🧵 MMF in 2025: Still the Lymphocyte Whisperer 1️⃣ 💊 Mycophenolate mofetil (MMF) remains a backbone immunosuppressant in lupus nephritis, ILD, and more. But in 2025, its story has evolved — from better combos to smarter uses. Let’s unpack the latest. 👇 Dr Ihab Suliman

5️⃣ 🏥 Clinical Uses (beyond LN) • Systemic sclerosis-ILD • ANCA vasculitis (maintenance) • Autoimmune hepatitis (select cases) • Uveitis, myositis, Sjögren’s (off-label) Versatile, especially when fertility or renal preservation matters.

6️⃣ 🧪 MMF vs AZA — 2025 Data A recent RCT confirms it: MMF > Azathioprine in preventing SLE flares during maintenance. 🛡️ Better disease control, same safety profile. Evidence is stacking up.

7️⃣ 🚨 Side Effects to Watch • GI: nausea, diarrhea • Cytopenias • Opportunistic infections (CMV, BK) • Rare: hepatotoxicity 🔄 Switch to enteric-coated MPA if GI issues persist. Stay alert, not afraid.

8️⃣ 👶 Pregnancy & Fertility 🚫 MMF is teratogenic — linked to miscarriage and malformations. 💡 Stop 6 weeks before conception. ✅ Use azathioprine or HCQ in pregnancy. Fertility-sparing, but not pregnancy-safe.

9️⃣ 🧠 Monitoring Tips No routine MPA levels. Focus on: • CBC, LFTs, renal function • Infection screening (CMV, TB, BK) • Adherence 🧬 And don’t forget: no live vaccines during treatment. 🔄 Recheck before vaccines or surgery.

📈 Emerging Uses (2025) • 🫁 Systemic sclerosis skin fibrosis — modest mRSS improvement in meta-analyses • 🧠 AI-guided lupus nephritis pathology scoring now helps personalize MMF dosing • 🧴 Liver transplant patients switching from CNIs to MMF show renal rescue! 🧬 It’s not

1️⃣1️⃣ 🧠 Pro Tips for 2025 Practice • MMF + belimumab = synergy • Splitting dose improves GI tolerance • Expect immunoglobulin dip → watch for infections • Counsel early on fertility & contraception 🎯 Use it wisely. It rewards experience.

1️⃣2️⃣ 💡 MMF in 2025 is not just about suppression — it’s about precision, preservation, and personalization. From lupus kidneys to scleroderma lungs, MMF continues to deliver. #RheumTwitter #NEETPG

💡 Lower Limb Edema — not always HF! ✅ 3–5 kg weight gain → Cardiac edema ✅ Unilateral? → DVT or lymphatic ✅ Periorbital? → Renal/myxedema ✅ Ascites before edema? → Constrictive pericarditis ✅ Face/arms edema? → SVC obstruction 💬 Reply “Tips” or DM to get your copy

👍SPEP Interpretation onconephindia.in/pdf/SPEP-blog.…

🧪Approach to abnormal liver tests Harrison

🫘Pillars of care in CKD NDT Hans-Joachim Anders academic.oup.com/ndt/article/40…

🥳The August issue is online! academic.oup.com/ndt/issue/40/8 🧐Editor's choice: Antibody-mediated rejection—treatment standard doi.org/10.1093/ndt/gf…

Antibody-mediated rejection—treatment standard 🧐Finally, there is hope for effective, approved therapies targeting different aspects of AMR pathobiology ▶️academic.oup.com/ndt/article/40…

🧵 Thread: ESR vs CRP – Friends? Foes? Or Just… Different? They’re both inflammatory markers—but they don’t always agree. Let’s break down how they differ, overlap, and mislead. #MedTwitter Dr Ihab Suliman Dr. Akhil 🇮🇳 Dr Celestino Gutiérrez González MD 🇪🇸🍏🇻🇪

🧵 HBV Reactivation — How to Avoid Triggering a Silent Killer Before Steroids or Biologics Every day, we start steroids, methotrexate, rituximab, TNF-inhibitors. If you miss hepatitis B status → you can cause fulminant hepatitis. Before you start immunosuppression — read this

Mixed Acid-Base Disturbances: Core Curriculum 2025

🇵🇰 Happy Independence Day, Pakistan!

Acid-Base Disorders Algorithm #medtwitter #foamed #usmle