 and IL-6; fibroblasts, RANKL-driven osteoclasts and chondrocyte MMPs then cause pannus formation, cartilage loss and bone erosion.

📊 Know your CDAI
CDAI = TJC28 + SJC28 + patient global + physician global—no laboratory test required.

▪️ Remission: ≤2.8
▪️ Low activity: >2.8–10
▪️ Moderate: >10–22
▪️ High: >22
▪️ Flare: increase ≥4.5

🎯 Treat-to-target: ≥50% improvement by 3 months; remission/LDA by 6 months.

💊 Start DMARDs ideally within 6 weeks. Escalate MTX to 20–25 mg/week within 4–8 weeks. If used, glucocorticoids should remain low-dose and be withdrawn within 3 months.

🔬 What do the trials show?

▪️ TICORA: monthly measurement + protocol-driven escalation achieved ACR70 in 71% vs 18% with routine care; OR 11.

▪️ NORD-STAR, n=795: CDAI remission at 6 months was 42.7% with MTX + glucocorticoids versus 52.6% certolizumab, 56.3% abatacept and 48.7% tocilizumab, each with MTX.

▪️ Biologic + MTX outperformed biologic monotherapy: ACR70 34% vs 25%; OR 1.82.

▪️ Adding tocilizumab rather than switching from MTX produced 70% vs 55% remission.

⚠️ JAK inhibitors require risk stratification. In ORAL Surveillance, tofacitinib versus TNFi was associated with more MACE: 3.4% vs 2.5% and malignancy excluding NMSC: 4.2% vs 2.9%.

📌 With timely escalation, approximately 80% achieve remission or low disease activity—but the 3-month response remains the strongest predictor of long-term control.

📖 Smolen JS et al. JAMA. 2026
DOI: 10.1001/jama.2026.15455

#RheumatoidArthritis #Rheumatology #TreatToTarget #CDAI #DMARDs #JAMA

[Dr.Mukesh , MD , DM @dr_immuno29]

🩸 OBSTETRIC APS | 2026 UPDATE

OAPS ≠ just placental thrombosis.
Think immunothrombosis → complement + NETs + trophoblast/placental injury.

💊 Treatment
• Criteria OAPS → LDA + prophylactic LMWH
• Prior thrombosis → LDA + therapeutic LMWH
• High-risk → LA+, triple-aPL, prior severe PE/FGR
• Refractory → consider HCQ ± LMWH escalation; IVIG in selected cases

⚠️ Important nuance
LMWH works best-established for classic OAPS/pregnancy loss.
For preventing recurrent PE/FGR/placental insufficiency, RCT evidence is surprisingly thin → only 53 randomized women in a 2026 systematic review.

🔥 What’s new?
IMPACT: certolizumab + LDA/LMWH in high-risk LA+ APS → placenta-mediated adverse outcomes 20% vs ~40% historical expectation. Promising, but single-arm → not standard care yet.

HCQ → growing observational/meta-analytic evidence for ↑ live birth.
Pravastatin → experimental for refractory PE/FGR; not routine.

🎯 2026 shift:
“Anticoagulate everyone” → phenotype + risk-stratified therapy targeting thrombosis AND inflammation.

📚 DOI:
10.1016/j.rpth.2026.103396
10.1016/j.autrev.2026.104013
10.1097/BOR.0000000000001152
10.1136/rmdopen-2025-005825

#ObstetricAPS #APS #Rheumatology #Pregnancy #Autoimmunity

[Dr.Mukesh , MD , DM @dr_immuno29]

🚨 UPDATE 2026 | SSc DIGITAL ULCERS

🔴 ACTIVE ULCER: PDE5i ± IV iloprost
🛡️ PREVENTION: Bosentan prevents new ulcers—it does not heal existing ones
🩹 DON’T NEGLECT THE WOUND: TIME-based care—Tissue, Infection/inflammation, Moisture, Edge
💉 REFRACTORY/SEVERE DU: Botulinum toxin conditionally recommended
⚡ EMERGING: Phase III shock-wave therapy reduced ulcer count by 4.47 vs 0.83 at 8 weeks

📌 Treat early, combine systemic + local therapy—and exclude infection, calcinosis and critical ischaemia.

DOI: 10.1177/23971983251340559 | 10.1177/23971983251339821 | 10.1093/mr/roae104

#SystemicSclerosis #DigitalUlcers #Raynauds #Rheumatology

[Gurveen soin @guvzsoin]

@Rheumat_Aravind Sarcoid
Tb
Malignancy
Rheumatoid arthritis
Hepatitis

[Dr. John Cush @RheumNow]

Gout and its' associated comorbidities - treat gout and its' comorbidities to target
Created by : @Rheumat_aravind

https://t.co/AKT3rAvDBH

[Aravind Palraj @Rheumat_Aravind]

Gout care needs a target—not just fewer symptoms.

GO TEST Overture (n=308): remission during months 18–24 was 39.4% with urate-targeted care vs 24.0% with symptom-driven care.

Treat-to-target improved clinical outcomes, not just a lab result.

#Gout #Rheumatology

[R3 | Rheumatology Rapid Review @BodhibrataB]

⭐ Incretin Based Therapies in Rheumatology

[Aravind Palraj @Rheumat_Aravind]

Psoriatic arthritis: treat the phenotype, not just the joints.

Skin psoriasis → think IL-17 / IL-23 pathways
Uveitis → favor monoclonal anti-TNF
Active IBD → avoid IL-17 inhibition

The dominant domain + extra-musculoskeletal disease should guide therapy.

#PsoriaticArthritis #Rheumatology #Psoriasis #Uveitis #MedEd @DurgaPrasannaM1 @IhabFathiSulima @docakx @Drkhenaizan @ArunInamadar

[Mithu Maheswaranathan, MD @MithuRheum]

🆕 Gout Part 2: In Collaboration with @RheumNow 🔵

Approach to Treatment of Gout:
💊 Acute Treatment Options
💎 Urate Lowering Therapy
🫘 Renal Dose Adjustment for CKD

#Gout #Rheumatology #Rheum #UricAcid

[Aravind Palraj @Rheumat_Aravind]

Hydroxychloroquine eye screening has evolved. 👁️

The 2025 AAO update emphasizes safer dosing, earlier baseline imaging, wide-field retinal assessment, and risk-based follow-up to detect toxicity before irreversible vision loss.

#Hydroxychloroquine #Rheumatology #Ophthalmology #MedEd #MedTwitter @IhabFathiSulima @docakx

[Rheuma Doc @LastManStand85]

#Lupus #SLE Comparison of the Various Nephritis Guidelines 👇👇

[Aravind Palraj @Rheumat_Aravind]

Antiphospholipid Syndrome is not just “start warfarin and follow INR.”

Management depends on:
• Thrombosis type (arterial vs venous)
• Obstetric profile
• Antibody pattern (triple-positive risk)
• Recurrent events

Triple-positive APS → Avoid DOACs
Recurrent arterial events → Consider higher INR target
Catastrophic APS → Anticoagulation + steroids + PLEX + IVIG

APS care is risk-stratified medicine.

#APS #AntiphospholipidSyndrome #Rheumatology #Autoimmune @IhabFathiSulima @docakx

[Aravind Palraj @Rheumat_Aravind]

Perioperative medication management is a common dilemma in rheumatology.

Should methotrexate be stopped before surgery? What about biologics, JAK inhibitors, and steroids?

Key principles:
• Continue most conventional DMARDs
• Hold biologics for one dosing interval before major elective surgery
• Hold JAK inhibitors 3 days before surgery
• Minimize glucocorticoid exposure when possible
• Restart therapy after satisfactory wound healing and absence of infection

A practical, guideline-based summary for daily clinical practice.

#Rheumatology #MedEd @IhabFathiSulima @docakx #PerioperativeMedicine #Immunology #MedicalEducation

[Dr. John Cush @RheumNow]

EULAR26: Reports on Systemic Sclerosis

https://t.co/knZZlMYlen

[American College of Rheumatology @ACRheum]

New! Axial SpA Guideline Summary Just Released

A new ACR clinical practice guideline summary is now available and provides evidence-based and expert guidance for the diagnosis and management of axial spondyloarthritis (axSpA) and associated extra-musculoskeletal manifestations (EMMs) in adults and children and adolescents.

MORE → https://t.co/cz80bz242T

[Aravind Palraj @Rheumat_Aravind]

Platelet-Rich Plasma (PRP) has become one of the most discussed regenerative therapies in musculoskeletal medicine.

PRP is prepared from a patient’s own blood, concentrating platelets and growth factors that may help reduce pain and improve function in selected conditions.

Current evidence supports its use primarily in:
• Mild–moderate knee osteoarthritis
• Lateral epicondylitis
• Plantar fasciitis
• Achilles and patellar tendinopathies
• Rotator cuff tendinopathy

Important reminder: PRP is not a cure, does not reliably regenerate cartilage, and should be viewed as a symptom-modifying therapy rather than a disease-modifying treatment.

Patient selection remains the key to achieving meaningful outcomes.

#PRP #PlateletRichPlasma #Rheumatology #Osteoarthritis #SportsMedicine @IhabFathiSulima #RegenerativeMedicine #MusculoskeletalMedicine #MedicalEducation #ClinicalImmunology #DrAravindPalraj

[Kazuo Matsui @kazuomatsui]

#EULAR2026 HOT Systemic Lupus Erythematosus by George Bertsias教授
・SLEは不均一な疾患である．初期では症状・所見が乏しいことがある．2019EULAR/ACR基準、SLEPRIは、早期発見と診断に有用である.
・HCQ±GCで効果不十分・GC減量困難か、予測されれば、免疫抑制薬・生物学的製剤を考慮する
・GC: 必要があれば使用する. 用量は臓器病変・重症度に基づき柔軟に選択する. 低用量でも毒性があり、≦5mg/dへの減量・中止を推奨する.
・MMF: 中等症・重症SLEで使用する; 2〜4ヶ月で改善→6-12ヶ月で寛解〜40-50%達成が期待できる
・生物学的製剤（BLM, ANI, OBI）: 高い疾患負荷、皮膚病変（IFN阻害薬）、活動性の血清反応、GC長期使用、早期疾患（<2年）、若年患者、バイオマーカー（IFNスコアなど）で考慮する
・T2T: DORIS寛解≧2年、LLDAS≧3年の維持は、新たな臓器障害のリスクを低下させる
・治療の漸減・中止：GC中止によるLN再燃は〜24%, MMF中止で再燃はさらに多い. 突然の中止ではなく、緩徐に漸減・中止する. 生物学的製剤投与下でのデータはまだない.
#SLE #Lupus
https://t.co/k10UpAhqXA
📗EULAR recommendations for the management of SLE: 2023 update
https://t.co/tmTJjuDBiE
📗EULAR recommendations for the management of SLE with kidney involvement: 2025 update
https://t.co/5ayTE3XxeH
📕Lupus or not? SLE Risk Probability Index (SLERPI): a simple, clinician-friendly machine learning-based model to assist the diagnosis of SLE
https://t.co/wqr0uFHEVq
📙Combination of clinical factors predicts successful glucocorticoid withdrawal in SLE: results from a multicentre, retrospective cohort study
https://t.co/LuZq7qpMeh

[Aravind Palraj @Rheumat_Aravind]

Not every ANA-positive patient has lupus.

Many disorders can closely mimic SLE, including Sjögren disease, MCTD, drug-induced lupus, viral infections, adult-onset Still disease, ANCA-associated vasculitis, sarcoidosis, tuberculosis, infective endocarditis, and fibromyalgia.

Recognizing the clues against SLE is just as important as recognizing the clues for it.

Which lupus mimic has challenged you the most in practice?

#Rheumatology #Lupus #SLE #AutoimmuneDisease #MedEd #FOAMed #RheumTwitter #MedTwitter #ClinicalReasoning #InternalMedicine @IhabFathiSulima @docakx

[ILLIASUL IBAD @IlliasulK]

If you remember only 4 lines from the 2026 ACR JIA Guidelines:

1- Poly / non-systemic JIA
MTX → TNFi when escalation is needed

2-Oligoarthritis

IAGC first-line, if feasible
Triamcinolone hexacetonide preferred

3-Systemic JIA
IL-1i / IL-6i FIRST

sJIA with MAS
IL-1i / IL-6i + systemic steroids

4-JIA-uveitis

MTX first; Adalimumab preferred biologic
Severe CAU: start MTX + biologic early

Save before your next clinic. 📌

#JIA #Rheumatology @docakx @IhabFathiSulima