Rheumatology with Dr. Aravind Palraj

Rheumatology with Dr. Aravind Palraj Evidence-based medical education in autoimmune and rheumatic diseases

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04/10/2026

EULAR RA 2025 update:

csDMARD target not achieved → add a bDMARD.
No need for poor-prognostic-factor stratification first.

JAK inhibitors: consider after MACE/VTE/malignancy risk assessment.
Steroids: short-term only.

Treat to target. Escalate promptly.

04/10/2026

Why is the thumb spared in primary RP but involved in secondary RP?

Rituximab without the infusion?A 2026 Rheumatology study tested ultra-low-dose subcutaneous rituximab in selected RA pat...
04/10/2026

Rituximab without the infusion?

A 2026 Rheumatology study tested ultra-low-dose subcutaneous rituximab in selected RA patients with stable low disease activity.

Model-based PK met the prespecified noninferiority criterion, with similar B-cell counts and disease control signals.

But this was a small, open-label study — not proof that SC rituximab is equivalent to standard IV therapy.

Promising convenience signal. Needs confirmation.

MCQ:
04/10/2026

MCQ:

🧪 RF vs Anti-CCP🚨 Positive RF ≠ RA🚨 Anti-CCP is more specific than RF🚨 Anti-CCP may precede clinical RA🚨 RF + Anti-CCP p...
04/10/2026

🧪 RF vs Anti-CCP

🚨 Positive RF ≠ RA

🚨 Anti-CCP is more specific than RF

🚨 Anti-CCP may precede clinical RA

🚨 RF + Anti-CCP positivity predicts more erosive disease

🚬 Smoking is strongly linked to Anti-CCP–positive RA

Not every ANCA-positive vasculitis is “primary” AAV.Hydralazine, PTU, minocycline and levamisole-cocaine are classic cul...
04/10/2026

Not every ANCA-positive vasculitis is “primary” AAV.

Hydralazine, PTU, minocycline and levamisole-cocaine are classic culprits.

Key clues:
• Multiple autoantibodies
• MPO ± PR3 positivity
• Low complement
• Renal/skin involvement
• Clear drug exposure

First step: **stop the culprit drug.**
Immunosuppression is reserved for organ-threatening disease.

An SLE patient develops acute severe abdominal pain with low complement, rising anti-dsDNA, bowel-wall thickening and me...
03/10/2026

An SLE patient develops acute severe abdominal pain with low complement, rising anti-dsDNA, bowel-wall thickening and mesenteric edema on CT.

What’s the diagnosis? 👀

A. Mesenteric thrombosis
B. Lupus enteritis
C. Intestinal pseudo-obstruction
D. Polyarteritis nodosa

Drop your answer 👇

Starting urate-lowering therapy in gout: **who, when, and how?**Tophi, radiographic damage, or ≥2 flares/year → think UL...
03/10/2026

Starting urate-lowering therapy in gout: **who, when, and how?**

Tophi, radiographic damage, or ≥2 flares/year → think ULT.
Start allopurinol low, titrate to **serum urate

SLE controlled on prednisone? 5 mg is not the finish line.Even low-dose long-term glucocorticoids carry risk. In stable ...
03/10/2026

SLE controlled on prednisone? 5 mg is not the finish line.

Even low-dose long-term glucocorticoids carry risk. In stable disease, aim to taper, minimise steroid exposure, and use steroid-sparing therapy when needed.

Renal biopsy in lupus nephritis doesn’t have to feel complicated.LM → IF/EM → % glomeruli involved → Class I–VI → Activi...
02/10/2026

Renal biopsy in lupus nephritis doesn’t have to feel complicated.

LM → IF/EM → % glomeruli involved → Class I–VI → Activity & Chronicity indices.

A simple algorithm to decode the biopsy report faster — and never forget the tubulointerstitial and vascular lesions.

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