Costochondritis and Chest Pain
Many people with axial spondyloarthritis (AxSpA) experience pain in their chest wall. While AxSpA primarily affects the spine and the SI joints (between the pelvis and the base of the spine), AxSpA can affect any number of joints in the body, including the joints between the spine and the ribs, or the ribs and the sternum (breastbone). When AxSpA causes inflammation and stiffness in these joints in the chest, it can cause pain and stiffness, as well as difficulty in deep breathing.1
AxSpA is a progressive disease, causing chronic inflammation in the joints and the entheses (the locations where tendons and ligaments attach to bones). The chronic inflammation wears away bone tissue, and the body's natural response to form more bony tissue becomes overactive, which can lead to a fusing of the joint. Fused joints between the ribs and the spine or the ribs and the breastbone can limit the movement of the chest and make it difficult to fully expand the chest cavity, causing chest pain or difficulty taking deep breaths.1
What is costochondritis?
Costochondritis is the inflammation of the cartilage around the ribs and breastbone. The pain felt in the chest wall from AxSpA can be due to costochondritis.1,2
AS may also cause pain in the chest due to damage to the joints between the ribs and the spine or the ribs and the breastbone.1
Another extra-articular (beyond the joint) manifestation of AxSpA is lung problems. The chronic inflammation in the body of someone with AxSpA can cause scarring of the connective tissue in the lungs (fibrosis) or other lung issues.3 This lung tissue damage is painless but can cause cough or shortness of breath.
How does chest wall pain from AxSpA differ from other conditions?
The pain caused by chest wall involvement in AxSpA can mimic chest pain that occurs during a heart attack: sharp pain that can radiate to surrounding areas. Because the pain can be similar to heart or lung problems, people with AxSpA who experience chest pain should be evaluated by a healthcare professional to rule out other health problems. The chest wall pain caused by AxSpA can also be variable and may last for a few hours to several weeks.1,2,4
Another similar condition is Tietze syndrome, named for the German physician who discovered it. Tietze syndrome also causes chest wall pain as it creates inflammation in the costochondral (rib) cartilage in the upper part of the chest. However, in people with Tietze syndrome, the upper front area of the chest becomes swollen. Costochondritis does not cause swelling.2,4
How is chest wall pain assessed?
It is critical that anyone experiencing chest wall pain be seen by a healthcare professional to rule out life-threatening causes of chest pain, such as heart disease or pulmonary embolism (blood clot that blocks one of the arteries from the heart to the lungs). Evaluation will include a physical exam where any tender points are noted and a symptom history including understanding when the pain is worse (such as when inhaling deeply or during certain movements or postures). Other tests may be performed to help rule out other conditions, including a chest x-ray.5
How is chest wall pain treated?
Costochondritis is usually a temporary condition that may resolve on its own. Treatment may involve NSAIDs (non-steroidal anti-inflammatory drugs) for pain and discomfort and restricting movements that worsen the pain.
If chest wall pain is caused by AxSpA affecting the joints of the ribs and the spine or the ribs and the breastbone, treatment may include a combination of medication, exercise, and physical therapy. Medications for AxSpA include6,7:
- Non-steroidal anti-inflammatory drugs (NSAIDs), which can help relieve pain and inflammation
- Biologic medications, which may help slow or stop the progression of the disease by blocking key processes or compounds involved in the inflammatory response
- Corticosteroids, which may be used for short-term relief of inflammation
- Slow-acting anti-rheumatic drugs (SAARDs), which may help relieve pain and inflammation, especially in those who cannot take biologic medications
Can you tell when a flare is coming?