🩺UK based Rheumatologist & Internal Medicine | Education | Arsenal Fan 35 Years -🏆🔴⚪️ | Just living the Dream ☔️| طب الروماتيزم | 🎬 🏋️‍♂️♟️🎱

England, United Kingdom
Joined July 2023
Steroids 2 mechanisms of action 1/ Genomic (activates @ 7.5mg-30mg Pred/day). Ceiling of saturation > 50mg. Limited additional anti-Inflammatory benefit beyond & ⬆️ Adverse 2/ NonGenomic. Act @ 100mg, Max sat 250-500mg & Less S/E as Shorter ⌛️ Less Is More! Great Slide 👇
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🚨 My new paper on small fiber #neuropathy in NONPAINFUL conditions is published. Neuropathy is traditionally defined by neuropathic (tingling, numbness, burning, shooting) pain, but there are neurologic and non-neurologic conditions where objective findings of small fiber neuropathy are highly prevalent despite the pain being absent or minimal. I outline comprehensive treatment options for small fiber neuropathy with both evidence-based and emerging therapies in the Table. 🧠 clinmedres.org/content/24/3/…
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Monthly Met its Primary end point but Despite the improvement in systemic disease activity, the trials did not show statistically significant benefits in key secondary endpoints: ESSDAI response (≥5-point reduction) ESSPRI symptoms SSSD symptom burden Fatigue and salivary flow
In two trials involving patients with active Sjögren’s disease, decreases in disease activity at 48 weeks were greater with monthly ianalumab than with placebo, but differences in response rates and symptom scores were not significant. Full results of the phase 3 NEPTUNUS-1 and NEPTUNUS-2 trials: nej.md/3VU4TAp Editorial: Ianalumab in Sjögren’s Disease — A First Step nej.md/4ivvs7E
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Slightly better than my handwriting… 📝🩺
🚨 𝗡𝗘𝗪: Football commentator Derek Rae shared his notes for Real Madrid vs Sevilla.
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Publication alert! Rheumatology (Oxford) 🔑 Key takeaways: • Myositis strongly associated with cardiac involvement • Cardiac involvement predicted mortality • Different causes-of-death patterns highlight the need for cardiac surveillance in SSc 🔗 track.smtpsendmail.com/90321…
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Rheuma Doc retweeted
Presented at #LIVES2026: An open-label, randomized, noninferiority trial showed that intermittent hemodialysis was not noninferior to continuous renal-replacement therapy in critically ill adults with acute kidney injury. Full ICRAKI trial results: nej.md/472QMel Editorial: Continuous or Intermittent Renal-Replacement Therapy — What is the Question? nej.md/4egLaB1
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Topical Steroids and their potency 👇
Topical Corticosteroids: Potency Classification from Class I (Super-High) to Class VII (Low)
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Nationwide Analysis of Eosinophilic Granulomatosis With Polyangiitis Hospitalizations ovid.com/10.1097/RHU.0000000…
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Case: 69 Male ex-smoker, with active & severe PsA & Axial-PsA established on MTX & SSZ. CXR shows incidental ILD, HRCT UIP pattern 20%, TLCO 61%, FVC 65% & mild chronic cough. What would be your next step in Management? [Resp will review in OPD in 3 months - will consider AFx]
11%TNFi
33%IL17i
11%IL23i or IL12/23
44%JAKi
36 votes • Final results
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And of course other…
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𝗦𝗲𝗰𝗼𝗻𝗱𝗮𝗿𝘆 𝗶𝗻𝗲𝗳𝗳𝗶𝗰𝗮𝗰𝘆, 𝗻𝗼𝘁 𝗽𝗿𝗶𝗺𝗮𝗿𝘆 𝗳𝗮𝗶𝗹𝘂𝗿𝗲, 𝗱𝗿𝗶𝘃𝗲𝘀 𝗺𝗼𝘀𝘁 𝗮𝗱𝗮𝗹𝗶𝗺𝘂𝗺𝗮𝗯 𝘀𝘁𝗼𝗽𝘀 𝗶𝗻 𝗕𝗲𝗵𝗰𝗲𝘁’𝘀 𝗱𝗶𝘀𝗲𝗮𝘀𝗲 In a single-centre retrospective chart review of 335 patients with Behçet’s syndrome who started adalimumab between 2008 and 2023, adalimumab showed good early persistence that declined gradually over time. All discontinuations were counted as events, regardless of cause. • 𝗥𝗲𝘁𝗲𝗻𝘁𝗶𝗼𝗻. Rates were 88.9% at 6 months, 78.3% at 12 months and 67.1% at 24 months. Over a mean follow-up of 26.6 months (SD 23), 137 patients (41%) stopped adalimumab. • 𝗥𝗲𝗮𝘀𝗼𝗻𝘀 𝗳𝗼𝗿 𝘀𝘁𝗼𝗽𝗽𝗶𝗻𝗴. Inefficacy was the leading cause, mainly secondary loss of response; primary inefficacy was uncommon. Adverse events, non-compliance, remission and other reasons followed. • 𝗣𝗿𝗲𝗱𝗶𝗰𝘁𝗼𝗿𝘀. Discontinuation was not significantly associated with age, sex, disease duration, prior tumour necrosis factor inhibitor use, concomitant conventional DMARD use, or major organ involvement. • 𝗗𝗼𝘀𝗲 𝗮𝗱𝗷𝘂𝘀𝘁𝗺𝗲𝗻𝘁. Interval extension in 36 patients with sustained remission led to relapse or flare in 5 (14%); all regained remission after the dose was restored. Dose intensification in 30 patients with active disease produced remission in 17 (56.6%). • 𝗣𝗿𝗮𝗰𝘁𝗶𝗰𝗮𝗹 𝗶𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻. Early retention is high, then falls mainly because of secondary inefficacy, adverse events and non-compliance. Both dose escalation for incomplete control and cautious de-escalation in sustained remission appear feasible. *Sonmez O, Esatoglu SN, Ucar D, et al. Drug survival of adalimumab across different manifestations of Behçet’s syndrome: a retrospective analysis in 335 patients. Rheumatology (Oxford). 2026;65(10):keag510. 🔗doi.org/10.1093/rheumatology…
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Small sample size but no difference in MMF vs CYCLO vs RTX Rx #Lupus Nephritis
RTX, MMF or cyclophosphamide for active lupus nephritis? Using the multicentre LOOPS registry, this real-world study analysed 93 patients with biopsy-confirmed active lupus nephritis treated with glucocorticoids plus RTX (n=27), MMF (n=42) or IVCY (n=24). At week 52: ✅ CRR: 48.1% / 45.2% / 37.5% ✅ uPCR <0.7: 62.9% / 64.3% / 58.3% ✅ Relapse: 7.4% / 7.1% / 8.3% No significant between-strategy differences. 🔓 rmdopen.bmj.com/content/12/3…
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Belimumab vs. Anifrolumab en #lupus y riesgo cardiovascular🫀 emulación de ensayo clínico con datos de TriNetX🇺🇸 🗞️acrjournals.onlinelibrary.wi…
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Sex differences with bimekizumab in axSpA: earlier gain in men, convergence by Week 52 Post-hoc sex analysis of bimekizumab (BKZ; dual IL-17A/F inhibitor) in the phase 3 BE MOBILE trials: BE MOBILE 1 (nr-axSpA, NCT03928704) and BE MOBILE 2 (r-axSpA, NCT03928743), through Week 52. Population. Sex balance differed by phenotype: nr-axSpA was roughly balanced (54.3% male); r-axSpA was male-predominant (72.3% male). At baseline, males generally had higher objective inflammation (MRI, hs-CRP), while females tended to report worse health-related quality of life (e.g. higher ASQoL). Week 16 (BKZ vs placebo). Treatment effect versus placebo was typically larger in men than in women on composite and patient-reported outcomes: ASAS40, ASDAS <2.1, BASDAI, BASFI, pain, fatigue, and HRQoL. That pattern held across both nr- and r-axSpA. Week 52 (BKZ-randomised patients). Responses were sustained or continued to improve in both sexes. Women showed clear longer-term gains, narrowing the early gap, though absolute rates often remained numerically higher in men—especially in nr-axSpA. Conference-reported Week 52 rates in BKZ-randomised patients (male vs female): • ASAS40: nr-axSpA 64.4% vs 56.4%; r-axSpA 59.4% vs 55.7% • ASDAS <2.1: nr-axSpA 72.0% vs 47.4%; r-axSpA 57.7% vs 55.8% • Mean BASDAI change: nr-axSpA −4.0 vs −3.6; r-axSpA −3.6 vs −3.4 ASQoL also improved substantially in both sexes by Week 16 and further by Week 52 (in some arms the Week 52 ASQoL gain was larger in women). Objective inflammation. Despite higher baseline MRI inflammation and hs-CRP in men, both sexes reached similarly low levels by Week 16, maintained through Week 52. Absolute MRI and hs-CRP values converged even when the Week 16 placebo-controlled difference favoured men. Takeaway. Men tended to respond earlier on clinical and patient-reported measures. Women caught up over the year, with substantial longer-term improvement. Suppression of objective inflammation was robust and comparable in both sexes by Week 16 and 52. Efficacy was shown across the full axSpA spectrum in both sexes. *Rudwaleit M, Ramiro S, Poddubnyy D, et al. Bimekizumab efficacy in male and female patients with axial spondyloarthritis: 52-week results from the phase 3 BE MOBILE trials. Rheumatology (Oxford). Published online August 14, 2026. 🔗doi.org/10.1093/rheumatology…
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Rheuma Doc retweeted
#RA after cancer: does DMARD choice alter cancer risk? The ARCA registry - a nationwide real-world study specifically designed to evaluate cancer-related safety of DMARD strategies - included 728 patients with RA and prior cancer from 24 centres. Across 11,022 person-years, 80 cancer events occurred (7.3 per 1,000 person-years): 47 new primary cancers, 25 locoregional progressions and 8 metastases. No significant differences in new cancer, progression or metastasis were detected across DMARD strategies. 🔓 rmdopen.bmj.com/content/12/3…
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The regular consumption of sugar-sweetened beverages is associated with an increased risk of developing gastric cancer, yet a similar link is not observed with beverages containing artificial sweeteners, despite carcinogenic warnings about the sweeteners, new research showed. “To our knowledge, this is the first study to demonstrate the association between sugar-sweetened beverage intake and gastric cancer incidence,” reported the authors in the study, published recently in Gastro Hep Advances. More on the study: mdsc.pe/4zcakcc
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