Rheumatoid Arthritis, Chest and Rib Pain: What Is Costochondritis?
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Costochondritis is caused by inflammation of the cartilage that connects your breastbone, also known as your sternum, to your ribs. The pain associated with this condition can closely mimic a heart attack or other cardiac problems, but research suggests that as many as 50 percent of all chest pains are caused by musculoskeletal disorders. Costochondritis is not life-threatening or even harmful, notes the Cleveland Clinic.
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Common Causes of Costochondritis
There are rubbery segments of cartilage — called costosternal joints — that attach the ribs to the breastbone, and chest pain can occur when the cartilage in those joints gets inflamed. “Costochondritis is typically a result of some sort of mechanical stress, like you coughed too hard or you reached too far and pulled something,” says Harry L. Gewanter, MD, a pediatric rheumatologist in Richmond, Virginia. For example, chest pain symptoms could occur after you physically strain yourself moving furniture.
Sharp Pain and Pressure: Costochondritis Symptoms Can Be Scary
The hallmark symptom of costochondritis is pain in the chest wall of varying intensity, and it tends to be described as “sharp,” “aching,” or “pressure-like,” according to research published in the journal American Family Physician. The pain can become even worse with upper body movement or with deep breaths, since it involves joints that flex when you inhale. Although the second to fifth costochondral joints of the ribs are most frequently affected — and especially ribs three and four — it can impact any of the seven rib junctions. Pain can take place in multiple sites, but it’s most frequently unilateral, which means it takes place on only one side of the body, often the left, notes the Mayo Clinic. “It can feel like someone stuck a knife in you, and it can take your breath away,” says Dr. Gewanter. But there’s a good chance that the cause behind the pain isn’t serious.
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Recognizing and Diagnosing Costochondritis
X-rays don’t show soft tissue well and there’s not a blood test for it, so costochondritis is typically diagnosed by a doctor through a physical exam. Older adults experiencing these symptoms may need to get an EKG to rule out the possibility of cardiac problems.
In diagnosing costochondritis, your doctor will rule out other causes of similar chest pain, which can include heart disease, lung disease, gastrointestinal issues, and osteoarthritis, according to the Mayo Clinic.
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The Costochondritis–Rheumatoid Arthritis Connection
Costochondritis is not arthritis in the ribs or the chest and isn’t directly related to RA, but inflammation from RA can be a reason for damage to the rib cartilage. “Costochondritis also happens in people with rheumatic diseases because their joints aren’t working properly, so they can move the wrong way and tweak their bodies even further,” says Gewanter. “It’s a biomechanical issue, and it can become a house of cards.”
While the chest pain may be related to an inflammatory disease, such as rheumatoid arthritis or ankylosing spondylitis, it can also be partially caused by noninflammatory conditions, such as fibromyalgia.
Costochondritis Is Not the Same as Tietze Syndrome
Costochondritis is often confused with Tietze syndrome, a similar but less-common disorder that typically involves swelling of the second or third rib and can last for months. According to the American Family Physician review, Tietze syndrome typically affects people who are younger than 40 and is considered rare. Costochondritis is more common and can affect children, teens, and adults, says Gewanter. In fact, he adds, “the rib cages of kids are extra flexible, so that increases the opportunity to irritate the costochondral junctions.” Local swelling is typically present with Tietze, while it is not with costochondritis. “In reality, whatever you want to call it, both conditions are treated in essentially the same way,” says Gewanter. Tietze syndrome can subside without treatment, but over-the-counter pain medication may be used.
How Costochondritis Chest Pain Is Treated
Treatment typically takes the form of oral pain relievers — typically either Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen). Ice or heating pads can help, says Gewanter, as can minimizing activities that provoke your symptoms. Cough suppressants can reduce discomfort, and sometimes physical therapy is used to alleviate soreness. Antidepressants and anti-seizure medications may be prescribed for chronic pain, according to the Mayo Clinic.
Easing Pain and Other Symptoms of Costochondritis
Some people find relief by splinting the chest using an Ace wrap or something similar to try to minimize chest movement, Gewanter says. “But there really is no great way to treat it, outside of time,” he says.
There’s also no real way of knowing how long the pain will last. The American Family Physician report says that it can last from weeks to months, but for some it may last for a year. “Patients with costochondritis should be educated and reassured that this is a benign condition that will eventually resolve itself,” the journal states, sometimes without any treatment at all.
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