Costochondritis: Underlying Diseases, Causes, and When to Seek Medical Attention

What diseases cause costochondritis?

Costochondritis is an inflammation of the cartilage that connects the ribs to the breastbone (sternum), often causing localized chest pain. While frequently idiopathic (of unknown cause), it can be a manifestation or symptom of various underlying systemic diseases, particularly those involving inflammation, infection, or malignancy.

Understanding Costochondritis: A Brief Overview

Costochondritis affects the costochondral and/or costosternal joints, which are the cartilaginous connections between the ribs and the sternum. This inflammation leads to localized chest wall pain, often described as sharp, aching, or pressure-like. The pain typically worsens with deep breaths, coughing, sneezing, or direct pressure on the affected area. While often benign and self-limiting, its presentation can mimic more serious cardiac or pulmonary conditions, necessitating careful differential diagnosis. When swelling accompanies the pain, the condition is referred to as Tietze's syndrome, though this is less common.

Primary Categories of Diseases Linked to Costochondritis

While many cases of costochondritis arise from physical strain or trauma, a significant proportion can be attributed to or exacerbated by underlying medical conditions. These can broadly be categorized as inflammatory arthritides, infections, and malignancies.

Inflammatory Arthritides and Systemic Rheumatic Diseases

Systemic inflammatory conditions, particularly those affecting joints throughout the body, are a notable cause of costochondritis. These diseases involve an overactive immune response that can target various tissues, including cartilage and entheses (sites where tendons or ligaments insert into bone).

• Ankylosing Spondylitis (AS): A chronic inflammatory disease primarily affecting the spine, AS can also involve peripheral joints and entheses, including the costochondral and sternoclavicular joints. Inflammation in these areas can lead to significant chest wall pain and stiffness.
• Psoriatic Arthritis (PsA): Associated with psoriasis, PsA can cause inflammation in various joints, including those of the chest wall. Enthesitis (inflammation where tendons/ligaments attach to bone) is a hallmark of PsA and can directly affect the costochondral junctions.
• Reactive Arthritis (formerly Reiter's Syndrome): This form of arthritis develops in response to an infection elsewhere in the body (e.g., gastrointestinal or genitourinary). It can cause inflammation in multiple joints, including the chest wall.
• Rheumatoid Arthritis (RA): While primarily affecting smaller peripheral joints, RA can, in some cases, involve larger joints and entheses, leading to inflammation of the costochondral junctions.
• Systemic Lupus Erythematosus (SLE): A chronic autoimmune disease that can affect virtually any organ system. Musculoskeletal symptoms, including arthralgia and arthritis, are common, and chest wall pain due to costochondritis or pleurisy can occur.
• Fibromyalgia: While not an inflammatory arthritis, fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and tenderness in specific points. Individuals with fibromyalgia often experience heightened pain sensitivity, and costochondral pain can be one of their manifestations.

Infections

Both local and systemic infections can lead to costochondritis, either directly by affecting the cartilage or indirectly through systemic inflammatory responses.

• Bacterial Infections:
  • Post-Surgical Infections: Following chest surgery (e.g., sternotomy), bacteria can infect the sternum or costochondral joints.
  • Intravenous Drug Use: Infections from contaminated needles can spread to the sternum or ribs.
  • Tuberculosis: Though less common in developed countries, TB can affect bones and joints, including the ribs and sternum.
  • Fungal Infections: Rare but serious, fungal infections (e.g., Aspergillus, Candida) can affect the chest wall cartilage, especially in immunocompromised individuals.
• Viral Infections: While less direct, severe respiratory viral infections (e.g., influenza, common cold, COVID-19) can lead to prolonged coughing or respiratory distress, which can strain the chest wall and precipitate costochondritis. The inflammatory response associated with these infections might also contribute.

Malignancies (Cancers)

Though less common, tumors, both primary and metastatic, can infiltrate or compress the costochondral junctions, leading to pain and inflammation mimicking costochondritis.

• Primary Bone Tumors: Rare tumors originating in the ribs or sternum (e.g., chondrosarcoma, osteosarcoma) can cause localized pain and swelling.
• Metastatic Cancer: Cancers that spread from other parts of the body (e.g., lung, breast, prostate, kidney, thyroid) can metastasize to the ribs or sternum, causing bone pain and potentially inflammation of the adjacent cartilage.
• Leukemia and Lymphoma: Infiltrating these areas, though less common, can cause bone and joint pain.

Differentiating Costochondritis from Other Chest Pain Causes

Given that chest pain can indicate serious conditions like heart attack or pulmonary embolism, it is crucial to differentiate costochondritis from other causes. A key feature of costochondritis is that the pain can be reproduced by pressing on the affected costochondral joints. However, a medical evaluation is essential to rule out more life-threatening etiologies, especially in the absence of a clear traumatic cause or if accompanied by systemic symptoms.

Diagnosis and Management Principles

Diagnosis of costochondritis is primarily clinical, based on a detailed medical history and physical examination. Imaging studies (X-rays, MRI, CT scans) are typically normal in simple costochondritis but may be used to rule out other conditions or identify underlying causes like tumors or severe infections. Blood tests may be ordered to check for inflammatory markers or signs of infection if a systemic cause is suspected.

Management focuses on pain relief, often with over-the-counter pain relievers (NSAIDs), heat/cold therapy, and avoiding activities that aggravate the pain. When an underlying disease is identified, treating the primary condition is paramount to resolving or managing the costochondritis.

When to Seek Medical Attention

It is always advisable to seek medical attention for new or unexplained chest pain, especially if accompanied by:

• Shortness of breath
• Radiating pain to the arm, neck, or jaw
• Dizziness or sweating
• Fever or chills
• Persistent pain that does not improve with rest
• Any signs of swelling or deformity in the chest area

Conclusion

While often a benign condition, costochondritis can serve as an important indicator of underlying systemic diseases. From various forms of inflammatory arthritis to infectious processes and even malignancies, a thorough medical evaluation is crucial to identify the true cause of chest wall pain. For fitness enthusiasts and professionals, understanding these potential etiologies emphasizes the importance of a holistic approach to musculoskeletal health and the necessity of medical consultation for persistent or atypical symptoms.