Jijith krishnan @jijithedu

#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 my-congress.eular.org/programme/pres… 📗EULAR recommendations for the management of SLE: 2023 update pubmed.ncbi.nlm.nih.gov/37827694/ 📗EULAR recommendations for the management of SLE with kidney involvement: 2025 update pubmed.ncbi.nlm.nih.gov/41107121/ 📕Lupus or not? SLE Risk Probability Index (SLERPI): a simple, clinician-friendly machine learning-based model to assist the diagnosis of SLE pubmed.ncbi.nlm.nih.gov/33568388/ 📙Combination of clinical factors predicts successful glucocorticoid withdrawal in SLE: results from a multicentre, retrospective cohort study pubmed.ncbi.nlm.nih.gov/39762120/

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#EULAR2026 HOT Systemic sclerosis by Oliver Distler教授 ・臓器障害に基づいた治療アプローチが基本 ・SSc-ILD 最もエビデンスが"豊富": SLS II, SENSCIS, focuSSced ・GCは腎クリーゼ・リスクのため使用しない ・治療選択のためのバイオマーカーはまだない ・新規治療：FIBRONEER-ILD試験：Nerandomilast (PDE4阻害薬) 52週時FVC変化↓, 自己免疫性ILDで死亡リスク↓ #SSc my-congress.eular.org/programme/pres… 📗EULAR recommendations for the treatment of systemic sclerosis: 2023 update pubmed.ncbi.nlm.nih.gov/39874231/ 📗2026 ERS/EULAR clinical practice guidelines for CTD-ILD pubmed.ncbi.nlm.nih.gov/40912974/

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ApoB reflects “how many bullets are in the gun”, while Lp(a) indicates “how sharp and sticky the bullets are”. Both contribute to atherosclerosis, but through overlapping yet mechanistically distinct pathways: - ApoB drives lipid deposition - Lp(a) combines lipid deposition with thrombogenic potential.

🧬 Can you predict the cytogenetics before the FISH returns? After seeing thousands of myeloma patients, certain morphology and clinical phenotypes start to become familiar. Myeloma often whispers its biology before the genomic report arrives. More to see in the figure 👇 #myeloma #hemetwitter

A.Fib Note 📝

SEIZURE

¿ Hipotensión Ortostática en los pacientes crónicos y pluripatológicos ? 🩺 No se trata de "subir la presión", sino de prevenir caídas y mejorar síntomas. Gracias por compartir @FormigaFrancesc 👇🧵 doi:10.1001/jamainternmed.2026.0284 @IcyfaSemi @GT_Pluri_SEMI @semeg_es @seggeriatria @SEFRAOS_ @SENefrologia @SLANH_ @PerlaZambrano @FaustoHerediaDr @tavonavarro

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#antisynthetase #EULAR/ACR #classification #criteria #EULAR2026 @RheumNow Based on >2k pts Probable v definite Ignore low + #synthetase #antibodies Seems reasonable and applicable ➡️my opinion

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Familial Mediterranean Fever (FMF).

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Why You Have Pain In Your KNEE When You Climb Stairs Or Bend Your KNEE is fine when you walk on flat ground… But the moment you want to climb stairs, squat to pick something, or kneel down. SHARP PAIN. It feels like something is grinding, or giving way, or like a stone is inside. When you stand straight again, the pain disappears. People say: “Ah! It is rheumatism” or “Your bone is getting weak” or “You have old age pain.” You rub oil, take calcium, but it still pains you whenever you bend. 👉IT IS NOT JUST OLD AGE. IT IS THE CARTILAGE UNDER YOUR KNEECAP GETTING IRRITATED. Here is exactly what it is and how to fix it. 👇🏻 ✅ WHAT IS INSIDE YOUR KNEE?👇🏻 Your kneecap sits in a groove at the front of your thigh bone. Between them is smooth, slippery cushion called CARTILAGE which is like rubber or shock absorber. It lets your knee bend smoothly without grinding. ✅ WHAT GOES WRONG:👇🏻 When you stand or walk flat, your weight is light. When you bend, squat, or climb stairs, the pressure becomes 3 to 5 times your body weight. If the cartilage is rough, soft, or out of place, it rubs hard against the bone. That is the PAIN. 👉✅ NAME: It is called PATELLOFEMORAL PAIN SYNDROME. Which is very common. ✅ WHY IT HAPPENS:👇🏻 1. WEAK THIGH MUSCLES This is the #1 CAUSE. Your thigh muscle holds the kneecap in place. If it is weak, the kneecap pulls to one side and rubs. This happens even in young people 2. TOO MUCH KNEELING OR SQUATTING: Gardeners, traders, or housewives doing it everyday wears the cushion down. 3. FLAT FEET: Your foot shape changes how pressure falls on the knee. 4. WEIGHT: Extra weight adds extra pressure every time you bend. ✅ HOW TO KNOW IT IS NOT ARTHRITIS:👇🏻 1. THIS ONE: Only when bending or climbing. No pain resting. No swelling. 2. ARTHRITIS: There is Pain even you are resting, it is stiff in the morning, and swollen, it hurts in all positions. ❌ WRONG TREATMENT:👇🏻 1. RUBBING THE KNEECAP HARD: It Makes the irritation worse. 2. AVOIDING ALL MOVEMENT: It Makes your muscle weaker, problem worse. 3. CALCIUM ONLY: Calcium builds bone, does not fix the cushion or muscle. ✅ THE REAL CURE IS FOR YOU TO STRENGTHEN YOUR THIGHS. Do these simple exercises daily and no equipment needed:👇🏻 1. STRAIGHT LEG RAISE: Sit on a chair, straighten one leg, hold 5 seconds, lower slowly. 20 times per leg. It Builds strength without bending. 2. CLAMSHELL: Lie on side, knees together bent. Lift top knee like opening shell. 20 times. It Keeps the kneecap aligned. 3. REDUCE HIGH IMPACT: Stop deep squats, kneeling, jumping until it heals. Use rail when climbing the stairs. ✅ TIME: Do this for 4–6 weeks, You will notice big change. 👉KNEE pain when bending is a weak Muscle and Cushion, not old age. 👉 Strengthen your THIGHS

🧬 Obexelimab: A New Way to Control B Cells Unlike rituximab, which removes B cells, obexelimab functionally silences them by co-engaging CD19 and the inhibitory receptor FcγRIIB (CD32B). 🔹 Inhibits B-cell activation 🔹 Reduces plasmablast formation 🔹 Decreases antibody production 🔹 Suppresses inflammatory cytokines 🔹 Minimal B-cell depletion Obexelimab turns B cells “OFF” rather than wiping them out, potentially preserving immune function while controlling autoimmune disease. #RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

EULAR/ACR Classification Criteria for Anti-Synthetase Syndrome [2025] ✅ Definite total score >5.5 + atleast 1 clinical domain + anti-ARS ab mandatory ❓Probable >5 + atleast 1 clinical domian, anti-ARS ab not mandatory #Rheumatology #MedTwitter

Management of rheumatologic immune-related adverse events (irAEs), inflammatory conditions triggered by immune checkpoint inhibitor (ICI) cancer therapy Abstr OP0358 @RheumNow #EULAR2026

Everything you want to know about TEG /ROTEM sciencedirect.com/science/articl… Authors: @JanHartmannMD @HermelinMD @JerroldLevy #medtwitter & #livertwitter

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🚨 ACUTE MESENTERIC ISCHEMIA — SMLE SUMMARY One of the most lethal surgical emergencies and a classic exam topic 🩺 This visual summary covers: ▫️Arterial embolism vs arterial thrombosis ▫️Mesenteric venous thrombosis ▫️Non-occlusive mesenteric ischemia ▫️Risk factors and pathophysiology ▫️The classic clue: Pain out of proportion to examination ▫️CTA abdomen findings and diagnosis ▫️Management algorithm step by step ▫️When to anticoagulate, revascularize, or operate ▫️Complications and high-yield anatomy pearls Remember the golden rule 🔥 Time is bowel. Early diagnosis and intervention save both bowel and life. Telegram: t.me/Qsurgerysmle

🫁 Cy-Tb (C-Tb): bridging the gap between TST and IGRA in TB infection screening Cy-Tb (C-Tb) is a novel antigen-based TB skin test for detecting TB infection / latent TB infection (LTBI). It uses ESAT-6 and CFP-10-->the same M. tuberculosis-specific antigens used in IGRA assays. Compared with conventional TST, Cy-Tb offers higher specificity, particularly in BCG-vaccinated populations, where false-positive reactions remain a major limitation. ✨ Why Cy-Tb stands out: 🔹 High specificity-even after BCG vaccination 💉 🔹 Sensitivity comparable to both TST and IGRA 📊 🔹 No blood sample required 🩸❌ 🔹 Lower cost than IGRA 💰 🔹 Easy to perform👩‍⚕️ 🔹 Easier deployment in resource-limited settings 🌍 🔹 Defined cut-off for simpler interpretation ✅ 👥 Potential advantages in special populations: • Children 👶 • People living with HIV 🧬 • Areas with limited laboratory access 🏥 💡 In practical terms, Cy-Tb combines the simplicity of TST with specificity approaching IGRA, making it a promising option for latent TB infection screening, especially in high TB-burden settings. Particularly relevant for: ✔️ Contact screening ✔️ Pre-biologic / immunosuppressive therapy work-up 💉 ✔️ Public health TB screening programs 🌍 #RheumattDoc #MedTwitter #NTEP #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

Why is Cilostazol such a game-changer for stroke prevention, especially in Asian populations with Intracranial Atherosclerosis (ICAS)? 🧠 Unlike standard antiplatelets, it doesn’t just prevent clots—it actively halts and can even promote the regression of arterial stenosis. Plus, it elegantly bypasses the common genetic clopidogrel resistance (CYP2C19) seen in East Asian demographics, all without increasing severe bleeding risks. A powerful and targeted tool in our secondary prevention arsenal! 💊🩸 #StrokePrevention #Neurology #NeuroIntervention #ICAS #Cilostazol #MedEd

This table outlines various bacteria found in the human oral cavity, their characteristics, and their clinical significance in dentistry. Key Clinical Takeaways... *Periodontal Disease: Primarily driven by Gram-negative bacteria like P. gingivalis, T. forsythia, and T. denticola (the "Red Complex"). *Caries (Cavities): Strongly associated with S. mutans due to its ability to produce significant amounts of acid. *Systemic Health: Bacteria like S. sanguinis and S. aureus are notable for their link to infective endocarditis, highlighting the connection between oral health and heart health. bootcamp.com/blog/must-know…

B12 lab results can be misleading. The standard test measures B12 plus the inactive fraction your liver is about to clear. Up to 30% of "normal" results are functionally deficient. The tests that actually answer the question, holoTC and MMA, exist. However, it is not common for doctors to order them in routine fashion.