Chest Pain in Rheumatoid Arthritis: Costochondritis Anyone?
Severe chest pain can send you to the ER – unless you know it’s “just” the Rheumatoid
This past week, someone turned up the volume on my chest pain. I was glad I’d heard other patients say they went to the ER for chest pain and it turned out to be “just” costochondritis. Maybe that prepared me so I wasn’t frightened when it happened to me. The chest pain has gotten severe, and it joins the chorus of the shoulders, knees, neck, hands, wrists, and toes… A chorus of disharmony.
Costochondritis is not new to me. The first time we met Dr. Smart, doc pressed on my rib joints and asked, “Is that tender?” Surprised to be asked that, I said, “Yes.” Doc said it’s common with RA. Really?
Common like cricoarytenoid joint arthritis (which doc didn’t believe in)? Or like ear pain? Or neck inflammation? Or shortness of breath? Or other Rheumatoid Disease-caused problems we don’t know what to do about?
(Doc never doubted my DIP joints though – and injected one of them with steroids.)
Costochondritis: one of the neglected Rheumatoid symptoms
As early as 1964, the journal Radiology published a study explaining that the effects of Rheumatoid Arthritis on the rib joints “have not been adequately described in the literature.”[1] Mayo Clinic’s description of costochondritis makes it clear the word describes a symptom, pain or inflammation of the rib joints that can be caused by various illnesses.[2,3] The term is also confusing because there can be varying diagnoses with similar symptoms, as you can see in the Medscape costochondritis diagnosis page.[4]
But I’ve also read some skeptical articles about the symptom, to put it politely. Costochondritis is considered by many a garbage can diagnosis or related to hypochondriasis.
Costochondritis is sometimes distinguished from Tietze syndrome because the latter has swelling. However, as we’ve learned, inflammation often includes inconspicuous swelling. I suspected my own rib joints were swollen yesterday, and compared to how they are now, I’m certain of it.
With the many common RD mix-ups like this, my solution is to specifically describe what’s happening, especially when talking to a doctor, and leave out the hot-potato word. Without thinking, that’s what I did in my inventory post: it discusses ribs along with clavicle inflammation, but doesn’t say costochondritis.
Costochondritis obviously does exist.
Like many things in medicine, it is doubted or mocked by some because too little is known. And it is all too real to people living with inflammatory diseases that attack joints.
Costochondritis is treated, like other joint inflammation, by rest, NSAIDs, ice or heat, and prednisone. Pain medications can help manage severe costochondritis. And if it is persistent, steroid injections can be used. Usually, as with other joints, the inflammation subsides to a more manageable level in a few days. I’m counting on that because the only other solution I can think of is to not breathe. It hurts too much.
Have you had pain where your sternum meets your ribcage? Did you ever notice swelling? What did your doctors say?
Recommended reading
- Inventory of Rheumatoid Disease: One Patient’s Experience
- Sternoclavicular Joint Involvement in Rheumatoid Arthritis: Fascinating Discovery of a “Neglected Joint”
- Should Chronic Pain Patients Be Treated in the ER?
- Traveling with Chronic Illness/RA Part 2: 20 Helpful Tips
FOOTNOTES
1 Alpert M, Feldman F. The rib lesions of rheumatoid arthritis. Radiology. 1964 May [cited 2013 Aug 27]; 82: 872-875
2 Mayo Clinic [Internet]. Costochondritis. 2012 May 6 [cited 2013 Aug 27]. Available from: http://www.mayoclinic.com/health/costochondritis/DS00626
3 HealthHype.com [Internet]. Severe costochondritis – causes, symptoms, treatment. 2010 May 9 [cited 2013 UF 27]. Available from: http://www.healthhype.com/severe-costochondritis-causes-symptoms-treatment.html#more-8619
4 Flowers LK. Medscape [Internet]. Costochondritis. 2012 Apr 13 [cited 2013 Aug 27]. Available from: http://emedicine.medscape.com/article/808554-overview
5 Wikipedia contributors. Costochondritis [Internet]. Wikipedia, The Free Encyclopedia; 2013 Aug 23 [cited 2013 Aug 27]. Available from: http://en.wikipedia.org/w/index.php?title=Costochondritis&oldid=569906531
thank you i too thought i was the only one with this horrible pain in chest as describe by all you good people on here my ribs swell up and between them is sore to touch as well and of course the knife pain to the heart area which nearly dropped me to floor last week it was so bad i was diagnose when in my 40 years and every time before that in cardiac they looing at me as though i was putting it on im 72 now and have just had a pace maker fitted due to iregular heart beat felt really good but my crontivitus has increase so much ive to go to doctor tomorrow but now knowing im not the only one and armed with some of your suggestion im hopefull thanks to all and hope you all get relief
Tanks for the info! I have had pain there and will tell my rheumatologist about it.
I’m so impressed with your blog and so happy to have found it; it’s a great combination of common sense explanations and links to technical info. I have RA and was just at the ER (recommended by my primary care physician as a precaution) this week with chest pain and shortness of breath and they cleared me and had me follow up with my cardiologist. It was the cardiologist who pressed on my sternum (ouch!) and speculated that it might be an RA thing, I’m so glad he mentioned that. I had started a flare (caused by the abrupt weather changes in the east i think) the day before the chest pain but never thought to associate it with RA, now I’ll at least know this in the future and make sure to keep my rheumatologist in the loop on this symptom. Thanks so much for your insight and information.
Cathy
I too have been to the er for chest wall pain. I ended up leaving because the wait was too long. I started to realize that it felt like ra as it moved from the left chest/back to the right. My rheumatologist office did x-rays but nothing showed. It has been 6 weeks now and some days are unbearable. I was glad to see this post and will start using heat.
I have being diagnose with costochondritis a fewmonths ago.Now I’m having j joint pains.I need more information.
I have had chest/rib tenderness almost constantly for 4 years, to the point where underwire bras left me in agony. I only get the sharp pains when I’ve been working too hard, I’m a seamstress & milliner. It was suspected that I had RA 3 years ago, but not sent to a Rheumatologist, until I had a frozen shoulder & changed GP because I was getting no help. “just take so anti inflammatories & exercise – you’ll be fine.” but I can’t lift my arm!
Started seeing a rheumatologist a year ago & when I mentioned my rib issues he told me he had never come across a case costochonditis in 25 years, so clearly I can’t have it.
I have finally found a supportive wireless bra, from Victoria Secret of all places, & the pain is not as bad, but it never goes away.
You mention clavicle swellings…I have those also but can’t find any info on them. If you have some I would be most grateful – they were my very first RA symptoms 20 years ago. I have incredibly tender clavicles- and pressure at all is painful. I have swelling around back of my neck but negative for any other illness. Now I have wicked rib pain on my right side. It began before the Rituximab infusions I just had. Very interested in this article. .like you its toes,ankles, knees, hips, shoulders, elbows, wrists. …the list goes on. Add to that a brain stem stroke and now Thalmic pain syndrome and life is a whole heap of fun.
I was diagnosed with RA in 2005. My symptoms stayed in my wrists, hands, and shoulders. Several of these attacks were literally years apart, but extremely painful when they were flairing. For the past several years my worst was very mild, only tight hands or a sore wrist for a few days. Until last week. I walked out of a restaurant fine… within 100 feet I was experiencing a pain in my centre chest and very restricted breathing. Another 400 feet to the car was absolute torture. Yeow! seems like a possible heart attack I thought. This now felt like a baseball on the middle of my chest and a ratchet strap being tightened mercilessly around that. I was panting, only able to say two words per breath with heavy pain on each inhale. Probably using 5% of my lung capacity at a maximum. Arrived at the ER within 10 minutes and was given test for a heart attack… nothing! Had high blood pressure 190/110 (my normal is 120/70) and very shallow breathing. Every breath felt like a knee was being forced into my chest. They had given me Nitroglycerine and 3 hits of morphine.. the pain did not abate. After a battery of tests, xrays, and blood work… an internalist the next morning diagnosed RA… yup, my first attack of costocondritis. He gave me prednisone and basically liquid celebrex… relief! not total but a huge step toward feeling normal. 3 days later.. released from the CCU and saw my Rhuemmy … even he doubted the costocondritis diagnosis until he did a bit of a physical and reviewed the hospitals results. Now its prednisone and celebrex for a month (I don’t normally take these, its on an as required basis). Symptoms that led up to this very distressing event were: fatique, tingling fingers, cold feet, blurred vision for a day or two… almost 2 weeks before the “event”. Each one on its own didnt raise any alarms in my head. The night before I had experienced some pain in my chest (right side)with painful inhaling… but this subsided after an hour. It wasn’t to the point that I felt I needed medical aid.. Went to my GP the next day and mentioned what had happened… but I was somewhat brushed off. I should have complained more vigorously, I guess. It was the evening of the GP visit that got me into the hospital. Now I am being much more vigilant on my aches pains and other warning signs.. I certainly am not looking forward to another go round of this! I suppose its just natural progression of this disease, but if I can be more proactive I may avoid or lessen the impact of one of these attacks.
Hi my name is Desiree and I am an 18 year old woman and I have been having chest pain in my left and right aide of my chest. Also I get pain in my spine and right shoulder at the same time. I have went to over 6 hospitals 4 ER’s in the past month. They took blood work chest x rays checked everything and told me I’m fine. I just wish I could find out what is causing these pains.
I also have suffered the pains of costochondritis. When I did not know any better, we used to refer to it as my “third breast”. it was that swollen over the sternum area and clavicle joints. It hurt. I asked my Rheumy and it was not a concerning symptom to him. it wasn’t his rib cage! Soon afterwards I became a patient at NIH. Those dr.’s checking symptoms asked me about rib pain. I told them it was not Important as it wasn’t a significant joint.
well, they did not fall for it, as they said. in fact they paid attention to it. it gave me validation.
since that time I have been on a number of biological drugs, 6 in fact. while my disease is some better, the rib pain is nearly all gone. I am grateful for one set of problems to have been eliminated. Heat pads helped a lot. some pain rx also helped.
if something hurts you be sure to mention it. it hurts you and the dr. will never know if you don’t bring it up.
it is wonderful to see this discussed!
Thank you again, kids. I do have chest pain. I’m not crazy. Thank you.
Thank you for this post. I have severe RA, diagnosed 4 years ago. Also am a breast Cancer survivor. I have been having chest and side pains, which really scared me. I thought it might be a recurrence of the cancer. But now I think it is probably another RA symptom. Thank you for relieving my anxieties.
Kelly,
I first want to thank you for this blog, I know it’s a lot of work but it has helped me quite a bit. Many things you have written about have validated my symptoms, which I would never have thought could be related to RA.
I’m in my 40’s and have lived with this condition for over 20 years. I am very fortunate that my doctor is amazing, he has been treating me since the 1990’s, and I still have consulted specialists all over Florida and even abroad and my local doc is great. That said, I have had several issues (chest pain) that I never thought could be related, been hospitalized for weeks trying to figure out why the chest pain and not a single physician in the hospitals mentioned Costochondritis, reading your posts makes me feel less desperate and think that I could have this and not some “mysterious” unknown, heart transplant needed condition. I will mention this to my Rheumatologist (he was not involved in my hospitalizations due to distance) and pick his brain.
Thanks again for your time, insight and research, means a lot!
I too get rib pain and have RA. It often comes on suddenly and does feel like a knife to the chest. I have a good physio therapist who cracks why chest (doesn’t like to do it but knows it relieves the pain for me). He does it from the upper part of my back having me breathe out and then putting pressure on the joints. I often have shoulder and neck tightness but when my chest, shoulders and neck all get sore and tight and then once it’s harder to breathe deep I need to get it cracked. I do get my husband do to it occasionally but he doesn’t like to do it as he’s afraid he’ll hurt me. I haven’t found any particular medications decrease the pain.
Candice,
That’s so interesting – when the spine and ribs are inflamed it feels so tight, I’ve often imagined it would feel relief to have it “cracked.” Thanks for sharing. It does scare me a bit too much knowing what bad shape my discs are in.
Thank you for the post, Kelly. I sensed my rib and chest pain was from my RA and as I was researching, I came across your blog post. I really hate the predmonster (prednisone). I just weaned myself off it again so I’m going to try heat first.
RA is new territory for me, I’m 24 and my symptoms started about a year and a half ago weeks into my first pregnancy. Pain and stiffness primarily in my knees and wrists were a sudden onset, months after having my baby and the pain not subsiding I decided to see my doctor and after being referred to a Rheumatologist I was diagnosed with RA. The chest pain started a few months back and it has been consistent daily and pretty scary i’d say I was sure there was something wrong with my heart. I’ve had one ER visit where I was diagnosed with costochondritis after blood work and an EKG came back normal. Having pain everyday you learn to cope with it and go about your day but some days are really funky and it’s hard for people who don’t experience the pain to relate so I’m very happy to have read that I’m not the only one who thinks she’s going bananas over this chest pain business.
Am suffering from same chronic pain on ribs joints it feel like some one stabbing and transfer to my shoulder, scapula, upper back and have difficulty in breathing it feels like some one stabbing and bones are breaking in million pieces , I went to ER 3 times nothing came out then MRI shows a little inflammation in sternum , I tried all the pain killers, prednisone , palexia Sr. , and now sulfasalzone, but still same , I want to get rid of it tired of sitting in bed 24/7 with fear of heart attack all the time, specialists said it is RA… But how to get rid of it , it hard on normal life to survive …. Am just 28, and having it from last 2 years, can’t sleep properly and can’t go anywhere or enjoy. My body can’t cope with pain sometime and my body starts getting numb and shaking.please if anyone have any suggestion let me know.
Thanks so much Kelly for this article. I have been diagnosed with RA 4.5yrs ago.. But just last month I started to have pain in my chest, sternum wrapping around to my back. I thought maybe it was heart related, but now I think it is costochondritics. Only because wearing and underwire bra anymore is painful as is pressing on my sternum.
The sad part is no one knows about costichondirits or RA and they even can’t feel the pain we going through , it’s so disstressing and scary , I can’t explain it to anyone even after changing of 15 GP my rheumatologist found a inflammation in sternum after MRI but he don’t believe that it’s still same painful and even more worse after taking so many steroids and codien … I don’t know how to get rid of this and when , I want to go back to my normal life want to go out , work and spend my rest of life without any invisible pain, people don’t believe that am in so much pain no one understand, I have spend so much money , and still suffering from pain in left side of chest.please someone help me
Just spent the night again in the hospital for monitoring after heart attack like symptoms. My risk factors are very high so they always keep me. Never has anyone mentioned to me that RA could be the culprit- and my physical medicine doctor told me that my ribs that pop out and move around was just something that happens. Anyhow, really good articles on RA and cardiac issues and costra chindritis.
Question? I also have what they are calling Demylenating Disease Syndrome. 3 neurologists all agree that I could be diagnosed with MS. But all of them think it’s related to RA. Anyone else had brain involvement with RA?
These posts have been very informative and I needed to hear that others are experiencing the chest pains. I just had my second chest paint attack and it is scary. I thought I was having a heart attack but figured some four hours later if that were true I’m having the longest heart attack in the world.
I’ve had RA for three years and just recently diagnoised with SA and put on Otesla. It’s been a miracle med but now the chest pains start. There seems to be no end to how it will attack.
It took my doctor three years to accept I had psoriatic arthritis and he almost killed me with infusions and other meds. I finally had to take control.
Anyway, the best to all!
I Also have Corochondritis ,of my ribs and my clavical.My Clavical has seperated from my body .You are right the pain is bad ,and makes it hard to breath,but some DRs. dont want to admit it is real because they dont know enough about it. I guees we just have tp live with it.
I have RA and take Metoject (Methrotrexate) for 13mths, I have pain in my chest and pain breathing – costochondritis could be the issue I’m experiencing presently. I’ve been to my doctor 3 times and rheumatology nurse, and had all the tests: chest X-ray, breath function test, ECG for heart, blood tests and these are all showing I’m supposedly normal. I was given a Ventolin Inhaler to help with the slight wheezing I’m experiencing and help with the involuntary cough, and was beginning to feel like a hypochondriac but the pain in my chest has intensified but as yet no confirmation from the doctor as to what Is causing this. Initially, I thought I must have some sought of Methrotrexate toxicity – as I have a dry cough, chest pain, difficulty breathing which also relates to hypersensitivity pneumonitis, but the test results suggest otherwise.
I see there are some chest stretching/opening exercises you can do, and pain killer and icing. How long do people typically find it takes for the condition to subside? Is this like an RA flare?
Diana, if the joints along your sternum are inflamed, it is a flare, yes. Ice packs can help greatly & I find it’s better in a few days with frequent ice or increased steroid doses. If you take prednisone or other anti-inflammatory, that can help. There are also topical creams with anti-inflammatory ingredients similar to advil – your doc can prescribe. The med does absorb, so remember that if you also take pills.
Sometimes it hurts like an ache. but other times it can be very sharp and many patients have thought it is a heart attack because it’s so severe. If it gets bad, get a gel ice pack on it asap. best to you.
Whenever I get this chest pain I rub good amount Aspercreme on, then relax in my chair. In about an hour I feel a lot better. If I don’t use the creme it takes forever for the pain to subside usually after I have had a nights sleep.
thanks for sharing. I’m glad that helps. When mine is very sharp, ice packs help. But it does take a while.
Back in 2014 I had multiple episodes of chest paint, once in my Family doctor’s office where she called an ambulance thinking that I was having a heart attack. It took several month to find a diagnose and in all this time I was drug up and in bed. The final word was Jack Harmer Esofagus Espamus. I’m still taking medication for it…… now I’m confused! Do I have JHEE or not?
In just been diagnosed by our local hospital as having costochondritis, it started 18th March 2020, just as we went into lockdown because of corona virus, I ended up in a and e ,7 times by ambulance , I had various blood tests 2 chest stays to make sure I didn’t have the virus, and was diagnosed with this horrendous illness, if been in bed 5 weeks now and I’m on morphine as that’s the only thing they can give me because I react to an awful lot of medications, I can still only get to the bathroom and that’s with help and we live in a small bungalow in uk, doctors are not very sympathetic, I understand the situation is horrible at mo, and a our hospital workers and care givers are amazing, but I’m still struggling