What is Tietze's syndrome (costochondritis)?

From the Guidelines

Tietze syndrome is a benign inflammatory condition characterized by tenderness of the costochondral joints, which can be diagnosed by physical examination and managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs) and local heat application. The condition is often confused with costochondritis, but it is distinguished by the presence of visible swelling at the affected cartilage 1. According to the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline, Tietze syndrome is one of the non-coronary cardiac conditions that can cause chest pain, and it can be diagnosed by tenderness of the costochondral joints 1.

Key Characteristics

• Tietze syndrome is a benign condition that causes pain and swelling of the costal cartilages
• It is characterized by tenderness of the costochondral joints
• The condition can be diagnosed by physical examination without the need for diagnostic imaging 1
• It is often confused with costochondritis, but it is distinguished by the presence of visible swelling at the affected cartilage

Management

• Conservative management with NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 7-14 days to reduce inflammation and pain
• Local heat application for 15-20 minutes several times daily to relieve discomfort
• Rest and avoiding activities that exacerbate symptoms are recommended during the acute phase
• For persistent pain, a local injection of lidocaine with corticosteroid may be considered
• Physical therapy focusing on gentle stretching and posture correction can be beneficial for long-term management 1

Prognosis

• Tietze syndrome is not a dangerous condition and typically resolves within weeks to months
• Recurrence is possible, and patients should be reassured that the condition is benign
• If symptoms worsen significantly or don't improve with treatment after 2-3 weeks, further evaluation may be needed to rule out other conditions 1

From the Research

Definition and Characteristics of Tietze's Syndrome

• Tietze's syndrome is a rare form of chest wall costochondritis with joint swelling, which can cause significant chest pain and decline in ability of daily activities 2.
• Characteristic findings include painful, localized inflammation of the costosternal, sternoclavicular, or costochondral joints, typically of the second and third ribs 3.
• The syndrome is benign and has an excellent prognosis, but its etiology is unknown, with suggested implications of recurrent microtrauma of the anterior chest wall in the development of characteristic degenerative changes 4.

Clinical Presentation and Diagnosis

• Tietze's syndrome may present with a tender and fusiform swelling at the level of the upper costosternal joints, mimicking other conditions such as lymphomas 5.
• A thorough clinical investigation is necessary to exclude severe and life-threatening conditions, especially in the elderly 4.
• Diagnostic tools such as telethermography, computerized tomography, lymphography, and bone marrow biopsy may be used to confirm the diagnosis and rule out other conditions 5.

Treatment Options

• Treatment for Tietze's syndrome is usually symptomatic, with options including non-steroidal anti-inflammatory drugs (NSAIDs), oral corticosteroids, and prolotherapy 2, 6.
• Surgical management may be considered in patients with debilitating cases of Tietze's syndrome that are resistant to conservative therapies 3.
• Prolotherapy has been shown to be an effective therapy for Tietze's syndrome, with faster recovery and significantly reduced clinic findings compared to conservative therapy with NSAIDs 6.