2a) Our returning expert author is Pankti Mehta @PanktiMehta24, MBBS, MD Med, Asst Prof @KGMUindia, Lucknow | Clinical #Immunology & #Rheumatology @SGPGI | DSMC member @rheumjnl @IJRheum @IndianRheum| @KEMhospital, Mumbai 🇮🇳 pic.twitter.com/CL2Qk0ZWnP
— @rheum_ce (@rheum_ce) June 7, 2023
3) You learned a lot when we last were visited by @PanktiMehta24, when she discussed the history of lab methods for assessing #antinuclear antibodies #ANA. You can still earn 🆓CE/#CME from that program at https://t.co/i8ZQdnK6lB. Welcome to Part 2! pic.twitter.com/GapBpPtFCW
— @rheum_ce (@rheum_ce) June 7, 2023
5) 1️⃣Look at the uniform staining & staining of the dividing cells (🔺) associated with Ab to #histone, #nucleosome & #dsDNA– characteristic of #lupus🦋 pic.twitter.com/gKENJRe1iB
— @rheum_ce (@rheum_ce) June 7, 2023
7) What do you think about 6⤴️? Pattern is
— @rheum_ce (@rheum_ce) June 7, 2023
9) Now check this out–more speckling throughout the nucleoplasm 🫥 What do you see?
a. dense fine speckled
b. coarse speckled
c. fine speckled pic.twitter.com/hilgOunMPr— @rheum_ce (@rheum_ce) June 7, 2023
11) 4️⃣Next🔬:#Specklesagain, but they are coarse this time!
Can you tell me the associated antibodies?
a. Ro, La, Sm
b. Sm, U1RNP, Ro
c. Sm, U1RNP, RNA pol 3 pic.twitter.com/uXm9qT9XsT— @rheum_ce (@rheum_ce) June 7, 2023
13) How is #DFS different from #FS?
Look at the coarse speckled staining of the metaphase end plate(🔺)!
It can be confused with homogenous pattern too, looking at the 🐀 liver helps!
This Ab is negatively associated with autoimmune disease: 🔔🔔🔔 + #ANA🚫= #autoimmunity— @rheum_ce (@rheum_ce) June 7, 2023
15) It's 1b!
6-20 discrete dots in the nucleoplasm is classic of multiple nuclear dots……OK, 7️⃣: This🔬shows staining of the nucleoli (3-5/ nucleus)
👉Classic of all these Ab:
🔹Pm/Scl
🔹Th/to
🔹Fibrillarin
🔹RNA pol I pic.twitter.com/Ap7CCMZXgN— @rheum_ce (@rheum_ce) June 7, 2023
17) We've left out one important pattern: the combination pattern 🍹
🔹Speckled nucleoplasm
🔹Metaphase chromosomal staining plus 🔺staining of the NOR ⭕
🔹cytoplasmic staining (look for ↗️)
🔹+/- nucleolar staining
⭐anti topoisomerase/Scl70 in diffuse systemic #sclerosis⭐ pic.twitter.com/OS5ft8yQ02— @rheum_ce (@rheum_ce) June 7, 2023
19) ✅ answer is 1.
Now, is a positive #ANA enough to start thinking of autoimmune diseases? Or is a negative ANA enough to rule them out??
Of course not! 🚫— @rheum_ce (@rheum_ce) June 7, 2023
21) Other recognized causes:
👉Malignancies: most common are hematologic, eg #multiplemyeloma
👉 Acute infections: infective endocarditis, acute viral infections
👉chronic infections: #HIV, #tuberculosis, #Hansen's— @rheum_ce (@rheum_ce) June 7, 2023
23a) One quick knowledge check:
What pattern do you see here?
a. Centromere
b. Fine speckled
c. Diffuse fine speckled pic.twitter.com/Mhw2PA9V2L— @rheum_ce (@rheum_ce) June 7, 2023
24) And you just earned 0.25hr 🆓CE/#CME! Claim your certificate at https://t.co/dUNX2gBkxC.
FOLLOW US for more #MedEd in #rheumatology, delivered wholly on Twitter!@PanktiMehta24 and @academiccme thank you for joining us!!#MedTwitter #lupus #autoimmune #immunology #FOAMed— @rheum_ce (@rheum_ce) June 7, 2023
