Arthritis and Chest Pain: Types, Mechanisms, and Management

Can arthritis cause chest pain?

Yes, certain forms of arthritis can indeed cause chest pain, primarily by affecting the joints and cartilage of the rib cage and spine. While less common than other causes of chest pain, it is crucial to understand the mechanisms involved and, importantly, always rule out more serious cardiac issues through professional medical evaluation.

Understanding Chest Pain and Arthritis

Chest pain is a symptom that demands careful attention due to its potential association with life-threatening conditions, particularly those involving the heart. However, not all chest pain originates from the heart. Musculoskeletal issues, including various forms of arthritis, can manifest as discomfort or sharp pain in the chest region. Arthritis, characterized by inflammation of joints, can affect any joint in the body, and the intricate structure of the rib cage and spine provides several points where arthritic inflammation can lead to chest pain.

Types of Arthritis That Can Affect the Chest

Several forms of arthritis have the potential to cause chest pain by impacting the joints and connective tissues of the thoracic region:

• Rheumatoid Arthritis (RA): As a systemic autoimmune disease, RA can affect joints throughout the body, including the small joints of the spine (costovertebral and costotransverse joints), the sternoclavicular joints (where the collarbone meets the breastbone), and even the sternocostal joints (where ribs meet the breastbone). Inflammation in these areas can lead to localized pain, stiffness, and tenderness in the chest. In rare, severe cases, RA can also cause inflammation of the pericardium (the sac around the heart) or pleura (lining of the lungs), leading to chest pain.
• Ankylosing Spondylitis (AS): This chronic inflammatory disease primarily affects the spine, leading to stiffness and fusion of vertebrae. When AS affects the thoracic spine (mid-back) and the costovertebral joints (where ribs join the spine), it can significantly reduce chest wall expansion, leading to pain, stiffness, and difficulty taking deep breaths. The inflammation can also extend to the sternum and rib joints.
• Psoriatic Arthritis (PsA): Similar to RA, PsA is an autoimmune condition that can affect various joints, including those of the chest wall and spine. Inflammation of the sternoclavicular joints, costochondral joints, and spinal joints can all contribute to chest pain.
• Osteoarthritis (OA): While less common in the primary chest wall joints, osteoarthritis can affect the thoracic spine, leading to degenerative changes that cause pain which may radiate to the chest. The costovertebral joints can also be affected by OA, contributing to localized discomfort.
• Gout: Though typically associated with peripheral joints like the big toe, gout (a form of inflammatory arthritis caused by uric acid crystal deposition) can, in rare instances, affect joints in the chest wall, such as the sternoclavicular joint, leading to acute, severe pain and swelling.

Mechanisms of Arthritis-Related Chest Pain

Arthritis can cause chest pain through several distinct mechanisms:

• Inflammation of Joints: Direct inflammation of the joints connecting the ribs to the sternum (sternocostal joints), the ribs to the vertebrae (costovertebral joints), or the collarbone to the sternum (sternoclavicular joints) can cause localized pain, tenderness, and swelling. Movement, breathing, or pressure on these joints can exacerbate the pain.
• Inflammation of Cartilage (Costochondritis/Tietze's Syndrome): Costochondritis is inflammation of the cartilage that connects the ribs to the breastbone. While it can occur independently, it is more common in individuals with inflammatory arthritis. Tietze's syndrome is a rarer form of costochondritis that also involves swelling of the affected cartilage. Both conditions cause sharp, localized chest pain, often worsened by deep breaths, coughing, or specific movements.
• Referred Pain: Arthritis affecting the thoracic spine can cause pain that radiates or "refers" to the chest. Degenerative changes or inflammation in the spinal joints can irritate nerves that supply sensation to the chest wall, leading to pain perceived in the front of the body.
• Spinal Involvement: Conditions like ankylosing spondylitis can lead to stiffening and reduced mobility of the thoracic spine and rib cage. This restriction can cause a constant ache or sharp pain, particularly with attempts at deep breathing or twisting movements.

Differentiating Arthritis Pain from Other Causes

Distinguishing arthritis-related chest pain from more serious conditions, especially cardiac events, is paramount. While only a medical professional can make a definitive diagnosis, understanding typical characteristics can guide your actions:

• Cardiac Pain: Often described as a pressure, tightness, squeezing, or burning sensation. It may radiate to the left arm, jaw, neck, or back. It can be accompanied by shortness of breath, sweating, nausea, or lightheadedness, and often worsens with exertion.
• Musculoskeletal Pain (including Arthritis):
  • Localized: Often sharp, stabbing, or aching, and can be pinpointed by touch.
  • Positional: Worsens with specific movements, posture changes, coughing, or deep breaths.
  • Reproducible: Pain can often be reproduced by pressing on the affected area.
  • Variable: May fluctuate throughout the day and with activity levels.
• Gastrointestinal Pain: Can be burning (heartburn), sharp, or dull, often related to meals, and may be accompanied by indigestion, difficulty swallowing, or regurgitation.
• Pulmonary Pain: Often sharp, localized, and worsens with deep breaths or coughing, indicative of conditions like pleurisy or pneumonia.
• Psychological Factors: Stress, anxiety, and panic attacks can also manifest as chest pain, often accompanied by hyperventilation, tingling, or dizziness.

When to Seek Medical Attention

Any new, severe, or unexplained chest pain should be considered a medical emergency and requires immediate professional medical evaluation to rule out life-threatening conditions like a heart attack.

Even if you have a known history of arthritis, new or worsening chest pain warrants a doctor's visit. Seek immediate emergency care if the chest pain is accompanied by:

• Shortness of breath
• Sweating
• Nausea or vomiting
• Dizziness or lightheadedness
• Pain radiating to the arm, jaw, or back
• A feeling of impending doom

For persistent, non-urgent chest pain that you suspect is related to your arthritis, consult your rheumatologist or primary care physician. They can perform a thorough examination, order imaging (X-rays, MRI) or blood tests, and recommend appropriate management.

Management Strategies for Arthritis-Related Chest Pain

Once a diagnosis of arthritis-related chest pain is confirmed and more serious causes are excluded, management typically focuses on reducing inflammation and pain:

• Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment. For inflammatory arthritis, disease-modifying anti-rheumatic drugs (DMARDs) or biologics may be necessary to control the underlying disease.
• Physical Therapy: A physical therapist can provide exercises to improve posture, strengthen supporting muscles, increase chest wall mobility, and teach pain-relieving stretches.
• Heat and Cold Therapy: Applying heat or cold packs to the affected area can help alleviate pain and inflammation.
• Activity Modification: Identifying and avoiding movements or activities that exacerbate the pain can provide relief.
• Posture Correction: Maintaining good posture, especially during prolonged sitting or standing, can reduce strain on the thoracic spine and rib cage.

Conclusion

While the heart is the primary concern when experiencing chest pain, it is vital to recognize that musculoskeletal conditions, specifically various forms of arthritis, can also be a contributing factor. Understanding the anatomy of the chest wall and spine, and how inflammatory processes can affect these structures, provides valuable insight into the potential origins of such pain. However, due to the critical nature of cardiac conditions, any chest pain should always be promptly evaluated by a healthcare professional to ensure an accurate diagnosis and appropriate management.