Cristina Medina

🧠 EULAR 2025 Recommendations – Behçet’s Syndrome 🚦 Step 1: Assess severity •Not organ/life-threatening → start with: •csDMARDs (AZA ± cyclosporine*) •± glucocorticoids 👉 If response → continue 👉 If NO response → escalate to biologics ⚠️ Organ / Life-Threatening Disease ➡️ Always start high-dose glucocorticoids Then phenotype-based treatment: 👁️ Uveitis •Monoclonal TNFi (adalimumab/infliximab) + csDMARDs •Early biologic use emphasized ⭐ 🩸 Venous disease •TNF inhibitors •± anticoagulation (case-by-case) 🫀 Arterial disease •Infliximab (IFX) > Cyclophosphamide (CYC) •Interventions if needed (aneurysm, occlusion) 🧠 Parenchymal CNS •IFX preferred over other immunosuppressives •(Shift from older AZA-first approach) 🍽️ Gastrointestinal •Monoclonal TNFi 🟢 2. Mucocutaneous + Joint Disease 🪜 Stepwise approach Step 1: Local + baseline therapy •Topical treatments •Colchicine (cornerstone) Step 2: Response check ✅ If controlled → continue ❌ If NOT controlled: 🔸 Mucocutaneous disease •Apremilast or TNFi ⭐ (new stronger positioning) 🔸 Arthritis •Azathioprine or TNFi ⭐ Key Takeaways •Phenotype-driven treatment is central •TNF inhibitors moved earlier across domains •Infliximab preferred in severe vascular & CNS disease •Apremilast upgraded for mucocutaneous disease •Steroid-sparing strategy emphasized •Anticoagulation = adjunct, not primary therapy #RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1 @docakx

💉 IVIG (Intravenous Immunoglobulin) 🔹 What It Is 🧪 A sterile preparation of pooled IgG antibodies derived from the plasma of thousands of donors. → Acts as immune support or immune modulator, depending on indication. 🔹 Mechanism of Action ⚙️ 💭 Depends on indication: •🛡️ Immunodeficiency: Provides passive immunity (antibody replacement). •🔄 Autoimmune / Inflammatory: • 🧩 Fc receptor blockade → ↓ phagocytosis of autoantibody-coated cells • 🎯 Neutralization of pathogenic autoantibodies • 🔥 Suppression of proinflammatory cytokines • 🌿 Expansion of regulatory T cells (Tregs) • 🧊 Inhibition of complement activation 🔹 Common Clinical Uses 🏥 🧬 Immunodeficiency: •CVID •X-linked agammaglobulinemia ⚡️ Neurology: •Guillain–Barré syndrome •Myasthenia gravis crisis •Multifocal motor neuropathy •Autoimmune encephalitis ❤️ Rheumatology: •Systemic lupus erythematosus (SLE) – esp. refractory cytopenias or neuropsychiatric lupus •Dermatomyositis / Polymyositis – steroid-sparing or rescue therapy •Antisynthetase syndrome •Vasculitis (e.g., ANCA-negative or refractory cases) •Catastrophic antiphospholipid syndrome (CAPS) •Systemic sclerosis overlap syndromes 👶 Other: •Kawasaki disease •Immune thrombocytopenia (ITP) 🔹 Dosing 💊 •Induction: 1–2 g/kg total (over 2–5 days) •Maintenance: 400–600 mg/kg every 3–4 weeks (replacement therapy) 🔹 Adverse Effects ⚠️ •😣 Mild: Headache, fever, chills, fatigue •⚡ Moderate: Aseptic meningitis, thrombosis, hemolysis •🚨 Severe: Renal failure (esp. sucrose-containing IVIG), anaphylaxis (IgA deficiency) 🔹 Monitoring 🧾 •💧 Baseline renal function •🧫 Serum IgG levels (for replacement therapy) •👀 Monitor for thrombosis or hemolysis #RheumatDocX #MedTwitter #RheumTwitter #rheumatology @IhabFathiSulima @DrAkhilX @CelestinoGutirr @Janetbirdope