🩺 Livedo dilemma 🔹 Livedo reticularis •Net-like, regular, symmetric, reversible •Physiological (cold exposure) or secondary (vasculitis, CTD related, haematological etc) 🔹 Livedo racemosa •Broken, irregular, asymmetric, persistent •Almost always pathological (e.g.,

🩺 CDASI (Cutaneous Dermatomyositis Disease Area and Severity Index) 📊 Purpose: Measures skin disease activity & damage in dermatomyositis (DM). 🔹 Activity score: •Erythema (0–3) •Scale (0–2) •Erosion/ulceration (0–2) •Excoriation (0–1) 👉 Evaluated in 15 body regions 🔹

MMT-8 💪 (Manual Muscle Testing – 8) 📋 Quick tool to assess muscle strength in inflammatory myopathies (DM/PM). 🧩 Muscles tested (8 pairs): 1️⃣ Neck flexors 2️⃣ Deltoids 3️⃣ Biceps 4️⃣ Wrist extensors 5️⃣ Gluteus maximus 6️⃣ Gluteus medius 7️⃣ Quadriceps 8️⃣ Ankle dorsiflexors ⚖️

CLASI – Cutaneous Lupus Erythematosus Disease Area & Severity Index 🦋 A validated tool to quantify skin involvement in all forms of cutaneous lupus (ACLE, SCLE, DLE). 🔹 Two Components 1️⃣ CLASI-A (Activity Score): Assesses ongoing inflammation → potentially reversible.

🧠 NAPSI – Nail Psoriasis Severity Index💅 🔹 Purpose: Quantifies severity of nail psoriasis Each nail ➡️ 4 quadrants Matrix & Bed scored separately (0–4 each) Nail Matrix signs: • Pitting • Leukonychia • Red spots in lunula • Nail plate crumbling Nail Bed signs: •

🔥 Systemic Score in Adult-Onset Still’s Disease (AOSD) Each clinical feature = 1 point 🧩 Components : •Fever 🌡️ •Typical rash 🎨 •Pleuritis / Pneumonitis / Pericarditis 💨❤️ •Hepatomegaly / ↑LFTs 🧫 •Splenomegaly 🍈 •Lymphadenopathy 🧠 •Leukocytosis >15,000/mm³ 🧮

🧬 Psoriatic March – The Link from Skin to Systemic Disease Think of it as the “Domino effect” in psoriasis leading to metabolic and cardiovascular issues 👇 🔹 Stepwise Pathophysiology: 🩹 1️⃣ Skin inflammation: Chronic psoriasis → ↑ TNF-α, IL-6, IL-17, IL-23 → systemic

🧬 2025 ACR/EULAR Classification Criteria – Anti-synthetase Syndrome (ASS) 🔹 Entry: Patients suspected of ASS ⚖️ Clinical Domains 🦴 Joint involvement • Inflammatory arthritis → +1.0 💪 Muscle involvement • Subclinical (CK↑/EMG/MRI) → +1.0 • Clinical myositis → +1.5

🧩 Anti–Synthetase Syndrome (ASS) 🔑 Core Concept: An autoimmune syndrome defined by the presence of anti–aminoacyl tRNA synthetase (ARS) antibodies ⤴️ Characterized by varying combinations of myositis, interstitial lung disease (ILD), arthritis, Raynaud’s phenomenon, and

🧩 IgG4-RD Responder Index (RI) A standardized tool to measure disease activity & response in IgG4-related disease 📊 Why it matters •Tracks multi-organ involvement •Distinguishes active vs quiescent disease •Guides treatment decisions & monitors relapse 🧠 How it works Each

So true!!

🧬 2019 ACR/EULAR Criteria IgG4-Related Diseases 🩺 Step 1: Entry criteria ✅ Clinical/radiologic involvement of ≥1 typical organ (Pancreas, biliary tree, salivary/lacrimal glands, kidney, lung, aorta, retroperitoneum, pachymeninges, thyroid) 🚫 Step 2: Exclusion criteria

💊 METHOTREXATE TOXICITY-Triggers Even low-dose MTX can turn toxic when balance is lost ⚖️ 📦 Dosing error(Most common) ❌ Daily instead of weekly 💀 Classic cause of fatal toxicity 💧 Renal dysfunction ⬇️ MTX clearance → ↑ toxicity 💦 Dehydration, AKI, CKD = danger zone

👁️ Fundus Autofluorescence (FAF) 🆕 Newer imaging modality 🔬 Non-invasive imaging of the retina 💡 Detects natural fluorescence of lipofuscin in RPE 📷 Reveals metabolic & structural health of retinal pigment epithelium ⚙️ Principle: 💙 Blue / 💚 Green light → excites

It’s my responsibility to remind you all of this regularly.

👁️ HCQ Retinopathy 🔹 Dose-related retinal toxicity (irreversible) 🔹 Risk ↑ with dose & duration 📌 Risk factors •5 mg/kg/day (real weight) •5 yrs of use •Renal disease •Tamoxifen use •Pre-existing maculopathy 🧪 Screening (American Academy of Ophthalmology 2021

✋ Jaccoud’s Arthropathy (JA) 🧵 📌 Definition •Non-erosive, deforming arthropathy •Seen in SLE & other CTDs • First described in patients with rheumatic fever. ⚠️ Clinical Features •🦢 Swan-neck deformity •👉➡️ Ulnar deviation •✍️ Z-thumb deformity •✨ Reducible

🧵 RA Prevention Trials – Where We Stand 🔹 Why prevention? RA evolves over years → autoantibodies (ACPA, RF) → systemic inflammation → clinical arthritis. Targeting this pre-clinical phase may delay/prevent RA. 🔬 Key Trials ✅ PRAIRI •ACPA+/RF+, no arthritis •Rituximab