From the Guidelines
Yes, costochondritis and rheumatoid arthritis can affect the ribcage, specifically the costochondral junctions where the ribs connect to the cartilage at the sternum. Arthritis can affect the costovertebral joints (where ribs connect to the spine) and costochondral junctions, leading to pain and reduced mobility in the chest area 1. The most common types affecting the ribs include osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and costochondritis (inflammation of rib cartilage).
Symptoms and Diagnosis
Symptoms typically include pain with deep breathing, coughing, or certain movements, along with tenderness and sometimes swelling at the affected joints. Bone scans can be useful in diagnosing costochondritis and rheumatoid arthritis, especially in cases where radiographs and CT scans are negative 1.
Treatment
Treatment usually involves pain management with NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), physical therapy, and gentle stretching exercises 1. Heat or cold therapy can also provide relief. For severe cases, doctors might prescribe stronger pain medications or corticosteroid injections.
Management of Rheumatoid Arthritis
The management of rheumatoid arthritis rests on several principles, including drug treatment with disease-modifying antirheumatic drugs (DMARDs), non-steroidal anti-inflammatory drugs, and glucocorticoids, as well as non-pharmacological measures such as physical, occupational, and psychological therapeutic approaches 1. The European League Against Rheumatism (EULAR) has formulated recommendations for the management of rheumatoid arthritis, including the use of synthetic and biological DMARDs 1.
Key Points
- Costochondritis and rheumatoid arthritis can affect the ribcage
- Symptoms include pain with deep breathing, coughing, or certain movements, along with tenderness and sometimes swelling at the affected joints
- Treatment involves pain management with NSAIDs, physical therapy, and gentle stretching exercises
- Bone scans can be useful in diagnosing costochondritis and rheumatoid arthritis
- The management of rheumatoid arthritis involves drug treatment with DMARDs and non-pharmacological measures 1.
From the Research
Costochondritis and Ribcage
- Costochondritis is an inflammation of the costochondral junctions of ribs or chondrosternal joints of the anterior chest wall, which can affect the ribcage 2.
- The condition is usually self-limited and benign, but it should be distinguished from other, more serious causes of chest pain, such as coronary artery disease 2.
- Palpation of the affected chondrosternal joints of the chest wall elicits tenderness, and history and physical examination of the chest that document reproducible pain by palpation over the costal cartilages are usually all that is needed to make the diagnosis in children, adolescents, and young adults 2.
Rheumatoid Arthritis and Ribcage
- Rheumatoid arthritis (RA) can affect the ribcage, particularly the costovertebral joints (CVJ), although it is less common than in radiographic axial spondyloarthritis (rAxSpA) 3.
- A study found that RA patients had fewer total CVJ lesions, fewer lesions in the head-vertebral joints (HVJ), and fewer lesions in the costotransverse joints (CTJ) compared to rAxSpA patients 3.
- However, RA can still cause structural changes in the CVJ, including ankylosis, erosions, joint space narrowing, and osteophytes, although these changes are less frequent than in rAxSpA patients 3.
Anatomy of the Ribcage
- The anatomy of the anterior rib cage and costal margin can vary, with interchondral joints present between ribs 5 to 8, and significant variability in the chest wall and costal margin compared to traditional teaching 4, 5.
- The presence of interchondral joints and the morphology and mobility of ribs can affect the transmission of forces across the chest wall and the mobility of the rib cage 4.
- Upward forces at the costal margin can result in increased mobility of the lower half of the ribs, and the eighth/ninth ribs often have mobile tips, and the 10th is often a floating rib 4.