iiinova — where your digital self keeps evolving

Rheumify @rheumify.bsky.social · 10/07/2026

Friday recall — anabolics: Teriparatide, abaloparatide (PTH), romosozumab (anti-sclerostin) Very-high-risk → anabolic FIRST, then antiresorptive; never reverse Romosozumab: CV boxed warning, avoid after recent MI/stroke GIOP: protect early at low-dose steroids

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Rheumify @rheumify.bsky.social · 09/07/2026

Board trap: romosozumab builds bone fast by blocking sclerostin — but it carries a cardiovascular boxed warning. Avoid it in patients with an MI or stroke in the past year. The right drug for the bones can be the wrong drug for the heart.

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Rheumify @rheumify.bsky.social · 08/07/2026

Case: a 68-year-old woman on alendronate fractures her hip with minimal trauma. DXA T-score −3.4. Her physician doubles down on the bisphosphonate. Best move?

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Rheumify @rheumify.bsky.social · 07/07/2026

Resident pearl: anabolics aren't last-resort. For very-high-risk patients — T-score ≤ −3.0, recent fracture, or fracture while on an antiresorptive — build bone FIRST with an anabolic, then lock it in.

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Rheumify @rheumify.bsky.social · 06/07/2026

Mnemonic Monday — anabolics build bone: the PTH twins teriParatide and abaloParatide (both have Para), plus romosozumab. The flip: each must be followed by an antiresorptive, or the new bone you built melts away.

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Rheumify @rheumify.bsky.social · 03/07/2026

Friday recall — antiresorptives: Bisphosphonates: bind bone, block clasts; holiday after 5y oral / 3y IV Denosumab: anti-RANKL; NO holiday — stopping = rebound fractures, always bridge Watch: atypical femur fracture, osteonecrosis of the jaw

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Rheumify @rheumify.bsky.social · 02/07/2026

Board trap: dull, aching thigh or groin pain in someone on long-term bisphosphonate or denosumab isn't just arthritis — think atypical femur fracture. Subtrochanteric, transverse, often bilateral, and visible before the bone fully breaks. Image both femurs.

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Rheumify @rheumify.bsky.social · 29/06/2026

Mnemonic Monday — bisphosphonates, the 3 B's: they Bind Bone and Block osteoclasts. The flip: take on an empty stomach with water and stay upright 30–60 minutes, or you risk pill esophagitis.

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Rheumify @rheumify.bsky.social · 28/06/2026

Case: a 74-year-old woman has taken denosumab for 4 years and wants to stop for cost. Her doctor agrees and simply discontinues it. Three months later — acute back pain. What happened?

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Rheumify @rheumify.bsky.social · 27/06/2026

Resident pearl: bisphosphonates earn a drug holiday after ~5 years oral / 3 years IV in lower-risk patients — they linger in bone and keep working. Denosumab does not. There is no denosumab holiday.

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Rheumify @rheumify.bsky.social · 26/06/2026

Friday recall — osteoporosis basics: Clasts consume, blasts build Dx: T ≤ −2.5, OR fragility fracture, OR high FRAX T-score = vs young adult; Z = vs same age Treat at FRAX ≥3% hip / ≥20% major

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Rheumify @rheumify.bsky.social · 25/06/2026

Board trap: a normal DXA T-score does NOT rule out high fracture risk. A prior fragility fracture or a high FRAX score diagnoses osteoporosis regardless of BMD. Treat the risk, not just the number.

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Rheumify @rheumify.bsky.social · 24/06/2026

Wednesday Q: a 45-year-old premenopausal woman gets a DXA. Do you report her bone density as a T-score or a Z-score — and who gets which?

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Rheumify @rheumify.bsky.social · 23/06/2026

Resident pearl — the highest-yield mechanism in bone: RANKL (the demolish order, mostly from osteocytes) binds RANK to make osteoclasts; OPG is the decoy that mops up RANKL. Mnemonic: RANK says WRECK; OPG says protect.

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Rheumify @rheumify.bsky.social · 22/06/2026

Mnemonic Monday — how do you build bone? "Wnt? Why not build!" The Wnt signaling pathway tells a mesenchymal stem cell to become a bone-building osteoBlast. Block Wnt — which is exactly what sclerostin does — and the pour crew slows; lift that brake with romosozumab and building resumes.

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Rheumify @rheumify.bsky.social · 21/06/2026

New on the Rheumify Substack — Osteoporosis Module 1: bone remodeling and why the osteoclast/osteoblast tug-of-war decides who fractures. open.substack.com/pub/rheumify/p/os…

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Rheumify @rheumify.bsky.social · 19/06/2026

ScriptCycle for Rheumatology just got AI agents — they draft cover letters, suggest target journals, and triage your paper ideas. It runs your whole publishing cycle (manuscripts, submissions, abstracts) in Notion. Still free: notion.com/templates/scriptcycle

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Rheumify @rheumify.bsky.social · 19/06/2026

Friday recall — GCA in one screen: Who: >50, new headache, jaw claudication, vision loss, scalp tenderness, PMR overlap Labs: high ESR/CRP (can be normal) Dx: temporal artery biopsy or ultrasound halo Tx: steroids NOW; tocilizumab to spare steroids pubmed.ncbi.nlm.nih.gov/34235884

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Rheumify @rheumify.bsky.social · 18/06/2026

Board trap: a negative temporal artery biopsy does NOT rule out GCA — pooled sensitivity is only ~61%. Skip lesions and large-vessel-predominant disease mean biopsy can miss it. If suspicion is high, treat and image. pubmed.ncbi.nlm.nih.gov/33811481

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Rheumify @rheumify.bsky.social · 17/06/2026

Vision loss in GCA is usually arteritic anterior ischemic optic neuropathy — from occlusion of the posterior ciliary arteries that supply the optic nerve head, not the central retinal artery. Once it's lost, it rarely comes back. pubmed.ncbi.nlm.nih.gov/9559737

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Rheumify @rheumify.bsky.social · 16/06/2026

Resident pearl: suspect GCA? Start high-dose steroids now — don't wait for biopsy. In a VA cohort, delaying prednisone 14–28 days after diagnosis tripled 1-year ophthalmic complications in biopsy-negative patients. pubmed.ncbi.nlm.nih.gov/33417014

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Rheumify @rheumify.bsky.social · 15/06/2026

GCA week. Of all GCA symptoms, jaw claudication carries the highest likelihood ratio for a positive temporal artery biopsy. Masseter pain that builds while chewing and eases with rest is ischemia, not TMJ. pubmed.ncbi.nlm.nih.gov/11754714

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Rheumify @rheumify.bsky.social · 14/06/2026

ANCA vasculitis pearl: PR3/c-ANCA skews toward GPA, MPO/p-ANCA toward MPA — and PR3 positivity predicts higher relapse risk, which shapes how long you maintain therapy.

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Rheumify @rheumify.bsky.social · 14/06/2026

ANCA vasculitis pearl: for remission maintenance, scheduled rituximab outperformed azathioprine at preventing major relapse (MAINRITSAN). pubmed.ncbi.nlm.nih.gov/25372085

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Rheumify @rheumify.bsky.social · 13/06/2026

ANCA vasculitis pearl: PEXIVAS reset two habits — plasma exchange did NOT reduce death or end-stage kidney disease in severe AAV, and a reduced-dose glucocorticoid regimen was noninferior with fewer serious infections. pubmed.ncbi.nlm.nih.gov/32053298

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Rheumify @rheumify.bsky.social · 13/06/2026

ANCA vasculitis: the FDA is moving to withdraw avacopan (Tavneos), alleging ADVOCATE remission endpoints were re-adjudicated after database lock — flipping a nonsignificant result to significant — and citing 76 serious liver-injury cases. Comment by June 29. fda.gov/media/192160/download

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Rheumify @rheumify.bsky.social · 12/06/2026

Friday recall — ANCA in one screen: c-ANCA / PR3 → GPA (airway + kidney) p-ANCA / MPO → MPA (kidney + lung) & EGPA (asthma + eosinophilia) Induction: rituximab or cyclophosphamide + steroids.

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Rheumify @rheumify.bsky.social · 11/06/2026

Board trap: a negative ANCA does NOT rule out vasculitis. ~50% of EGPA is ANCA-negative, and limited GPA can be too. ANCA supports the diagnosis; tissue + clinical picture make it. Treat the patient, not the titer.

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Rheumify @rheumify.bsky.social · 10/06/2026

Resident case: 58M, months of bloody nasal crusting + a new saddle-nose deformity, now hemoptysis and Cr 2.4 with RBC casts. What test do you order while awaiting the results of the renal biopsy?

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Rheumify @rheumify.bsky.social · 09/06/2026

Resident pearl: think GPA when you see the triad — destructive upper airway (saddle nose, chronic sinusitis), pulmonary nodules/hemoptysis, and pauci-immune glomerulonephritis. Upper + lower airway + kidney.

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Rheumify @rheumify.bsky.social · 08/06/2026

Mnemonic Monday "GrandPA Cs the PR3tty cytoplasm." GPA = c-ANCA = anti-PR3, cytoplasmic staining. Flip side: Perinuclear (p-ANCA) = anti-MPO = MPA & EGPA. This week: ANCA-associated vasculitis.

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Reposted by Rheumify

Alison Bays, MD (she/her) @alisonbays.bsky.social · 02/12/2025

I did a thing! I created a free manuscript (and abstract/idea) tracker for rheumatology researchers in Notion. check it out here! Would love feedback: quartz-keyboard-29d.notion.site/ScriptCycle-...

open.substack.com

ScriptCycle: Notion for Rheumatology Researchers

Free!

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Rheumify @rheumify.bsky.social · 21/11/2025

RheumCast is complete! It’s 14 AI generated podcasts reviewing the ACR’s clinical practice guidelines! Listen free on SoundCloud: soundcloud.com/rheumify

open.substack.com

RheumCast is complete!

Clinical Practice Guidelines

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Rheumify @rheumify.bsky.social · 18/11/2025

Why is the answer often “B”? Rheumify update Questions: 518 Flashcards: 565 Podcasts: 5

Rheumify @rheumify.bsky.social · 12/11/2025

Worked on the spaced repetition flashcards today for Rheumify! Validated Questions: 510 Validated Flashcards: 523 Uploaded Podcasts (Clinical Practice Guidelines): 4 (SLE, ILD, RA, vaccination)

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Rheumify @rheumify.bsky.social · 06/11/2025

Rheumify updates: Validated Questions: 504 Validated Flashcards: 445 Uploaded Podcasts (Clinical Practice Guidelines): 3

open.substack.com

Rheumify: mistakes were made

Vibe coding errors!

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Rheumify @rheumify.bsky.social · 04/11/2025

Rheumify has a podcast! One episode so far with AI hosts discussing lupus nephritis guidelines. You can listen for free on Substack, more guideline podcasts to come.

rheumify.substack.com

Announcing...RheumCast

Rheumatology + Podcast + Clinical Practice Guidelines

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Rheumify @rheumify.bsky.social · 02/11/2025

Using Claude and Airtable to get insights on the Rheumify Question Bank!

open.substack.com

Rollin' with Rheumify

Question bank insights

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Rheumify @rheumify.bsky.social · 31/10/2025

Check out the 5 step method for improving your rheumatology (and internal medicine!) board exam taking skills!

open.substack.com

Rheumify: 5 step question process

How to tackle rheumatology boards

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Rheumify @rheumify.bsky.social · 31/10/2025

Update on rheumify! 497 validated questions and 371 validated flashcards. Next up, I'm working with AI to analyze and categorize question types to help trainees with their board test taking skills.

open.substack.com

Rheumify: Improving Test Taking Skills

Building a board exam strategy

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Rheumify @rheumify.bsky.social · 06/10/2025

Here's how I'm making a rheumatology news feed and adding it to my question/flashcard app! Current status: 273 flashcards, 441 questions validated.

rheumify.substack.com

Building a Rheumatology News Feed

Claude and N8N

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Rheumify @rheumify.bsky.social · 29/09/2025

Why is it important to validate medical practice questions created with AI? I asked Claude to avoid medical buzzwords. In one instance, Claude described “velcro crackles” as “dry inspiratory sounds resembling hook-and-loop fasteners”. Claude was quite proud.

open.substack.com

Validating the Question Bank

Rheumify Ruminations

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Rheumify @rheumify.bsky.social · 26/09/2025

How I used GlideApps and NotebookLM to update Rheumify. Now with a question randomizer and progress bars.

rheumify.substack.com

Rheumify updates

Question randomizer & progress reports

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Rheumify @rheumify.bsky.social · 24/09/2025

Spaced Repetition is live on Rheumify! Here's more info on how I set that up.

open.substack.com

Rheumify: Spaced Repetition is Live

Flashcard Frenzy

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