Benjamin Cheah MD 🇲🇾

Consultant Physician & Rheumatologist, Pantai Hospital KL, @MedicineMsia @rheumatologymy @HackingHealthKL 🇲🇾

[Alberto Giraldo @alb_giraldo]

A serum #IgG4 cut off level of 135 mg/dl has been incorporated into the original Comprehensive Diagnostic criteria as well as the 2020 Revised Comprehensive Diagnostic criteria for IgG4-related disease (IgG4-RD). However, although elevated serum IgG4 levels are commonly observed in IgG4-RD and serve as a useful supportive marker, but they are not a gold standard for diagnosis due to variable performance (sensitivity 51-80%, specificity 60%).

In addition to traditional #biomarkers like serum IgG4 levels and characteristic histology, several novel indicators —including IgG2, serum soluble IL-2 receptor (sIL-2R), and CCL18— can help diagnose IgG4-RD more accurately and predict treatment response by reflecting inflammation and fibrosis. Ongoing research is focused on identifying specific autoantigens and exploring new potential biomarkers, such as various serological and histopathological immune cells (macrophages, mast cells, T and B cell subsets, and pathways like I-IFN/IL-33).

Due to the frequent multi-organ involvement in IgG4-RD, non-invasive PET-CT imaging is also valuable for improving diagnosis and differential diagnosis.

*Adapted from: Umehara H, Okazaki K, Kawa S, et al. The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. Mod Rheumatol. 2021;31(3):529-533.
🔗https://t.co/7WMTpGNzHX

[Aravind Palraj @Rheumat_Aravind]

Idiopathic Inflammatory Myopathies made simple 🔥

Autoantibodies are not just diagnostic — they define the disease.

🧵 Key patterns you must know:

• MDA5 → Rapidly progressive ILD (high mortality)
• TIF1-γ → Malignancy (adult DM)
• HMGCR → Statin-associated necrotizing myopathy
• SRP → Severe myopathy + cardiac involvement
• Jo-1 → Classic antisynthetase syndrome

Clinical mapping = exam gold:

ILD dominant → PL-7, PL-12, MDA5
Cancer → TIF1-γ, NXP2
Good prognosis DM → Mi-2

⚠️ ANA can be negative (cytoplasmic staining)

Negative ANA ≠ No myositis

This is precision rheumatology in practice.

#Rheumatology #Myositis #Dermatomyositis #Pulmonology @DrAkhilX @IhabFathiSulima #MedTwitter #NEETPG #INI #MRCP

[Dr. John Cush @RheumNow]

SMART study - Single vs. Split Dose Methotrexate in RA

Split dose weekly, oral methotrexate (MTX) was shown to be superior to single dose MTX in treating active rheumatoid arthritis (RA) patients.

https://t.co/JN5wPGNjao

[Rheuma Doc @LastManStand85]

Reproductive health guidelines
[Cuoghi Edens]
➡️TNFi safe in pregnancy & BF no need for “certolizumab switch” and risk flares
➡️RXB: Dose pre-conception or 1st trimester to minimise fetal exposure
➡️ Stop NSAIDS after 28 wks
➡️ NO Paracetamol link to autism/ADHD
#Rheumatology

[Benjamin Cheah MD 🇲🇾 @techeah]

Catching @XBaraliakos on his whirlwind tour of Asia talking biosimilars in axial SpA. @SandozGlobal

[ERM @Owner_X429]

Osteoporosis medical treatments

[Dr Ai Lyn Tan @DrAiLynTan]

CAR-T cell therapy

▶️New concept of immune reset potentially leading to cure of autoimmune diseases

via Prof Schett #EULAR2025

[Lupus Hub @lupus_hub]

CONGRESS | #EULAR2025 | PRESENTATION
Saira Sheikh, @UNC, presented results from the ongoing phase I/II RESET-SLE trial (NCT06121297) evaluating the safety and efficacy of rese-cel (resecabtagene autoleucel), a fully human, autologous 4-1BB, anti-CD19 CAR T-cell therapy, in non-renal #SLE and #lupus nephritis (N=8). As of June 2, 2025, rese-cel was well tolerated, with low grade CRS reported in 2 patients and ICANS in 1. DORIS was achieved in 3 of 4 patients with SLE, and the first patient with LN achieved CRR.

Follow our live feed for more updates: https://t.co/fJPOBGgKlP
#RheumTwitter #MedEd #MedicalCongress

[Matteo Piga @RMD_clinic]

🔴 NEW EULAR recommendations for #SLE with #kidney involvment (2025)!

➡️ early biopsy
➡️ early combination
➡️ non immune treatment

#EULAR2025

[Dr. Dinesh Khanna @sclerodermaUM]

Excited to present WIN #scleroderma #eular2025. This slide highlights the opportunities in drug development in SSc. Come and join on Saturday 6/14 at 9 AM CET.

[Dr hanady manasfi @hanadymanasfi]

APS classification criteria
#EULAR2025

[Benjamin Cheah MD 🇲🇾 @techeah]

The results appear revolutionary! Drug free in refractory cases! Wow! The side effects appear to be minimal despite needed lymphodepletion?

#EULAR2025

[Omar Dhrif @Rupee_Indipexy]

🧵[1/2] Dr Georg Schett follow up of 🚗 CAR-T cell therapy pilot cohort

⚡️Now 50 patients under treatment,

⚡️Longest follow up of nearly 5 years ➡️ 72 patients year

⚡️92% remission 96% off drugs 2 relapses

#EULAR2025 @eular_org

[Dott. Simone Parisi @Sim_Orizon]

🚨 Mind-blowing insights from Georg Schett at #EULAR2025:
CAR-T in autoimmune diseases is no longer experimental — it’s revolutionizing care.
✅ Immune reset → drug-free remission
✅ Efficacy in highly-resistant AID
✅ Allogenic & “armed” #CAR_T moving fast into clinics

[Dr. John Cush @RheumNow]

Biologics in Pregnancy Patients With Autoimmune Disease

A large cohort, claims data study shows that among pregnant women receiving biologic therapies for autoimmune conditions, 72% continued their biologics pregnancy, more so among inflammatory bowel disease (IBD) patients than those with rheumatoid arthritis (RA), psoriasis (PsO) or psoriatic arthritis (PsA).

https://t.co/kuAa8i0P3b

[Benjamin Cheah MD 🇲🇾 @techeah]

Did the US just exploit the war in Ukraine for its own means through this minerals deal?

#Ukraine #UkraineWar

https://t.co/vlm34muzX5

[Benjamin Cheah MD 🇲🇾 @techeah]

Often a topic of discussion in rheumatologist consultations. “Does stress cause or worsens autoimmunity?” It is almost impossible to measure stress. I often would focus on stress management techniques as no one can truly remove stress.

https://t.co/hydUuC3yiL

[Antoni Chan MD (Prof) @synovialjoints]

Treatment of rheumatologic complications (inflammatory arthritis, polymyalgia rheumatica and myositis/myalgia) from immune checkpoint inhibitors. Review by Cappelli LC et al

https://t.co/w4LRoe58BR

[Autoinmunes Medicina Interna Parc Taulí @autoinMI_tauli]

Late-onset Systemic Lupus Erythematosus

⏩Lo-SLE is a spectrum that behaves differently .
⏩ Though major organ involvement in the form of nephritis is less common, damage accrual over the years is greater.

https://t.co/9UWApvxId1

[Benjamin Cheah MD 🇲🇾 @techeah]

The process of ensuring that patients with uncontrolled #epilepsy aren’t allowed to drive is shrouded in uncertainty in Malaysia. There is no way of enforcing and solely based on one’s prudence.

https://t.co/Ix0IL4jj12

[Benjamin Cheah MD 🇲🇾 @techeah]

Suzetrigine may offer great value for rheumatologists as well in managing #pain

https://t.co/0kphhavwZ0