What Is This Chest Pain? Learn More About Costochondritis & Tietze Syndrome

Last updated: April 2023

Chest pain with psoriatic arthritis might be a sign of another condition.

What is Costochondritis?

Costochondritis is chest pain caused by inflammation of the cartilage around the sternum—the area in the body where the ribs connect to the breastbone. Cartilage is the tissue the connects the joints between bones. It typically acts as a shock absorber, cushioning the joints, but when the sternum cartilage becomes inflamed it can lead to symptoms such as:1,2

  • Chest wall pain
  • Pressure
  • Sharp pain
  • Aching pain

In costochondritis, the inflammation can occur in multiple areas on both sides of the sternum but is usually only on one side.1 Certain things can increase the pain, such as movement, exertion, or deep breathing. Pain can also increase with a certain posture, like lying down, pressure on your chest, or coughing and sneezing.1,2

What is Tietze syndrome?

Costochondritis is often confused with another, similar condition known as Tietze syndrome. Both conditions can cause pain and inflammation around the sternum. Tietze syndrome, however, also includes swelling, which is a distinguishing characteristic. Swelling does not occur with costochondritis.1,2

Patients with Tietze syndrome may also have redness, tenderness, and warmth around the sternum, and the pain can be sharp and is sometimes confused with a heart attack. However, a heart attack usually causes more widespread pain and additional symptoms, like breathlessness, nausea, and sweating. Tietze syndrome is less common than costochondritis and tends to affect young adults under 40, whereas costochondritis tends to affect adults aged 40 or over.1,2

What causes these two conditions?

The exact cause of these conditions is not known, but there are several things that may contribute, such as a genetic predisposition, certain viruses or infection, repeated physical strain, or injury. Costochondritis and Tietze syndrome can occur on their own, but certain rheumatic disease, such as psoriatic arthritis (PsA), can increase the risk of developing either condition.1,2

How are they diagnosed?

The path to diagnosis for both costochondritis and Tietze syndrome is similar. Doctors will examine the history and area of chest pain. Patients with Tietze syndrome will also have swelling.1,2

Some tests may be required to rule out other conditions. These tests could include:1,2

  • An electrocardiogram (ECG) to measure heart activity
  • A blood test to assess inflammation
  • A chest x-ray to look for injury

Blood testing may show signs of inflammation in patients with Tietze syndrome, whereas patients with costochondritis alone typically have normal tests for inflammation.1,2

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Understanding treatment options

The prognosis for both costochondritis and Tietze syndrome is usually good. Sometimes the conditions will improve on their own after a few weeks. Still, pain can persist for months or more.1,2

Most patients will respond well to treatment. Doctors may suggest rest and avoiding activity. They may also prescribe one or more of the following treatments:1,2

  • Nonsteroidal inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
  • Prescription painkillers
  • Corticosteroid injections
  • Transcutaneous electrical nerve stimulation (TENS)—a method of pain relief where a mild electric current is delivered to the affected area

There are no long-term problems associated with costochondritis or Tietze syndrome. However, recurrences are more likely in those who also have an underlying rheumatologic disease, such as PsA.1,2

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