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Rheumatology Pearls from Twitter - Really?

May 19, 2015 12:00 am

Twitter?  Really?  

To many of my colleagues (admitted Luddites) the mere mention of Twitter results in the “omi-god 360” eye roll with an accompanying snide comment. To them Twitter, Facebook and all other forms of social media are soapbox forums for the unknowing, propounding the unimportant or unthinkable to an audience of unaccountable unmentionables. Isn’t Twitter an endless tickertape of irrelevant tidbits? Doesn’t the 140 character limit suit the Tourette-blurting egomaniacs amongst us?

Despite similar doubts and trepidations and after examining its use amongst medical types, I decided to give it a try with a single focus in mind: to daily tweet the answer to a rheumatology test question, a pearl or key study results. With nearly 30 years of teaching rheumatology, I thought the content and words should be easy to come by.

I started in late 2012 and have had numerous trainees and young rheumatologists pronounce that my Twitter feed has helped them prepare for their careers. With such encouragement, I forged ahead and @RheumNow (my Twitter handle) has since sent 2000 tweets and gained nearly 2000 followers. Who are these tuned-in followers?  I don’t know for sure, but I can say that for about two weeks I was followed by @LadyGaga (not the real one). I do know there are many trainees, young and old rheumatologists, health professionals, pharma folks, medical societies, publishers and patients in that mix.  

I’m proud to be amongst a group of talented and forward-thinking rheumatologists who regularly tweet about  rheumatology – its advances, practice issues, pearls, controversies, etc.  I once tweeted about the results of a Cochrane review of folic acid use and was surprised to watch a three-day Twitter discussion about how varied rheumatologists are worldwide with regard to folate use with methotrexate.

The following is a top 10 list of my tweets and a short comment on why these may have risen to the top. Engagement by the readership may have been based on the topic, insight, accompanying figure or picture.  


Intl Rheums agree on algorithms for lupus Rx. Least agreement (60%) for constitutional Rx 

March 2015 AC&R article based on the consensus opinion of 37 lupus experts on how they manage specific lupus scenarios. One table says it all!


MTX-induced nodulosis is rare; more in RF+ than RF; mostly fingers; unrelated to sex, RA duration, MTX dose/duration.

I took a picture of one of my patients with MTX nodules and researched how often and who gets this - turns out, not so often.


Drs. Cush, Kavanaugh & Stein announce the launch of Free Online Rheum Textbook "" @#ACR14 - yes. It’s free

In October (at the ACR meeting) we launched our free online rheumatology text called “RheumaKnowledgy”.  Written to provide concise answers about tests, diagnoses or drugs. Try it, you’ll like it...and it’s free.


#ACR14 Very high titers of CCP antibodies are associated with a >10% risk of interstitial lung disease, with or without a diagnosis of RA  #1377

A 2014 ACR abstract by Bussey et al showed increasing CCP levels associated with more ILD in RA and non-RA patients. Levels >300 IU had a 10% chance of having ILD.


#ACR14 SIRAS database of 949 Ankylosing Spondylitis patients shows that smokers have more disease activity & worse function than ex-smokers #563

A 2014 ACR abstract by Azeni et al showed smoking and disease activity are common conspirators in AS, as they are in RA.


The greater the ignorance the greater the dogmatism. - Sir William Osler

When I run across a good quote, I put it on the refrigerator (in between all the magnets). If it’s really good, I’ll tweet it.  MDs love Osler; he is the Bill Murray of medicine.


Chinese study Bx-proven lupus nephritis shows signif more remissions w/ Combo tacrolimus/MMF/Pred vs ivCTX (46 v 26%)

IV CTX is a standard in managing lupus nephritis. This Chinese study comes along and outperforms iv CTX with combo tacrolimus, MMF and prednisone, a surprise to many. Efficacy (response and time to response) was better and adverse event rates were similar.


FDA today approved #apremilast (Otezla) for use in #psoriatic arthritis. based on 3 "Palace" trials in 1493 #PsA pts

Apremilast made a splash with several key studies in psoriasis, psoriatic arthritis and recently Behcet’s.


Study of 367 Knee Osteoarthritis pts shows 1500mg/d of Turmeric is equal to or better/safer than ibuprofen 1200mg/d

The popularity of this tweet underscores the fact that I have many followers who are non-rheumatologists (e.g., patients, pharma folks, societies).


#ACR2014 abstract #692 - SSA/Ro positivity is associated with a higher risk of severe mitral regurgitation-adding to a long list of other SSA associations

This 2014 ACR abstract by Higuera et al showed the presence of SSA/Ro antibodies conferred a OR of 6.5 (P=0.03) for the presence of severe mitral regurgitation.


How you use Twitter or what you write is up to you. Dr. Ronan Kavanagh (@ronankavanagh) said, “The act of distilling the essence of a paper into 140 characters knowing it’s to be read by colleagues focuses the mind like nothing else!”. While I try to stick with news, information and medical education, I sometimes inspire others (or is it myself?) with:

  • “Idealism and cynicism are easy. It's negotiating the in-between that's difficult, interesting and worthwhile.”

  • “Never overestimate your power to change others 0R underestimate your power to change yourself. Winners do what losers don’t want to.”

  • “Tis risky to base practice on anecdotalism, wiki- or google-medicine when evidence exists in the form of randomized clinical trials.”

You should sign up for Twitter and let your influence shine while learning from others. It’s easy: choose a name (handle) and you can start to follow the musings and teachings of few or many. Next, you can choose to teach and share or learn and watch others.

Follow me (@RheumNow) as I remain committed to providing good info to make good rheumatologists better.  Other rheumatologists who you should follow include @RonanTKavanagh, @PhilipGardiner, @doctorakerkar, @philipcrobinson, @ronfvv (Ron van Vollenhoven), @jesdaile (John Esdaile), @ProfDavidHunter, @HausmannMD (Jon Hausmann), @drhectorchinoy, @EDRosten (Eliot Rosenstein), @HaniElgabalawy, @DrBhana, @DrAiLynTan, @RWCSmtg (Artie Kavanaugh),  @Rheummd (Steve Paget), @alvinwellsmd, @Dr_Noe_Olvera, @JointMD (Eric Ruderman), @psufka (paul Sufka) and @emartinmola (Emilio Martin Mola).

Twitter! Really!


Dr. Cush is the Executive Editor of and also Co-Edits the online textbook 
Dr. Cush's interests include medical education, novel drug development, rheumatoid arthritis, spondyloarthritis, drug safety, and Still's disease/autoinflammatory syndromes. He has published over 140 articles and 2 books in rheumatology.
He can be followed on twitter: @RheumNow