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Costochondritis and Rheumatoid Arthritis


Rheumatoid arthritis (RA) is a systemic autoimmune disease in which the body is under attack by its own cells. While most people see it as a disease of the joints and connective tissues, it can actually affect many parts of the body including the lungs and digestive system. Certain related conditions are often seen in RA patients and costochondritis is one of those illnesses.      

The word costochondritis literally means inflammation of the cartilage of the ribs. It occurs where the ribs attach to the sternum with the upper seven pairs of ribs. It may occur bilaterally, but most commonly only one side is affected. Sometimes more than one pair of rib cartilages is involved as well.  

The symptoms of costochondritis are tenderness in the costochondral region (the edge of the breastbone where it connects to the ribs), and pain which can be quite sharp or more of a deep and gnawing nature. The pain is most commonly on the left side and can easily be mistaken for heart-related chest pain. As many as 30% of the patients who are seen in emergency rooms for chest pain turn out to have costochondritis.   

All chest pain is normally assumed to be connected to the heart, so patients with costochondritis often get extensive cardiac tests before the real diagnosis is determined. Costochondritis is a common condition and is proportionately even more common in patients with underlying autoimmune diseases such as rheumatoid arthritis, Crohn’s disease and fibromyalgia.  

Interestingly, blood work such as the CRP (C-reactive protein) test and the sedimentation rate (ESR or “sed” rate) usually are not elevated when a patient has costochondritis. This is not the case in Tietze syndrome, a condition with similar symptoms but one important difference. Tietze syndrome is also inflammation of the rib and sternal connective cartilage, but in it swelling over the area is present. This area may be so tender that even the weight of a sheet may cause severe pain. In Tietze syndrome, blood work will often indicate the presence of inflammation.  

Otherwise, symptoms of Tietze syndrome and costochondritis are very similar. Coughing, deep breathing, and any exertion that moves the chest wall will cause pain and breathing may be difficult. It is rare to know what has caused either disease, although either is sometimes seen after an injury or surgery in this area. Treatment is directed to the symptoms and the condition is normally self-limited. RA patients need to have their disease under good control for best results in therapy.  

Treatment measures can include steroid injections into the painful area, ice packs, lidocaine patches, and rest. Anti-inflammatory medications are also used to treat both Tietze’s syndrome and costochondritis.          

Resources      

Comparison of costochondritis and Tietze syndrome:   www.medicinenet.com/costochondritis_and_tietze_syndrome/      

Costochondritis as a cause of pain in RA:   arthritis.about.com/      

Costochondritis as a cause of chest pain:   www.cnn.com/      
Frequency of costochondritis in women and men:   www.emedicine.com/

RESOURCES:

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