Rheumatologist, @NarayanaHealth Bengaluru, India | Passionate about Sjögren’s Syndrome | Calicut - JIPMER - CMC Vellore | Co-convenor APLAR & IRA #Sjogrens SIG
Bangalore
Joined May 2022
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#Sjogrens Syndrome - Year-end thoughts.
Ever since I have been a rheumatologist, I have always found diagnostic delay distressing, and perhaps nowhere is it as prevalent as in Sjogren's.
I am summarising some of my thoughts in a short-long🧵
New Study from OMRF: Salivary antibodies in so-called "sicca non-Sjogrens"
👉Saliva tests detected anti-Ro60 in 75 seronegative sicca patients
👉 Could be a new phenotype
PMID: 40320334
Could salivary antibodies also redefine the diagnosis of #Sjogrens in non-sicca phenotypes?
Sandhya Pulukool retweeted
May is #LupusAwareness month! @rheumnow is running a #Lupus campaign: Keys to Unlocking Lupus.
First blog by Dr Sammaritano rheumnow.com/news/contracept…
@Lupusreference @LupusOrg @EricFMorand @edvital @alhkim @alvinwellsmd @Janetbirdope
Sandhya Pulukool retweeted
Why do we think Sjogrens is only dryness? Is it time to contact our med schools and academies to ask them to address the incomplete (& inaccurate) education they provide so we can provide better care thru better understanding?
#MedTwitter #RheumTwitter #NeuroTwitter
Sandhya Pulukool retweeted
I am happy to see great interest in our new new paper on what not to say to people with complex #chronicillness in a #rheumatology newspaper.
#MedTwitter #NeuroTwitter #LongCovid #MECFS #Dysautonomia
Read full article here: 👇
medscape.com/viewarticle/wha…
Sandhya Pulukool retweeted
You’d never know it from the outside, but someone with a chronic illness can hold a conversation, smile, even laugh…all while simultaneously fighting a battle inside their body.
Brain fog, tachycardia, fatigue, dizziness and more.
We get real good at pretending we’re okay.
Sandhya Pulukool retweeted
Studies show ⬆️mortality in Sjogren’s, SMR ranging from 1.5 -4. Respiratory infections are a top cause. I expect this will increase both directly from Covid and from the immune system damage caused by Covid.
Air cleaners, N95 masks, and vaccines are all important.
🗨 “We knew infections were a concern, but we didn’t expect them to be the leading cause of death,” @RusinovichOlga told us.
Click for more on this #Sjogrens study 👇
healio.com/news/rheumatology…
Sandhya Pulukool retweeted
Fascinating! Gut microbiota in patients may be a possible trigger of small fiber neuropathy in the skin. Conversely, gut microbiota of healthy people might reduce small fiber neuropathy in patients. There is a lot to be learned, but one thing is clear: your #fibromyalgia, #dysautonomia, #POTS and small fiber neuropathy are not caused by your thoughts and attitudes from higher cortical functions. 😉
Sandhya Pulukool retweeted
It’s also good to remember that all of these tests can be negative and you can still have Sjogren’s. This is true for me and many other people with Dysautonomia and small fiber neuropathy. I have multiple systemic manifestations, but 34 years from symptom onset to diagnosis.
Sandhya Pulukool retweeted
🌍 Sjögren’s Awareness Month ends — but our voice stays strong 💙
Thank you for sharing, supporting & raising awareness 🌟
You’ve shown one powerful truth: you are not alone.
We keep going. Together. 💙
#SjögrenEurope #SjögrenAwareness #YouAreNotAlone #Sjögrendisease
🌐 Sjögren’s: The Autoimmune Chameleon of Neurology! 📷SS has the widest neurological manifestations described for any autoimmune disease. CNS < PNS. As pointed out by @NeuroSjogrens, motor neuropathies, CIDP, brain fog, seizures, psychiatric etc, are to be added to the list
Sandhya Pulukool retweeted
👏👏👏👏👏
TY Dr. Pulukool!
(Please RT if you'd like more to be aware about Sjogrens.)
🧠 Which neurological features should make you suspect Sjögren’s?
⚠️ Think beyond & before dryness
➡️ Sensory Neuronopathy/Ganglionopathy
➡️ Small Fiber Neuropathy
➡️ Autonomic Dysfunction
➡️ Optic Neuritis
➡️ Myelitis
➡️ Cranial neuropathy- esp trigeminal
#SjögrensAwareness
Sandhya Pulukool retweeted
Hot off the press 💫
Full article link below :
trebuchet.public.springernat…
🧠 Which neurological features should make you suspect Sjögren’s?
⚠️ Think beyond & before dryness
➡️ Sensory Neuronopathy/Ganglionopathy
➡️ Small Fiber Neuropathy
➡️ Autonomic Dysfunction
➡️ Optic Neuritis
➡️ Myelitis
➡️ Cranial neuropathy- esp trigeminal
#SjögrensAwareness
Sandhya Pulukool retweeted
Can we have the benefits of steroids without their notorious side effects?
Vamorolone, a novel dissociated steroid, shows promise in TNF-α-driven arthritis mice:
— Equal anti-inflammatory power as prednisolone
— Resistant to 11β-HSD1 metabolism
— No adrenal atrophy, muscle wasting, or bone suppression
— Effects sustained even in 11β-HSD1 knockout models
A potential game-changer for safer long-term GC therapy
See the link fir further reading👇
doi.org/10.1093/rheumatology…
#Rheumatology #SteroidRevolution #Autoimmune #Vamorolone #TNFtg #Rheumatology #Immunology
#Sullysrounds #MedX #Medtwitter #Mnemonics #Medicine #History
@DrAkhilX @IhabFathiSulima @Janetbirdope @Lupusreference @RheumNow #MedTwitter #RheumTwitter
Hypokalemic paralysis: Neuro or Nephro?
Hypokalemic periodic paralysis is a channelopathy. The defect is in muscle ion channels. In these channelopathies, ABG is normal & there is no renal potasium loss. In this section of UpToDate, its mentioned secondary hypokalemia should be ruled out.#neurotwitter #nephrotwitter
Cases of Sjogrens + RTA reported in literature till Dec 2021."Rare" cases still being reported without citing this or other papers. pubmed.ncbi.nlm.nih.gov/3632…
Sjogrens is very well documented to cause hypokalemic periodic paralysis. Google scholar link below. I stopped at 40 pages of references re same, some dating to 1980's. Please spread the word.
#MedX #RheumX #NeuroX
scholar.google.com/scholar?h…
📊 440 cases of Sjogrens-RTA (lit review 1965-2021):
🌏 64% from Asia
👥 Median age 37y (range 6-78)
❗Only 7.7% had prior Sjogrens diagnosis
🔍 Subclinical sicca symptoms but high objective sicca positivity
🚨 RTA often an early sign of Sjogrens
#Sjogrens #Renaltubularacidosis
Sandhya Pulukool retweeted
Sjögren’s can also affect gynaecological health too From vaginal dryness to painful intimacy, these symptoms are often under-discussed but deeply impactful. It’s time we shine a light on all aspects of this, because awareness leads to better care.
#sjogrens #sjogrensuk #sjögrens
