From the Guidelines
Yes, Tietze syndrome can occur on only one costochondral joint. Tietze syndrome is characterized by painful, non-suppurative swelling of one or more costochondral junctions, most commonly affecting the second or third rib. While it can involve multiple joints, it frequently presents as localized inflammation of a single costochondral junction, typically on the left side of the chest. According to the latest guidelines 1, Tietze’s syndrome is distinguished by pain in costosternal transitions, unilateral, self-limiting symptoms after weeks-months and not due to intercostal enthesitis in psoriatic arthritis. Treatment typically includes rest, application of heat or ice, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for pain relief and to reduce inflammation. For persistent cases, local corticosteroid injections may be considered. The condition is self-limiting and benign, though symptoms may persist for weeks to months. The exact cause remains unclear, but it's believed to result from minor trauma, respiratory infections, or physical strain. Unlike costochondritis, Tietze syndrome specifically includes visible or palpable swelling at the affected joint, which helps distinguish it from other causes of chest pain, as noted in the evaluation and diagnosis of chest pain guidelines 1. Key characteristics of Tietze syndrome include:
- Painful, non-suppurative swelling of one or more costochondral junctions
- Typically affects the second or third rib
- Frequently presents as localized inflammation of a single costochondral junction
- Self-limiting symptoms after weeks-months
- Not due to intercostal enthesitis in psoriatic arthritis.
From the Research
Tietze Syndrome Characteristics
- Tietze syndrome is a rare and benign cause of chest pain that may be confused with life-threatening conditions 2
- Characteristic findings are painful, localized inflammation of the costosternal, sternoclavicular, or costochondral joints typically of the second and third ribs 2
- The disease most often involves articulations: sternocostal, sternoclavicular, or costochondral joints 3
Unilateral Occurrence
- The characteristic symptoms are tenderness, pain and edema involving one of the aforementioned joints on one side 3
- A case of Tietze syndrome where a 70-yr-old man was seen for left chest pain that had lasted for several weeks, with focal tenderness of the left third costochondral joint 4
- A case of Tietze's syndrome is reported where a 43-year-old woman experienced right anterior chest pain and tender swelling of the right first costosternal junction for seven months 5
Diagnosis and Treatment
- Diagnosis of Tietze's syndrome is based on physical examination, laboratory tests, and imaging studies (USG, MRI) 3
- Treatment can include ultrasound-guided corticosteroid injection, oral corticosteroids, and non-steroidal anti-inflammatory drug (NSAID) treatment 4, 6
- Surgical management may be considered in patients with debilitating cases of Tietze syndrome that are resistant to conservative therapies 2