Chest Pain

Reviewed by: HU Medical Review Board | Last reviewed: January 2023

Axial spondyloarthritis (axSpA) can affect many different joints in your body. These include the joints between your spine and ribs or between your ribs and breastbone (sternum). Inflammation in these joints leads to pain and stiffness, making it hard to take a deep breath. While not as common as back pain, chest pain is reported by many people with axSpA.1

What causes chest pain with axial spondyloarthritis?

AxSpA is a progressive disease, which means it can worsen over time. Long-term (chronic) inflammation occurs in the joints and the areas where the tendons and ligaments attach to bones. These areas are called the entheses, and inflammation there is called enthesitis.1

Over time, this inflammation wears away the bone. The body responds by forming more bone, which can lead to the bone tissue growing together (fusing). If your ribs are fused to your spine or breastbone, it can limit how much your chest can move. This might cause chest pain or make it hard to take deep breaths.1

Costochondritis is when the tissue around your ribs and breastbone gets inflamed. The pain you feel in your chest from axSpA could be because of costochondritis.2

How does chest pain with axSpA feel?

The chest pain caused by axSpA may be sharp or achy, and it can move around. It usually affects more than one rib. It also worsens when you take a deep breath, cough, sneeze, or move your chest.1,2

If you have chest pain, see a doctor right away. They will need to rule out any life-threatening conditions (such as heart disease) that could be causing the chest pain.1

How is it diagnosed?

A detailed physical exam is needed to find the cause of chest pain. Your doctor will ask you about your pain, including when it started, how long you have had it, and what makes it better or worse. They will also ask if you have any other symptoms.3

Your doctor will order tests to see what is causing your pain. Tests your doctor might order include:3

  • Blood tests – These tests check for signs of infection, inflammation, or heart attack.
  • X-rays – These images can show problems with your ribs and lungs.
  • Computed tomography (CT) or magnetic resonance imaging (MRI) – These scans can give more detailed images of your chest and lungs.
  • Electrocardiogram (EKG) – This test lets your doctor see the electrical activity and rhythm of your heart.
  • Stress test – This test can check how well your heart functions while you are active.

How is it treated?

Costochondritis is usually temporary and resolves on its own. The overall goal of axSpA treatment is to relieve symptoms and prevent further damage to your joints. Treatment options include:3,4

  • Pain relievers – Over-the-counter (OTC) pain relievers, such as ibuprofen and acetaminophen, can help relieve mild pain. Your doctor might also prescribe stronger pain relievers.
  • Disease-modifying antirheumatic drugs (DMARDs) – These drugs can slow the progression of axSpA.
  • Biologics – Biologics are newer drugs that target specific proteins that play a role in inflammation.
  • Corticosteroids (steroids) – Steroids are powerful anti-inflammatory drugs. They can be taken orally, injected into the joints, or injected into the muscles. These are used for short-term treatment and only as needed.

You might also need physical therapy to help stretch and strengthen the muscles around the affected joints. Physical therapy can help you learn how to move in a way that does not worsen your pain.4

Chest pain can be a symptom of axSpA. If you have chest pain, see a doctor so they can rule out other causes and begin appropriate treatment. With treatment, you can relieve your symptoms and prevent further damage to your joints.1,4

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