In this episode, we review Sjögren syndrome, a systemic autoimmune disorder that primarily affects the exocrine glands, leading to dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). We explore the immune-mediated pathophysiology involving lymphocytic infiltration of salivary and lacrimal glands, the role of autoantibodies such as SSA/Ro and SSB/La, and the increased risk of B-cell lymphoma associated with chronic immune activation. The episode highlights common clinical features including ocular and oral dryness, parotid gland enlargement, fatigue, and a variety of extraglandular manifestations affecting the lungs, kidneys, nerves, and skin. We also discuss diagnostic evaluation with tests such as the Schirmer test, autoantibody panels, and salivary gland imaging or biopsy, along with supportive and systemic treatment options. High-yield clinical pearls reinforce how to recognize this frequently underdiagnosed autoimmune condition in both clinical practice and board-style scenarios.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Kuryata O, Lysunets T, Karavanska I, Semenov V. Duration till diagnosis and clinical profile of Sjögren's syndrome: Data from real clinical practice in a single-center cohort The Egyptian Rheumatologist. 2020; 42(1):41-46.
3. Bunya VY, Maguire MG, Akpek EK, et al. A New Screening Questionnaire to Identify Patients With Dry Eye With a High Likelihood of Having Sjögren Syndrome . 2021; 40(2):179-187.
4. Carsons SE, Blum MA. Sjogren Syndrome. [Updated 2025 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431049/

In this episode, we review reactive arthritis, an inflammatory arthritis that develops days to weeks after a gastrointestinal or genitourinary infection, most commonly associated with Chlamydia trachomatis, Shigella, Campylobacter, or other enteric pathogens. We discuss the immune-mediated pathophysiology involving molecular mimicry and T-cell activation, as well as the association with the HLA-B27 gene. The episode highlights the classic clinical presentation of asymmetric oligoarthritis of the lower extremities, often accompanied by extra-articular features such as conjunctivitis, urethritis, and enthesitis—remembered by the classic mnemonic "can't see, can't pee, can't climb a tree." We also review diagnostic evaluation, including testing for preceding infections and ruling out other inflammatory arthritides, and discuss treatment strategies focusing on NSAIDs, management of the triggering infection, and DMARDs for persistent disease. High-yield clinical pearls reinforce how to recognize this important seronegative spondyloarthropathy in both clinical practice and board-style exams.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Cheeti A, Chakraborty RK, Ramphul K. Reactive Arthritis. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499831/
3. Denison HJ, Curtis EM, Clynes MA, Bromhead C, Dennison EM, Grainger R. The incidence of sexually acquired reactive arthritis: a systematic literature review Clin Rheumatol. 2016; 35(11):2639-2648.
4. Ehrenfeld M. Spondyloarthropathies Best Practice & Research Clinical Rheumatology. 2012; 26(1):135-145.

In this episode, we review polymyalgia rheumatica (PMR), an inflammatory rheumatic condition that commonly affects adults over age 50 and presents with symmetrical pain and stiffness of the shoulders, neck, and hip girdle. We discuss the immune-mediated pathophysiology, including the role of IL-6–driven inflammation, and the strong association with giant cell arteritis (GCA). The episode highlights classic clinical features such as morning stiffness lasting more than 45 minutes, rapid onset of symptoms, and difficulty with everyday activities like rising from a chair or lifting the arms. We also review key diagnostic clues including elevated ESR and CRP with negative autoimmune serologies, supportive imaging findings, and the ACR/EULAR classification criteria. Finally, we cover treatment strategies—particularly glucocorticoids as first-line therapy, steroid tapering protocols, and monitoring for complications—along with high-yield clinical pearls for recognizing PMR in clinical practice and on board exams.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Lall M, Jackson CD. What Is Polymyalgia Rheumatica? JAMA. 2024; 332(6):514-.
3. Acharya S, Musa R. Polymyalgia Rheumatica. [Updated 2025 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537274/
4. Milchert M, Brzosko M. Diagnosis of polymyalgia rheumatica usually means a favourable outcome for your patient . 2017; 145(5):593-600.

In this episode, we review polyarteritis nodosa (PAN), a rare systemic necrotizing vasculitis of medium and small arteries that leads to vessel inflammation, narrowing, thrombosis, and aneurysm formation. We discuss the underlying pathophysiology, including vascular injury and ischemia affecting multiple organ systems—most commonly the renal, dermatologic, neurologic, gastrointestinal, and cardiovascular systems. The episode highlights key clinical features such as hypertension from renal involvement, painful skin nodules, abdominal pain from intestinal ischemia, and mononeuritis multiplex. We also review diagnostic evaluation, including laboratory studies to rule out other vasculitides, the role of angiography or tissue biopsy, and the association with hepatitis B infection. Finally, we cover treatment strategies ranging from glucocorticoids and immunosuppressive therapy to antiviral management in hepatitis-associated disease, along with important clinical pearls to help clinicians recognize this high-yield systemic vasculitis.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Stanton M, Tiwari V. Polyarteritis Nodosa. [Updated 2023 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482157/
3. Pagnoux C, Seror R, Henegar C, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: A systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French vasculitis study group database Arthritis & Rheumatism. 2010; 62(2):616-626.
4. Schnappauf O, Sampaio Moura N, Aksentijevich I, et al. Sequence‐Based Screening of Patients With Idiopathic Polyarteritis Nodosa, Granulomatosis With Polyangiitis, and Microscopic Polyangiitis for Deleterious Genetic Variants in Arthritis & Rheumatology. 2021; 73(3):512-519.

In this episode, we review lumbar spinal stenosis, a common degenerative condition characterized by narrowing of the spinal canal or neural foramina that compresses nerve roots of the cauda equina. We discuss the pathophysiology of age-related spinal changes—including disk degeneration, facet hypertrophy, ligamentum flavum thickening, and spondylolisthesis—that contribute to canal narrowing. The episode highlights the classic clinical presentation of neurogenic claudication, including leg pain with walking or standing that improves with sitting or forward flexion, often referred to as the "shopping cart sign." We also review key exam findings, diagnostic imaging with MRI, important differential diagnoses such as vascular claudication, and treatment strategies ranging from conservative therapy and physical therapy to decompressive laminectomy in refractory cases.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. 2022;327(17):1688–1699. doi:10.1001/jama.2022.5921
3. Webb CW, Aguirre K, Seidenberg PH. Lumbar Spinal Stenosis: Diagnosis and Management. Am Fam Physician. 2024 Apr;109(4):350-359. PMID: 38648834.
4. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-2367. doi: 10.1016/S0140-6736(18)30480-X. Epub 2018 Mar 21. PMID: 29573870.
5. Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021 Jul 3;398(10294):78-92. doi: 10.1016/S0140-6736(21)00733-9. Epub 2021 Jun 8. PMID: 34115979.

In this episode, we explore rheumatoid arthritis (RA), a chronic systemic autoimmune disease that primarily targets synovial joints and leads to progressive inflammation, cartilage destruction, and bone erosion. We review the underlying pathophysiology, including the formation of the inflammatory pannus and the role of immune-mediated cytokine activity that drives joint damage. The episode highlights key clinical features such as morning stiffness lasting more than 30 minutes, symmetric polyarthritis of the small joints of the hands and feet, and extra-articular manifestations affecting the eyes, lungs, and cardiovascular system. We also discuss the 2010 ACR/EULAR diagnostic criteria, important laboratory markers like rheumatoid factor and anti-CCP antibodies, and imaging findings. Finally, we emphasize the critical 3–6 month "window of opportunity" for early treatment with disease-modifying antirheumatic drugs—especially methotrexate—to prevent irreversible joint damage and long-term disability.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA. 2018;320(13):1360–1372. doi:10.1001/jama.2018.13103
3. Di Matteo A, Bathon JM, Emery P. Rheumatoid arthritis. Lancet. 2023 Nov 25;402(10416):2019-2033. doi: 10.1016/S0140-6736(23)01525-8. Epub 2023 Oct 27. PMID: 38240831.
4. Peterson E, Gallagher MK, Wilbur J. Rheumatoid Arthritis: Diagnosis and Management for the Family Physician. Am Fam Physician. 2024 Nov;110(5):515-526. PMID: 39556634.
5. Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441999/

In this episode, we review Paget's disease of bone, a chronic skeletal disorder characterized by abnormal bone remodeling that leads to structurally weak, enlarged, and deformed bone. We discuss the underlying pathophysiology of accelerated bone turnover, common risk factors such as age over 50, family history, and European ancestry, and the bones most frequently affected—including the pelvis, spine, skull, femur, and tibia. The episode also highlights key diagnostic clues such as elevated alkaline phosphatase levels and characteristic radiographic findings like the "cotton wool" appearance on X-ray. Finally, we cover treatment strategies—including bisphosphonates as first-line therapy, supportive management, and potential complications such as fractures, hearing loss, and rare malignant transformation to osteosarcoma.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Rendina, D., Falchetti, A., Diacinti, D., Bertoldo, F., Merlotti, D., Giannini, S., Cianferotti, L., Girasole, G., Di Monaco, M., Gonnelli, S., Malavolta, N., Minisola, S., Vescini, F., Rossini, M., Frediani, B., Chiodini, I., Asciutti, F., & Gennari, L. (2024). Diagnosis and treatment of Paget's disease of bone: position paper from the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS). Journal of endocrinological investigation, 47(6), 1335–1360. https://doi.org/10.1007/s40618-024-02318-1
3. Bouchette P, Boktor SW. Paget Bone Disease. [Updated 2023 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430805/

In this episode, we review slipped capital femoral epiphysis (SCFE), the most common hip disorder in adolescents and an important orthopedic emergency. We discuss the pathophysiology of growth plate weakening that allows the femoral head to slip relative to the femoral neck, often during periods of rapid growth. The episode highlights classic risk factors such as childhood obesity and endocrine disorders, the typical presentation of hip or knee pain with a limp, and key physical exam findings including limited internal rotation and the Drehmann sign. We also review essential imaging findings—such as Klein's line (Trethowan sign)—and emphasize urgent management with non–weight-bearing status and orthopedic referral to prevent complications like avascular necrosis and long-term joint damage

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Cotton EV, Fowler SC, Maday KR. A review of slipped capital femoral epiphysis. JAAPA. 2022 Dec 1;35(12):39-43. doi: 10.1097/01.JAA.0000892720.49955.c0. PMID: 36412940.
3. Sarah E. Hampl, Sandra G. Hassink, Asheley C. Skinner, Sarah C. Armstrong, Sarah E. Barlow, Christopher F. Bolling, Kimberly C. Avila Edwards, Ihuoma Eneli, Robin Hamre, Madeline M. Joseph, Doug Lunsford, Eneida Mendonca, Marc P. Michalsky, Nazrat Mirza, Eduardo R. Ochoa, Mona Sharifi, Amanda E. Staiano, Ashley E. Weedn, Susan K. Flinn, Jeanne Lindros, Kymika Okechukwu; Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics February 2023; 151 (2): e2022060640. 10.1542/peds.2022-060640
4. Webb CW, Liu R, Bouchereau-Lal N. Slipped Capital Femoral Epiphysis: Rapid Evidence Review. Am Fam Physician. 2025 Oct;112(4):414-423. PMID: 41118186.

In this episode, we review costochondritis, a common cause of noncardiac chest pain resulting from inflammation of the costochondral junctions of the anterior chest wall. We discuss the underlying pathophysiology, common risk factors such as repetitive upper-body activity and chest wall strain, and the typical presentation of localized chest pain that worsens with movement or deep breathing. The episode highlights the importance of a careful history and physical exam—particularly the reproduction of pain with palpation—and when additional testing like an EKG or chest imaging is needed to rule out cardiac causes. We also cover evidence-based management with conservative therapies such as NSAIDs, heat, and activity modification, along with key clinical pearls to help clinicians distinguish costochondritis from more serious causes of chest pain.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Mott T, Jones G, Roman K. Costochondritis: Rapid Evidence Review. Am Fam Physician. 2021 Jul 1;104(1):73-78. PMID: 34264599.
3. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009 Sep 15;80(6):617-20. PMID: 19817327.
4. Expert Panel on Thoracic Imaging, Stowell, J. T., Walker, C. M., Chung, J. H., Bang, T. J., Carter, B. W., Christensen, J. D., Donnelly, E. F., Hanna, T. N., Hobbs, S. B., Johnson, B. D., Kandathil, A., Lo, B. M., Madan, R., Majercik, S., Moore, W. H., & Kanne, J. P. (2021). ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. Journal of the American College of Radiology : JACR, 18(11S), S394–S405. https://doi.org/10.1016/j.jacr.2021.08.004
5. Gulati, M, Levy, P. et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC. 2021 Nov, 78 (22) e187–e285. https://doi.org/10.1016/j.jacc.2021.07.053

In this episode, we review common fractures and dislocations of the upper extremity, focusing on key injury patterns, clinical presentation, diagnosis, and management. We discuss the mechanisms behind common injuries such as FOOSH-related fractures, shoulder dislocations, distal radius fractures, and pediatric growth plate injuries. High-yield conditions—including radial head fractures, Monteggia and Galeazzi injuries, Colles and Smith fractures, Boxer's fractures, Salter–Harris fractures, scaphoid fractures, and lunate dislocations—are highlighted with practical clinical insights. The episode also covers essential evaluation principles such as neurovascular assessment, imaging strategies, and indications for reduction or surgical referral. Key clinical pearls help clinicians recognize high-risk injuries and avoid commonly tested pitfalls in emergency and orthopedic care.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Basener, C. J., Mehlman, C. T., & DiPasquale, T. G. (2009). Growth disturbance after distal femoral physeal fracture. Journal of Pediatric Orthopaedics, 29(4), 356–361. https://doi.org/10.1097/BPO.0b013e3181a0c54c

3) Patel, D. S., Statuta, S. M., & Ahmed, N. (2021). Common fractures of the radius and ulna. American Family Physician, 103(6), 345–354. https://www.aafp.org/pubs/afp/issues/2021/0315/p345.html