How Twitter use in rheumatology has evolved

How I Came to Use Twitter

In December 2010, I wrote my first blog post. Blogging was cathartic and a way to reflect on why we do the things we do as rheumatologists, while also getting rapid feedback from the community. Blogging took time and it was hard work to craft a piece of writing, so my next foray was twitter. I set up my twitter account, @_connectedcare, in January 2011. Twitter had a very different rhythm to blogging. At that stage, you had to convey the message as a tweet of 140 characters. Feedback could be near instantaneous and the message quickly amplified by retweets.

Who Used Twitter in the Old Days

It was easy to work out all the rheumatologists on twitter at the start of 2011, a small, collegiate bunch. We had similar reasons for utilising twitter. Many were writing blogs to help educate patients and each other. Many were trying to correct the medical misinformation on social media. Most were early adopters in technology. We seemed to get on well on-line, supporting each other where we could.

Twitter was already used at the large rheumatology conferences. The American College of Rheumatology sought to promote this and established its own twitter account in May 2010, @ACRheum. The volume of conference tweets was more manageable then, with less industry involvement and less marketing. Tweets were designed to help others catch up on information they may have missed, to discuss opinions and experiences triggered by the presented data, to keep awake and to discuss what plans we had for sightseeing.

We had “tweet-ups”. Given the small community of regular twitter users, we would arrange to meet in person, using twitter, either at the conference or at some restaurant, an important bonding experience.

Engaging with the Public and Patients

The dynamic and open nature of twitter leads to some engagement with the public and with people who suffer from rheumatic disease.

The platform is clearly not suitable for specific medical advice. Most rheumatologists using twitter would have been asked direct questions from a member of the public about their personal health so replies will have to be considered and generic. Some rheumatologists would just choose to ignore such messages.

Enter RheumNOW

The single biggest influence in increasing use of twitter and social media in rheumatology has been Jack Cush, @RheumNow.

The RheumNow website^[1] started in 2015,. The offering includes a blog, video updates, a podcast, and a daily e-mailed newsletter.

It’s important to note that RheumNow is run as a business, supported by pharmaceutical companies. Rheumatologists are recruited globally to create independent content during the 2 major rheumatology conferences, the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR), with a coordinated, team approach to increase mentions, retweets, likes, and impressions for @rheumnow during an intense period of twitter activity. All this is backed up by a professional editorial and technical team.

RheumnNow has displayed great timing on the bell curve of technology adoption, engaging with our community as the early majority phase is reached.

Twitter Usage in Rheumatology in the Asia Pacific region

Compared with its Western counterparts, the Asia-Pacific League of Associations for Rheumatology (APLAR) represents a highly diverse group of countries and rheumatology societies. APLAR has attempted to increase its use of twitter around the time of its annual scientific conference with limited success.

One major issue is the diverse languages and different social customs of the rheumatologists within APLAR. For example, the Chinese rheumatology community is large and productive, with the ability to contribute research and clinical understanding at a scale that dwarves other rheumatology societies, so I would expect there to be use of Chinese-language social media platforms such as WeChat and Weibo. Twitter as a global platform is diminished by the absence of scholarly conversations from this group of Chinese rheumatologists.^[2]

Some countries within the APLAR region have regulations and restriction on social media use so this may also act as an impediment. Cultural inhibitions and the risk of miscommunication when utilising English as a second language may also act as deterrents to using Twitter.^[2]

Twitter Use and the Covid Pandemic

The corona virus disease 2019 (COVID-19) pandemic provided Twitter a prominent role in spreading and moderating scientific communication. There was much discourse about the use of immunosuppressive medications, Covid vaccines, the use of telemedicine and the reporting of Covid-related statistics.^[3] Twitter led directly to the rapid set-up of a digital crowdsourcing, scientific collaboration project, the COVID-19 Global Rheumatology Alliance registry.^[4]

Changing Use of Twitter by Rheumatologists

My personal use of twitter has steadily reduced and I have noticed the same amongst many early adopters. This is to be expected as people develop different interests and pursuits. There is contentment with seeing a new breed of rheumatologists of twitter, flying the flag, taking up the challenge to educate and promote rheumatology.

After the EULAR conference in June 2022, this twitter thread summarises how twitter is being used.

Academic Tweeting

Apart from curation and sharing of information, Twitter is being used by rheumatology academics for scientific discussion through virtual journal clubs, direct sourcing of information from a collective brains trust, promotion of published medical journal content, pre- and post-publication discussion, and branding.

Journals and their editors now tactically optimize their social media posts and tweets to generate commentary and to attract followers (Figure 1).^[5]

Figure 1

Summary Slides from Laurent Arnaud, @Lupusreference, summarizing the role of Twitter for the dissemination of medical information.^[6] EULAR, European League Against Rheumatism.

Conclusion

We now have a generation of rheumatologists who have grown up with social media and its use is embedded at all the global rheumatology conferences. English-speaking rheumatologists will utilise Twitter as a tool to engage and connect, to inform and reflect, to challenge and be challenged, to be supported and to lead, to learn and perhaps to inspire.