Episode 3: Autoimmune Statin Induced Myopathy: What Everyone Needs to Know youtu.be/WXU-6gySNKs?si… via @YouTube
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Michael Padberg Jr.
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Michael Padberg Jr.
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Michael Padberg Jr. retweetledi
#Antiphospholipid antibodies and #cardiovascular #thrombosis, now in @NatRevCardiol 👇:
dlvr.it/TRQCr6
Systematic summary across various conditions. In some cases, we challenge the old conventional thinking...
Truly multidisciplinary, led by our 🌟fellow @SinaRsh
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Michael Padberg Jr. retweetledi
FDA has granted Fast Track designation to J&Js nipocalimab for use in #SLE based on the results of a Phase 2b JASMINE study in which nipocalimab demonstrated reduction in lupus disease activity and potential for steroid sparing jnj.com/media-center/p…
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Michael Padberg Jr. retweetledi
Antimitochondrial antibodies (AMA)in systemic sclerosis? Retro study of 165 SSc pts (20% diffuse, 33% ILD, 7% PAH); 51% centromere AB+; 29% topoisomerase I+, 12% RNA polymerase III+)-- 22% AMA-positive: assoc w/ GI vascular dz(OR 13.3), gastric antral vascular ectasia (OR 8) & may be cause for GI bleeding, refractory Fe-deficiency anemia buff.ly/DJwHl9t
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Michael Padberg Jr. retweetledi
ICE was LITERALLY arresting a child sex offender when these protesters tried to stop it.
At what point does the Left examine themselves and go “Okay, maybe WE ARE the bad guys?"
Oliya Scootercaster 🛴@ScooterCasterNY
"We are trying to arrest a child s*x offender" ICE agents say as activists honk to alert to their presence in St Paul Minnesota.
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Michael Padberg Jr. retweetledi
Anti-mitochondrial M2 Ab (AMA-M2) in 987 IIM pts-- 55 (6%) were AMA-M2 positive. AMA-M2+ had signif. higher rates of polymyositis (56% vs 23.5%), GGT, alk phos levels, & 3 fold more cardiac involvement (60 vs 13%) (arrhythmias, CHF, pulm HTN (31-56%), but no effect on survival buff.ly/4yVjRRC
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Michael Padberg Jr. retweetledi
Low-titre ANA is frequently overinterpreted.
• Seen in up to 20–30% of healthy adults
• Often benign and transient
• ANA is a screening test, not a diagnosis
A major pitfall:
Mislabeling low-titre ANA positivity as lupus in asymptomatic young women.
Clinical context > lab reports.
Reassurance is often correct care.
#Rheumatology #MedEd #ANA #MedTwitter @DrAkhilX @Janetbirdope @IhabFathiSulima #ClinicalReasoning #InternalMedicine
Aravind Palraj@Rheumat_Aravind
When NOT to order ANA / ENA 🧵 • ANA is not a screening test • Low pre-test probability = false positives • Do NOT order for fatigue, body aches, OA, fibromyalgia, mechanical back pain • Do NOT repeat ANA/ENA—titres don’t track activity Order ANA only when clinical suspicion exists. Sometimes, not testing is better care. #Rheumatology #MedEd @DrAkhilX @IhabFathiSulima @ArunInamadar @drkeithsiau @Drkhenaizan #MedTwitter #InternalMedicine #ClinicalReasoning
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Michael Padberg Jr. retweetledi
🚨 Here is the full 42 minutes of my crew and I exposing Minnesota fraud, this might be my most important work yet. We uncovered over $110,000,000 in ONE day. Like it and share it around like wildfire! Its time to hold these corrupt politicians and fraudsters accountable
We ALL work way too hard and pay too much in taxes for this to be happening, the fraud must be stopped.
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Michael Padberg Jr. retweetledi
Update on therapeutic approaches in ANCA-associated vasculitis sciencedirect.com/science/articl…
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Michael Padberg Jr. retweetledi
A high ANA titer (≥1:640) in individuals without an autoimmune disease was found to be strongly associated with liver-related disorders, including nonalcoholic and alcoholic liver disease
Arthritis Care & Research
doi.org/10.1002/acr.25…
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Michael Padberg Jr. retweetledi
Anti-CCP vs RF in suspected RA:
RF is older and less specific; false positives occur with infections, cryoglobulinemia, liver disease, and in the elderly.
Anti-CCP is highly specific and predicts erosive disease.
Best practice: order both and interpret with the clinical picture.
@DrAkhilX @IhabFathiSulima
#Rheumatology #RA #MedTwitter
Aravind Palraj@Rheumat_Aravind
Tweet 4 – Anti-CCP vs RF Rheumatoid Factor (RF) and Anti-CCP are often tested together, but they differ: •RF is older, less specific, and can give false positives in infections or the elderly. •Anti-CCP is highly specific (about 95%) for Rheumatoid Arthritis and strongly predicts erosive disease. •The best practice? Order both in suspected RA — they complement each other.
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Michael Padberg Jr. retweetledi
🔬 Anti-dsDNA: Not just specific for SLE, but a direct clue to flare risk — especially lupus nephritis.
📈 Rising dsDNA + falling C3/C4? Think renal flare!
Consistent monitoring is key; trends matter more than single results.
@DrAkhilX @IhabFathiSulima @CelestinoGutirr #Rheumatology #Lupus #MedTwitter
Aravind Palraj@Rheumat_Aravind
Tweet 3 – Anti-dsDNA 🔬 Highly specific for SLE 🧭 Correlates with disease activity, especially lupus nephritis 📉 Titres fall in remission, 📈 rise in flare 💡 Pearl: Rising dsDNA + falling C3/C4 → possible renal flare.
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Michael Padberg Jr. retweetledi
Anti-Sm antibody 🔍
• Highly specific — but not sensitive — for SLE
• Part of ENA panel (with RNP)
• Marker of disease classification rather than activity
• Often linked with anti-RNP overlap (MCTD spectrum)
• Low prevalence in Europeans, higher in African ancestry
@DrAkhilX @IhabFathiSulima #MedTwitter #rheumatology
Aravind Palraj@Rheumat_Aravind
Anti Sm antibody: @IhabFathiSulima #MedTwitter #SLE #Rheumatology #Medicine #Lupus
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Michael Padberg Jr. retweetledi
🔬 Systemic sclerosis isn’t one disease — it’s a spectrum.
Autoantibodies not only define the subtype but also predict organ risks.
Know your antibody → anticipate the complication.
#Rheumatology #MedTwitter #SystemicSclerosis @DrAkhilX @IhabFathiSulima
Aravind Palraj@Rheumat_Aravind
Tweet 5 🧱 Systemic sclerosis spectrum •Scl-70 (Topo-I) → Diffuse cutaneous SSc, ILD risk •Centromere → Limited SSc (CREST), PAH risk •RNA polymerase III → Diffuse SSc, renal crisis risk
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Michael Padberg Jr. retweetledi
Autoimmune Hepatitis (AIH) — a rheumatology-hepatology bridge disease.
🔹 Common in young women
🔹 Labs: ↑AST/ALT, ↑IgG
🔹 Antibodies: ANA, SMA, anti-LKM1
🔹 Strongly linked with other autoimmune diseases (thyroiditis, SLE, RA, celiac)
Early diagnosis = reversible with steroids.
Delay = progressive fibrosis → cirrhosis.
@DrAkhilX @IhabFathiSulima
#Rheumatology #Hepatology #AutoimmuneHepatitis
Aravind Palraj@Rheumat_Aravind
2/ 📌 Autoimmune Hepatitis (AIH) •Mostly affects young women •Symptoms: fatigue, jaundice •Labs: very high AST/ALT, ↑IgG •Autoantibodies: ANA, SMA, anti-LKM Untreated → cirrhosis in a few years.
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Michael Padberg Jr. retweetledi
🧬 Anti-CarP antibodies in RA
🔹 Autoantibodies to carbamylated proteins
🔹 Found in ~30–40% of RA; also in some seronegative cases
🔹 Linked with severe & erosive disease
🔹 Appear before onset, predict progression
🔹 Lower sensitivity vs ACPA → complementary biomarker
@DrAkhilX @IhabFathiSulima
#RheumTwitter #MedEd #RA
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Michael Padberg Jr. retweetledi
🚨 CAR-T in Autoimmune Disease – 2025 Updates
From NEJM, Lancet Rheumatology, Front Immunol & Nature:
1️⃣ Remission in refractory SLE & other AI diseases
2️⃣ Immune “reset” after B-cell depletion
3️⃣ LICATS: new organ-specific toxicity
4️⃣ Safety & scalability challenges
5️⃣ Early allogeneic CAR-T signals
@DrAkhilX @IhabFathiSulima @CelestinoGutirr @CMEINDIA1 @DurgaPrasannaM1
#Rheumatology #CAR-T #Autoimmune
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Michael Padberg Jr. retweetledi
Beyond the antibodies - the clinical story of APS matters most.
Think clot + miscarriage + positive aPL = time to suspect Antiphospholipid Syndrome.
@DrAkhilX @IhabFathiSulima @APSFA
#Lupus #APS #Rheumatology
Aravind Palraj@Rheumat_Aravind
Tweet 7 – Antiphospholipid antibodies (aPL) Includes: •Lupus anticoagulant (LA) •Anticardiolipin (aCL) •Anti-β2GP1 Clinical impact: 🩸 Arterial/venous thrombosis 🤰 Pregnancy loss = Antiphospholipid syndrome (APS), can overlap with SLE.
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