Rosa Elena Salazar

Reumatología-Medicina Interna

[Autoinmunes Medicina Interna Parc Taulí @autoinMI_tauli]

Repurposing leflunomide and hydroxychloroquine to treat Sjögren's disease (RepurpSS-II): a randomised, double-blind, placebo-controlled, phase 2b trial

⏩reduced systemic Sjögren’s disease activity vs placebo at 24 weeks (ESSDAI difference −4.16)

https://t.co/LCQ79SEF6N

[NatRevRheumatol @NatRevRheumatol]

New content online: Navigating evidence-based recommendations for the management of systemic sclerosis https://t.co/04Tyyd1nF5

[Ravi Kumar @RheumattDoc]

“Doctor, I have rheumatoid arthritis, but only one joint is involved. Everything I read online says RA affects many joints. Is my diagnosis wrong?”

The answer is No.

RA is a heterogeneous disease and doesn’t always present as classical symmetric polyarthritis.

What questions do patients with Rheumatoid Arthritis ask you ???

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

[Aravind Palraj @Rheumat_Aravind]

VASCULITIS MIMICS

Not every purpura is vasculitis.

Before labeling a patient as having primary vasculitis and initiating immunosuppression, consider important mimics such as infective endocarditis, cholesterol embolization syndrome, antiphospholipid syndrome, thrombotic microangiopathy, calciphylaxis, atrial myxoma, fibromuscular dysplasia, levamisole-associated vasculopathy, septic emboli, and malignancy-associated vasculitis-like syndromes.

Recognizing the red flags can prevent diagnostic errors, unnecessary immunosuppression, and potentially life-threatening consequences.

Which vasculitis mimic have you found most challenging in clinical practice?

Infographic by Dr. Aravind Palraj

#Rheumatology #Vasculitis #ANCA #MedicalEducation #MedEd #FOAMed #InternalMedicine #Nephrology #ClinicalReasoning @IhabFathiSulima @docakx #AutoimmuneDisease #MedTwitter #RheumTwitter #MedX #Medicine #MedEdCommunity

[Aravind Palraj @Rheumat_Aravind]

Not every sacroiliitis is #SpA.

Before diagnosing axial spondyloarthritis, consider important mimics such as osteitis condensans ilii, infectious sacroiliitis, TB sacroiliitis, DISH, fibromyalgia, crystal arthropathies, oxalosis, SAPHO syndrome, and hyperparathyroidism.

Recognizing red flags can prevent misdiagnosis and inappropriate treatment.

#Rheumatology #AxialSpA #Sacroiliitis #MedEd #FOAMed #MedTwitter #RheumTwitter #InternalMedicine @IhabFathiSulima @docakx

[ACR_Journals @ACR_Journals]

Inosine-triphosphate-pyrophosphatase activity may predict methotrexate response in juvenile idiopathic arthritis, highlighting its potential for personalized treatment strategies

Arthritis & Rheumatology
https://t.co/Hbq7O9iWOo

[The Nobel Prize @NobelPrize]

Venezuelan artist Danny Ocean performs "Alma Llanera" during the 2025 Nobel Peace Prize award ceremony in Oslo City Hall.

The beloved Venezuelan song "Alma Llanera" ("Soul of the Plains") was created over a hundred years ago by Venezuelan musicians Pedro Elías Gutiérrez (composer) and Rafael Bolívar Coronado (lyricist) and is considered the country's unofficial second national anthem.

The 2025 Nobel Peace Prize is awarded to Maria Corina Machado “for her tireless work promoting democratic rights for the people of Venezuela and for her struggle to achieve a just and peaceful transition from dictatorship to democracy”

[NEJM @NEJM]

18C010 phase 3 trial: Patients with systemic lupus erythematosus need more effective and safer therapies than those currently available. Research findings on the dual cytokine inhibitor telitacicept are summarized in a new Quick Take video. https://t.co/seyyiEtSa1

[Dr.Mukesh , MD , DM @dr_immuno29]

•🎤 Highlight: Stellar DADA2 talk by Dr. Pui Y Lee at Vasculitis Conclave!
•🎯 DADA2: Top monogenic autoinflammatory disease, driven by ADA2 (CECR1) variants on 22q11—wild symptoms!
•🩺 Symptoms: Inflammation, fever, livedo racemosa, strokes, vasculitis, bone marrow failure, immunodeficiency.
•🧬 Dx: WES/targeted sequencing (>150 mutations, p.G47R in India) + plasma ADA2 assay (cut-off 1 U/L: 90% undetectable, 89% sens, 100% spec; 2 U/L: 96% sens, 98.8% spec vs carriers).
•📊 Milestones: CECR1 (2014), vasculitis ID (2014), phenotype expanded (2016-21), ICD10 (2019), consensus (2023).
•🌍 Prevalence: Est. 1/222K, >35K cases worldwide; uses gnomAD; resolves VUS.
•⏰ Testing: Start enzyme screening, confirm genetically, screen siblings.
•🔗 Genotype-Phenotype: Mutations link to vasculitis, PRCA, BMF; residual ADA2 from hypomorphic variants.
•💊 Therapy: Anti-TNF (e.g., etanercept) shines—0 strokes in 733 post-tx vs. 37 pre-tx (Ombrello et al, NEJM 2019); HSCT for severe cases. No luck with steroids, DMARDs, cyclophosphamide, anti-IL-1/6. Sharma et al (2020) notes varied PAN features with residual activity.
•🧪 Research: ADA2 replacement, gene therapy trials; early Dx, personalized Rx (2025).
•⏳ Future: Early Dx key, therapies in pipeline, global collab needed!
•🌐 Awareness: Boost DADA2 visibility; educate docs/patients; support groups vital now!
•📜 Consensus: International guide supports Dx/management.
#DADA2 #RareDisease #VasculitisConclave #MedicalResearch #Genetics #Health

[ACR_Journals @ACR_Journals]

A 79 y/o man with an 8-month history of VEXAS, with myelodysplastic syndrome, presented with acute-onset fever, bilateral anterior nodular scleritis, and a pustular skin rash. Exam showed large, widespread, non-follicular pustules

Clinical images in A&R
https://t.co/Y3nXy20Yxd

Captions:
Large, widespread, non-follicular pustules were observed (A and B). Skin biopsies from two separate lesions revealed a dense neutrophilic infiltrate in the superficial dermis containing poorly differentiated neutrophils similar to band neutrophils and prominent leukocytoclasia, with no evidence of vasculitis (C, D, and E)

[Dr. John Cush @RheumNow]

FDA Approves 1st new Fibromyalgia drug in 15 yrs - Tonmya (cyclobenzaprine HCl sublingual) as treatment of fibromyalgia in adults. Based on 2 phase 3 trials and 1400+ pts. Dose 2.8 mg tabs 1-2 SL qhs (peak concentration 4.3 hours; t1/2 life = 36 hrs, longer w/ elderly, liver dz) https://t.co/3HEB94TrYL https://t.co/mGTIDsIGvd

[Aravind Palraj @Rheumat_Aravind]

🧵 Hematological Manifestations in Autoimmune Diseases—2025 Clinical Update
1/ Blood disorders are common in autoimmune diseases and may be the first clue. Timely recognition can be lifesaving. Here’s a crisp clinical thread every practitioner should bookmark.
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @HematologyAdv @EHA_Hematology #MedTwitter #Rheumatology

[Dr. John Cush @RheumNow]

2025 ACR Guidance on Diagnosis and Management of VEXAS

The ACR has published a formal international consensus guidance on VEXAS as a resource for clinicians seeking to understand the disease and its management.
https://t.co/KoNjOiKdTq

[Lupus Hub @lupus_hub]

📝 The 2025 ACR guidelines published in @ACRheum recommend minimizing glucocorticoid exposure in patients with stable SLE by tapering prednisone from ≥5 mg/day to ≤5 mg/day within 6 months.

More news: https://t.co/IasX80R2wj

#lupus #SLE #MedNews #MedEd

[Aravind Palraj @Rheumat_Aravind]

🧵 MMF in 2025: Still the Lymphocyte Whisperer

1️⃣
💊 Mycophenolate mofetil (MMF) remains a backbone immunosuppressant in lupus nephritis, ILD, and more.
But in 2025, its story has evolved — from better combos to smarter uses.
Let’s unpack the latest. 👇

@IhabFathiSulima @drkeithsiau @DrAkhilX #MedTwitter

[ClinRheumatol @ClinRheumatol]

🔥NEW🔥
Refractory #PsoriaticArthritis: emerging concepts in whole process management 👉https://t.co/AYpikomcBd
📌Phases of #PsA development and strategies for prevention 👇

[Dr. Chokri Ben Lamine @abouabdrahman0]

🧵 Approach to Hyperferritinemia
(Serum ferritin >200 ng/mL ♀ or >300 ng/mL ♂)

🔹 Step 1: Check transferrin saturation (TSAT)

If TSAT >45%
👉 Check for risk factors: 🇪🇺 European ancestry, FHx
👉 Do HFE genetic testing
— If homozygous/compound heterozygous (C282Y, H63D, S65C) ➡️ 📌 Hereditary Hemochromatosis (HH)
— ⬇️ Proceed with MRI T2* ± Liver biopsy

🧬 If no HFE mutation → consider non-HFE HH, do further genomic testing
— MRI T2* ± Elastography / Biopsy

🔹 Step 2: If TSAT <45%
🛑 Rule out common causes:
• 🍺 Alcohol
• 🦠 Infections
• 🦾 Metabolic syndrome
• 🧬 Autoimmune disease
• 🧫 Cancer
• 🧠 MAFLD

👉 Treat cause ➕ Recheck ferritin
— If persistently high: do Liver MRI T2*

🔍 If no cause identified:
➡️ Evaluate for secondary iron overload:
• 🩸 Repeated transfusions
• 💉 Iron therapy
• ♻️ Hemodialysis
• 💥 Hemolysis
• 🧪 Hem disorders (e.g. thalassemia)
• 🧬 Rare genetic causes

🧠 Pearls:
• Liver enzymes↑, DM, arthritis, cirrhosis may guide toward iron overload
• MRI T2* is a key non-invasive tool

🧵 Credits: Dr. Mohammed Alshahrani
#Hematology #Liver #IronOverload #Ferritin #Hemochromatosis

[NEJM @NEJM]

Juvenile idiopathic arthritis (JIA) encompasses a group of pediatric inflammatory arthritides that includes oligoarticular JIA, polyarticular JIA, systemic JIA, psoriatic JIA, and enthesitis-related arthritis.

Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used to relieve musculoskeletal pain, but most patients require treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs), biologic DMARDs, newer targeted synthetic DMARDs, or a combination of DMARDs for disease control. Systemic glucocorticoids are generally avoided except as bridging therapy during the initiation of DMARD therapy in patients with severe JIA.

On the basis of mechanistic studies, new treatment strategies aim to induce early control and sustained suppression of inflammation in order to prevent additional joint involvement, joint damage, nonarticular complications, and disease flares. Tumor necrosis factor (TNF) inhibitors were the first biologic DMARDs shown to decrease disease activity in most JIA categories. More targeted therapies, such as interleukin-1 and interleukin-6 inhibitors for systemic JIA and interleukin-17 inhibitors for enthesitis-related arthritis, have been developed on the basis of the distinctive pathogenesis of each JIA category (Fig. 1, seen here).

Learn more in new Review Article: https://t.co/MV2pQhJVkl

[NatRevRheumatol @NatRevRheumatol]

New content online: Platelets as drivers of immunothrombosis in rheumatic diseases https://t.co/OTQlLc88RY

[JAMA @JAMA_current]

Immune thrombotic thrombocytopenic purpura (iTTP) is a rare immune-mediated disorder characterized by thrombocytopenia and microangiopathic hemolytic anemia, potentially causing life-threatening thrombosis.

Learn more in this Review.

https://t.co/F00poB9sgC