Autoimmune Sherlock | Rheumy | Med Educator Busting myths around joint pain, autoimmune disease & steroids.
Mumbai
Joined June 2020
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Deepak Malgutte retweeted
So grateful for the last 3 years at the University of Toronto. It's been amazing, and I've learned so much 🙌🏽
Huge thanks to the incredible mentors & colleagues who made this time so special. Excited for whatever comes next :)
@UHN | @pmcancercentre | @UofT
Deepak Malgutte retweeted
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
Deepak Malgutte retweeted
🎉 Congratulations, @PanktiMehta24 and the phenomenal Lupus team at @UHN 💪🏽
doi.org/10.1093/rheumatology…
Deepak Malgutte retweeted
🫁 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
Deepak Malgutte retweeted
Great work!
🔴 Importantly, 1/3rd of patients had a catastrophic health expenditure
of >20% of family income🔴
#ChronicIllness #Lupus
Deepak Malgutte retweeted
💉 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. 😅
Deepak Malgutte retweeted
#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
Deepak Malgutte retweeted
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
Deepak Malgutte retweeted
🧩 #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
Deepak Malgutte retweeted
Thank you for the feature!
Honoured to be a part of this brilliant team ❤️
#learnandgrow
@nihardesai89
It's #TraineeTuesday!
Meet Dr. Pankti Mehta, Clinical Fellow within the Psoriatic Arthritis Program and Lupus Program @SchroederInst.
"The Institute has become my family away from home."
Deepak Malgutte retweeted
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
Deepak Malgutte retweeted
❌ 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!
Deepak Malgutte retweeted
🧵 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
Deepak Malgutte retweeted
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
Deepak Malgutte retweeted
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
Deepak Malgutte retweeted
🩸Hematology for The Non-Hematologist🩸
(A practical educational series for internal medicine trainees and physicians)
Episode 7: Leukemia and Lymphoma Alphabet Soups: AML, CLL, CML, ALL, acute vs chronic - myeloid vs lymphoid. Let’s decode all this.
Listen up - 🧵
Deepak Malgutte retweeted
"The Molecule That Refused to Die: The Anti-TNF Story" 🧵
In medicine, some drugs fail spectacularly… and then return to change the world.
Story of anti-TNF starts with failure, rejection, to become a $20 billion/year lifeline for millions with autoimmune disease. Journey 👇