Manal

teacher,doctor,sister,daughter.. proud of every tiny bit that made me who i am

[Roxana González @RoxOsler]

IgG4-RD ➡️ Rare, heterogeneous disease (4 phenotypes; male:female 3:1).
Exclude malignancy, infection and inflammatory mimics before diagnosis. Cancer risk remains uncertain.
Limit cumulative GC exposure; consider baseline whole-body imaging case by case. #ACR26

[Reumatoscience @reumatoscience]

Sjogren’s Disease. Great talk from prof Ghaith Noaiseh, MD, University of Kansas Medical Center
#ACR26

[@DrParagRheum @paragvijay95]

#100DaysOfRheum Day 40 🧪

High uric acid, no gout. Start febuxostat?

18,889 people: even at urate ≥10 mg/dL, 51% stayed gout-free for 15 yrs
CKD-FIX, PERL: no kidney benefit
ALL-HEART: no heart benefit
ACR 2020: conditionally against drugs

Treat gout, not a lab value.

[The Lancet Rheumatology @TheLancetRheum]

🔥Hot off the press for #ACR26 🔥

The @IgG4ward foundation guidelines on the treatment of IgG4-related disease
https://t.co/B3NKHxDKzK
Free to read on https://t.co/gt6JPgLHUG

[Dr hanady manasfi @hanadymanasfi]

Current pharmacologic therapy in #Myositis
#ACR26

[Dr.Mukesh , MD , DM @dr_immuno29]

Before escalating immunosuppression, revisit the prescription.

#ACR26 pearls:

• PPIs → SCLE: often Ro+; latency weeks–years. Avoid class once implicated.

• Dupilumab → enthesitis/arthritis: normal inflammatory markers do not exclude it; withdrawal is not always needed.

• TNFi → sarcoid-like reactions: exclude TB/fungi first.

• DPP-4 inhibitors → disabling arthralgia: may begin years later; class rechallenge can trigger recurrence.

• Intravesical BCG → reactive arthritis: exclude disseminated BCG.

• MTX pneumonitis ≠ RA-ILD: stop for suspected pneumonitis; individualise continuation for joint disease in RA-ILD.

• IgA vasculitis + IBD: disease susceptibility ± TNFi trigger. Check urine.

Timeline. Exclude infection. Reassess after withdrawal.

Credit: Dr Ambreesh Chawla, Cleveland Clinic.

#ACRambassador #Rheumatology #DrugSafety

[Dr.Mukesh , MD , DM @dr_immuno29]

Menopause can mimic a flare. Ask before escalating.

#ACR26 | Hormone therapy in SARDs:

• Stable, aPL-negative SLE: consider for severe vasomotor symptoms after assessing contraindications.

• SELENA: mild–moderate flares ↑34%; no significant rise in severe flares. High-risk aPL/prior thrombosis excluded.

• APS: avoid systemic estrogen—even anticoagulation does not establish safety.

• Vaginal estrogen: may relieve dryness/dyspareunia after lubricant failure; minimal systemic absorption, limited SARD-specific data.

• RA: menopausal symptom and bone benefits; no proven disease-modifying effect.

• Systemic HT contraindicated? Consider nonhormonal options.

Match treatment to symptoms, disease stability and thrombotic risk.

Credit: Prof Karen H. Costenbader

#ACRambassador #Menopause #Lupus #Rheumatology

[Mithu Maheswaranathan, MD @MithuRheum]

🆕 Clinical Year in Review at #ACR26
By Dr. Liana Fraenkel @YaleRheumAller1

💡Review the most impactful #rheum studies and trials from the past year!
❓Any studies you would add to the list?

#RheumX #RheumTwitter #ACR2026

[Dr.Mukesh , MD , DM @dr_immuno29]

Erosions do not always mean inflammation. Sometimes, the clue is hormonal.

Hyperparathyroidism—the metabolic mimic worth remembering at #ACR26.

Six imaging pearls:

• Radial middle-phalangeal subperiosteal resorption: the classic giveaway.
• SI-joint resorption with pseudo-widening: a sacroiliitis mimic.
• Acro-osteolysis: look beyond systemic sclerosis.
• Brown tumours: bone lesions that can masquerade as neoplasia.
• Rugger jersey spine: think renal osteodystrophy and secondary hyperparathyroidism.
• Chondrocalcinosis: remember the association with CPPD.

A bone-health pearl: lumbar-spine DXA may miss the full picture in primary hyperparathyroidism. Remember the distal radius.

Read the image. Check the biochemistry. Reconsider the diagnosis.

Credit: Dr John A. Carrino, HSS.

#ACRAmbassador #Rheumatology #MSKImaging #Hyperparathyroidism

[Yuma Tada @yumatadadatta]

【VEXAS症候群、I型IFN阻害が���たな治療標的に？】

UBA1変異によるVEXAS症候群で、STING–IRF3–I型IFN経路の過剰活性化を確認。��治性皮膚病変を有する患者へのアニフロルマブ投与では、4週以内に皮膚症状が改善。12か月後には皮膚病変が消失し、PSLを20→7mg/日へ減量できた。臨床的な検証は1例であり、有効性は未確立。

📖 Leukemia. 2026.11.5
https://t.co/SDPcGgqPyX

#VEXAS症候群 #Anifrolumab
#朝活インプット

[Aravind Palraj @Rheumat_Aravind]

MRI SI JOINTS: axSpA OR A MIMIC?

Bone marrow oedema ≠ Axial spondyloarthritis!

Three MRI patterns worth recognising:

• axSpA → Subchondral BME ± erosions
• Osteitis condensans ilii → Iliac-sided sclerosis, preserved joint space
• Infection → Extensive oedema, effusion and soft-tissue inflammation

The key? STIR + T1 + lesion distribution.

Never diagnose axSpA from BME alone!

#Rheumatology #AxialSpA #Sacroiliitis #Radiology #MedicalEducation @IhabFathiSulima

[Dr Gurdeep S Dulay @gurdeep_dulay]

#APS in pregnancy

Risk of #APL Ab and adverse outcome
⚠️Strongest risk Lupus Anticoagulant

#ACR26

[Adela Castro @AdelaCastro222]

-Biologic DMARDs are generally safe for pregnancy: ETA and CZP safer compared to others.
-B cell depletion can be used in pregnancy but caution about neonatal cytopenias for first 6m if dosed in 2nd half og pregnancy.
-Counsel on vaccination for biologic exposed babies.
#ACR26 @RheumNow

[Dr.Mukesh , MD , DM @dr_immuno29]

Reproductive health in rheumatology: key takeaways

• Before conception: aim for 3–6 months of disease control on pregnancy-compatible therapy.
• SLE: continue HCQ; low-dose aspirin reduces preeclampsia risk. Monitor at least each trimester.
• Anti-Ro+: fetal cardiac surveillance at 16–26 weeks; HCQ reduces recurrent congenital heart block risk.
• Obstetric APS: aspirin + prophylactic LMWH; thrombotic APS requires therapeutic LMWH.
• Biologics: selected agents can support maternal disease control; placental transfer varies.
• Azathioprine: pregnancy-compatible, but new pruritus warrants assessment for cholestasis.
• Contraception: IUDs offer high efficacy; avoid estrogen-containing methods in aPL+/APS.
• Menopause: assess symptom overlap with rheumatic disease; individualise hormone therapy by disease activity and thrombosis risk.

Discuss reproductive goals routinely.

#ACR26 #ACRAmbassador #Rheumatology #ReproductiveHealth

[Manal @manal5878]

@Baraah33 A good endorsement would have solved that !

[Roxana González @RoxOsler]

#ReviewCourse ACR: Drugs & Pregnancy ➡️ Avoid MTX, leflunomide and mycophenolate. HCQ, sulfasalazine, colchicine and AZA: compatible in pregnancy/lactation.
👁️ AZA Compatible with pregnancy, but linked to cholestasis. Check bile acids if itching; stop if confirmed. #ACR26

[Dr.Mukesh , MD , DM @dr_immuno29]

An abnormal MRI is a finding. The diagnosis still needs context.

Six diagnostic pearls from “Rare Rheumatology Findings” at #ACR26:

• Postpartum SI-joint marrow oedema can mimic inflammatory sacroiliitis. MRI positivity alone does not establish axial SpA.

• SAPHO: anterior chest-wall involvement + contiguous thoracic vertebral osteitis, often with disc sparing.

• Sarcoid dactylitis: lace-like phalangeal osteolysis, typically without periosteal reaction.

• Acute neck pain + odynophagia: calcification anterior to C1–C2 with prevertebral oedema suggests longus colli calcific tendinitis. Around/behind the dens? Consider crowned dens syndrome.

• A huge knee effusion with surprisingly little pain, a Baker’s cyst and popliteal nodes: consider Lyme arthritis when exposure and geography fit.

• “Tophaceous pseudogout” at the TMJ may represent an FN1-fusion–associated calcified chondroid mesenchymal neoplasm.

The most useful imaging clue may be the one that makes you reconsider your first diagnosis.

Which mimic have you encountered?

Credit: Dr Mohamed Jarraya, MGH/Harvard.
#ACRAmbassador #Rheumatology #MSKImaging

[Manal @manal5878]

@2ttttj النادي مختلط ؟ 🫤

[Manal @manal5878]

@adir_13 @ifra772 مادري شلون اشرح لك بس فعليا اللي راكب وضعية سكوات مع شد الكور مستمرة مو مستسلم و جالس بالعكس رافع نفسه ! لا تقارنه بالجلوس والمشي لانه فعليا كانك تقارن wall sit بالجلسة علي كرسي و تقول نفس الشي

[@DrParagRheum @paragvijay95]

Day 15 #100DaysOfRheum 🔬
IgG4-RD or Erdheim–Chester? Both can involve the orbit and retroperitoneum.
🇮🇳 Indian IgG4-RD series (n=70): orbit 53%
🦴 ECD: long bones >95%, BRAF V600E ~50%
🧪 IgG4 can be high in ECD too.
No steroid response? Image the legs.
#IgG4RD #Rheumatology