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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

Answer: no. A fracture ON an antiresorptive defines very-high-risk and signals a switch to an anabolic (romosozumab, teriparatide, or abaloparatide), then resume an antiresorptive afterward. Build first, then protect.

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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

Fellow pearl: sequence is one-directional. Anabolic-then-antiresorptive maximizes gains; antiresorptive-first (especially after denosumab) blunts the anabolic response. Build, then protect — never the reverse.

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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

Answer: rebound-associated vertebral fractures. Stopping denosumab without bridging lets suppressed bone turnover overshoot, often causing multiple vertebral fractures. Never stop it cold — always transition to a bisphosphonate.

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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

Fellow pearl: stop denosumab and you get rebound — a wave of vertebral fractures within months as suppressed remodeling overshoots. Never just discontinue; always bridge to a bisphosphonate.

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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

Answer: Z-score. Mnemonic: Gen Z gets the Z; the older crowd gets the T. The young — premenopausal women, men under 50, and kids — are read on the Z-score (vs age-matched peers); postmenopausal women and men 50+ get the T-score. A Z ≤ −2.0 prompts a secondary-cause workup.

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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

Fellow pearl: denosumab is a monoclonal antibody to RANKL — same functional endpoint as the body's natural decoy OPG, just an antibody instead of a receptor. That's why stopping it unleashes rebound.

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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

Don't make steroids the whole plan — the 2021 ACR/VF guideline conditionally recommends tocilizumab plus glucocorticoids over glucocorticoids alone for newly diagnosed GCA. pubmed.ncbi.nlm.nih.gov/34235884

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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

And don't be reassured by normal labs: a subset of biopsy-proven GCA presents with a normal ESR and CRP. If the story fits, pursue the diagnosis and treat anyway. pubmed.ncbi.nlm.nih.gov/40682608

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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

PR3-ANCA (c-ANCA) → granulomatosis with polyangiitis; pauci-immune crescentic GN. In RPGN, treat — don't wait on biopsy. Induction: rituximab or cyclophosphamide + steroids.

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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

Fellow pearl: PR3-ANCA relapses more than MPO-ANCA, and in RAVE rituximab outperformed cyclophosphamide for relapsing disease.

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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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