The Man Who Never Got a Nobel, But Gave the World Methotrexate — A story of forgotten genius, cancer, arthritis, psoriasis… and hope. 💊💔🧬

Had the privilege to listen to some of the stories in person, now the whole world will read the path of this GOAT.. Congratulations to Lancet! Many more to come. #padmashri @IndianRheum @nileshnolkha @DurgaPrasannaM1 @Rheumat_Aravind @IlliasulK

@DrDeepakKrishn1 👆

🎉 Congratulations, @PanktiMehta24 and the phenomenal Lupus team at @UHN 💪🏽 doi.org/10.1093/rheumatology…

🫁 Tofacitinib vs Calcineurin inhibitors in MDA5 Dermatomyositis-ILD 📌 Large multicentre retrospective cohort (China, 2014–2023) Key Findings 🧪 Adults with newly diagnosed MDA5 dermatomyositis–ILD (course <3 months) 👥 Tofacitinib: 290 patients 👥 Calcineurin inhibitors (CNI): 225 patients 🟢 Primary outcome: 1-year lung-transplant–free survival •⚰️/🫁 Tofacitinib: 32.4% died or underwent transplant •⚰️/🫁 CNI: 46.7% died or underwent transplant •📈 After IPTW adjustment → Significantly higher survival with tofacitinib •HR 0.72 (95% CI 0.56–0.94; p=0.013) •Absolute survival benefit: 9.3% Who benefited most? 👶 Age <60 years ⏱️ Not rapidly progressive ILD 🌬️ PaO₂/FiO₂ ≥300 mmHg Safety 🦠 Opportunistic infections = major AE 📊 Incidence similar: 42.4% vs 45.3% Conclusion 💊 Tofacitinib offered significantly better 1-year survival than CNIs in MDA5 DM-ILD with comparable safety. #RheumattDoc #MedTwitter #RheumTwitter #rheumatology @DrAkhilX @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1 @Urchilla01 @eular_org

Same one, different seasons ❤️

Great work! 🔴 Importantly, 1/3rd of patients had a catastrophic health expenditure of >20% of family income🔴 #ChronicIllness #Lupus

Had one of those exhausting weeks — endless work, stress piling up, and no space to breathe. So I randomly clicked on Re-Tripling again — maybe the 3rd or 4th time. But this time, it hit differently. Chandan’s calm, Chanchal’s courage, and Chitvan’s carefree madness — all just synced with me. Somehow it felt like life’s reminder: even chaos can be beautiful when you pause and feel it. It didn’t just entertain me — it expanded my horizon, made me feel lighter, alive again. Sometimes we all need that gentle push — a story that resets your mood, your mind. What’s that one series or movie that does it for you? #ReTripling #WeekendVibes #StressBuster #FeelGoodSeries

💉 I’m pro-vaccine and I don’t want to get into this twitter war… But let’s clear a few things about this “pharma lobby” nonsense. Doctors don’t lose business because of vaccines or medicines. If anything, post-COVID we’re busier and richer because people refuse preventive care, skip vaccines, and experiment with “alternative” nonsense. Take rheumatoid arthritis for example 👇 🦴 Early on, it’s treatable with simple, affordable drugs and a rheumatologist’s guidance. But many patients waste months or years on home remedies, oils, or “natural detox.” When they finally come: •Their joints are already deformed, •Muscles wasted, •Need multi-drug therapy, rehab, sometimes joint replacement, •And lifelong disability that could’ve been avoided. 💸 The irony? They end up spending 10–20× more than what early treatment would’ve cost, all because someone told them “medicines are poison.” So no, we aren’t in a pharma lobby. We’re just fixing the mess that pseudoscience and poor judgment create. And trust me, ‘business’ (you call it business, we call it medical care or healing) isn’t going down because of anti-vaxxers / herbal treatments / ayurveda / homeopathy or alternative therapies, it’s booming because of them. 😅

#ACR25 Must-Read 🔥 | “Secrets & Pearls of Rheumatology in CTD” – Janet Pope MD 🔹 SLE Pearls •Not all lupus rashes are equal! • Malar → almost always SLE • Subacute cutaneous → 50% SLE • Discoid → 5–10% risk •Lupus vs DM rash → Between vs on knuckles. •“Lupus pernio” = Sarcoidosis mimic. 👉 Always biopsy if uncertain. ⸻ 🔹 Lupus Nephritis (LN) •Always biopsy first renal episode — defines activity, class, prognosis. •Combo Rx: MMF/CYCLO GC HCQ another IS (Belimumab/Voclosporin/Tacrolimus). •Manage BP, lipids, proteinuria (ACEi/ARB/SGLT2i). •SGLT2i & GLP1-RA → ↓ renal progression, ↓ MACE. •Taper IST only after 5 yrs remission (WIN-Lupus trial: early stop ↑ relapse). ⸻ 🔹 Myositis Pearls •No need for universal cancer screen. • High-risk: TIF1-γ, NXP2, >45 yrs, dysphagia, wt loss. •Skin biopsy findings mimic SLE — interface dermatitis, mucin, vacuolar change. ⸻ 🔹 Lab Wisdom 🧪 •Don’t order ANA without suspicion — false freaks out patients. •Never repeat a positive ANA. •ENA only matters if ANA . •Negative ANA → ignore dsDNA, unless anti-Ro52. •Stop serial dsDNA/C3/C4 if stable — waste of ₹💰. ⸻ 🔹 Systemic Sclerosis (SSc) •Primary RP <40 yrs → no workup. •Red flags: late onset RP, centromere Ab, abnormal nailfolds → “Prescleroderma”. → 30–40% progress to CTD within 5 yrs. •ILD can develop anytime — even late lcSSc! •Continue screening; 2/3 progress over 5 yrs. •PAH: screen early, confirm with RHC; dual therapy = better survival. ⸻ 🔹 Sjögren’s Syndrome •Don’t screen every patient for lymphoma! • High risk if ≥3 of 7 factors: persistent parotid swelling, LAD, ↓C4, cryoglobulins, MG, RF , SSA/SSB . ⸻ 🔹 Take-Home Truths 💡 •Believe labs only when they fit the clinical picture. •Many mimics exist — biopsy, think wide, act smart. ⸻ #ACR25 #RheumTwitter #MedEd #JanetPope #ClinicalPearls #SLE #SSc #Sjogrens #Myositis #LupusNephritis

Azathioprine in Pregnancy: friend or foe? [Evelyne Vinet] #ACR2025 [Crohn’s Colitis 2024] ➡️ 25% of pregnancies show shunting 🚩Use lowest effective dose 🚩Monitor metabolites if available 🚩Monitor for rising bile acids, pruritus,or ⬆️ LFTs 🚩Switch to tacrolimus if shunting/IC

🧩 #ACR25 Highlight | Skin in the Game: Cutaneous Clues in Rheumatic Disease By Dr. Katharina S. Shaw, Penn Medicine 🧵 Post 3 | Dermatomyositis & Localized Scleroderma • 💪 IMACS 2023: Cancer screening now risk-tiered (High > Intermediate > Low) • 🎯 Paraneoplastic DM ~5%, mostly High-Risk, cancers → within 2 yrs • 🧬 Non-paraneoplastic DM: >50% still High/Intermediate risk • 👶 Linear Morphea (En coup de sabre) → MTX IV steroids (CARRA) = standard • ⚠️ Craniofacial Morphea → CNS/eye/TMJ risk → MRI ophtho dental eval • 🧠 Early aggressive therapy prevents irreversible deformity #Dermatomyositis #Morphea #JuvenileScleroderma #ACR25 #ACRAmbassador #RheumDerm

Thank you for the feature! Honoured to be a part of this brilliant team ❤️ #learnandgrow @nihardesai89

Tweet 10/10 Here’s the simplest way to understand it 👇 💡 Concept: In absence of obstruction — 👉 RVSP ≈ PASP (Pulmonary Artery Systolic Pressure) 1️⃣ Find RAP from IVC: •≤2.1 cm & collapse > 50% → 3 mmHg •2.1 cm & collapse < 50% → 15 mmHg 2️⃣ Measure TR velocity (Vₜᵣ) PASP = 4(V_{TR})^2 RAP 👉 TR > 2.8 m/s or PASP > 40 mmHg → suspicious for PH 3️⃣ Estimate mean pressure: mPAP = 0.61 × PASP 2 👉 mPAP > 20 mmHg = Pulmonary Hypertension 🔹AcT < 80 ms → severe 🔹PVR > 2 WU → abnormal Echo gives you the answer if you know where to look. #Echo #MedTwitter #RheumTwitter #CardioTwitter #PulmonaryHypertension @IhabFathiSulima @CelestinoGutirr

Went with wife for dinner last night. New Bollywood & Punjabi songs were playing — nice, but nothing special. Then the DJ switched to a 90s track… and the whole restaurant transformed. People stood up, shouting lyrics, dancing like nobody was watching. One old song changed the entire energy of 40–50 strangers in seconds. And a thought hit me — Those singers, writers, composers probably have no idea that their work is still creating joy decades later. That’s the thing about good work — You don’t always see its impact, but it travels far in time. To all young people building careers — Work with ethics, skill and sincerity. You may not get instant applause. You may not even witness the results. But someday, because of your work, a moment, a smile, a life will change — exactly like that song did last night. Keep going. The world is silently storing your efforts.

❌ If you want to do cutting-edge research in India, just leave the country. Just fu#*ing leave. INDIA DOES NOT DESERVE YOU! I’m an AI researcher, travelling to RSNA (the “A*-star” equivalent conference in Radiology) this year with arguably the highest number of accepted presentations (double digits) from Indian academia. For the unaware, most govt. grants in India force you to ONLY book through IRCTC, Balmer Lawrie, or Ashok Tours. For international conferences, travel stay costs more than my yearly savings (not exaggerating). That’s why we depend on travel grants. And this past week of trying to book tickets has been horrific: ❌ IRCTC portal: glitchy, couldn’t even pick seats. ➡️ Shifted to Balmer Lawrie website: 100 seconds to load, then “NO TICKETS FOUND.” Frustrated finally went in-person to Scope Complex yesterday—holiday, shutters down (my mistake, we researchers tend to forget holidays as this concept often does not exist for us). ➡️ Returned today at 11 am: ❌ Balmer Lawrie guy: “We don’t do international booking, go to Okhla.” 😵‍💫 Ashok Travels guy: “No one is in office yet, try Balmer Lawrie.” Only in India does one govt. travel company push you to another just to avoid working. I said I can’t waste a day crossing the city, I’ll wait. It’s now 11:45. I’ve been sitting on an unclean sofa outside the office for 45 minutes! Is this how India wants to progress in research? By making it hell for researchers to showcase their work internationally? Or is the system only meant for those with a PA/PS to run around and get it done? I could earn 4x more just doing scans at a private centre. Instead, I chose to stay, build AI research here, and prove world-class science can be done from India. But this is how we are treated! If India doesn’t mend its ways, it is doomed. It should be! Please RT so this reaches the right authorities and actions are taken! No one else should have to go through this!

🧵 Ever stuck with a patient on anticoagulation, suspected APS, and wondering when and how to send sample for Lupus Anticoagulant? Let’s break down the pre-analytical pitfalls and what to do when you can’t stop anticoagulation 👇 #Rheumatology #Hematology #APS #Rheumatology #Immunology #Sullysrounds #MedX #Medtwitter #Mnemonics #Medicine #History @DrAkhilX @IhabFathiSulima @Janetbirdope @Lupusreference @RheumNow #MedTwitter #RheumTwitter @CelestinoGutirr

Difficult to remember interferonopathy? Here’s the mnemonic 👉 INTERFERONS 🔑 I – ILD Skin • Interstitial lung disease with skin manifestations. N – Neuro Skin • Neurological involvement with skin disease. T – TORCH-like • Neonatal presentations mimicking congenital infections (TORCH). E – ESR ↑ but CRP Normal • Characteristic lab pattern: raised ESR with disproportionately normal CRP. R – Raynaud’s Phenomenon • Recurrent or unexplained RP. F – Fever / Fluctuating Antibodies • Unexplained fever with variable autoantibody patterns. E – Encephalopathy • Unexplained CNS symptoms, seizures, developmental delay. R – Raised IFN • Elevated interferon signature on lab testing. O – Others • Cytopenias (esp. leukopenia), soft tissue calcifications. N – Neuro • CNS calcifications (basal ganglia, white matter). S – Skin • Chilblain lupus • Panniculitis • Lipodystrophy • Skin ulcers #RheumTwitter #MedTwitter #Immunology #Rheumatology #Immunology #Sullysrounds #MedX #Medtwitter #Mnemonics #Medicine #History @DrAkhilX @IhabFathiSulima @Janetbirdope @Lupusreference @RheumNow #MedTwitter #RheumTwitter

Arthritis… and still in terrible pain even as medicines keep increasing? Read this. It may be your missing piece. 💜 Mrs X came with a thick file. Every visit to a new clinic = one more tablet. Reports looked “okay.” Joints weren’t very swollen. Yet she hurt everywhere, slept badly, woke exhausted, felt “foggy.” She asked: “Why is nothing working?” Because the problem wasn’t only arthritis. It was fibromyalgia. What is fibromyalgia (in simple words): Your nerves become extra-sensitive and the brain turns the pain volume knob up. Blood tests and scans can look normal, but the pain is real. It often rides along with arthritis. When to suspect it: • Widespread pain; tenderness > visible swelling • Non-refreshing sleep, daytime tiredness, “brain fog” • Headaches, tummy upset/IBS, restless legs • Symptoms for months despite “okay” reports What actually helps (beyond “more tablets”): • Clear explanation & reassurance (you’re not imagining it) • Gentle, graded activity stretching/physio • Sleep routines, stress care/relaxation/CBT • If needed: nerve-pain medicines (e.g., duloxetine, amitriptyline, pregabalin) • Right-size arthritis treatment; avoid reflex steroid bursts For Mrs X, naming fibromyalgia changed everything. Weeks later: better sleep, lower pain, hope back. Ask your doctor: “Could I have fibromyalgia with arthritis? Can we plan to treat both?” #Arthritis #Fibromyalgia #ChronicPain #PainScience #PatientCare #RheumTwitter #MedTwitter #India

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) buff.ly/cF0PExI buff.ly/HeJqrCN