What is Tietze syndrome (costochondritis)?

From the Guidelines

Tietze syndrome is a benign inflammatory condition characterized by painful swelling of the cartilage connecting the ribs to the breastbone, primarily affecting the upper ribs, and is diagnosed by tenderness of the costochondral joints 1.

Key Characteristics

• The condition causes painful swelling of the costochondral junctions, which are the areas where the ribs meet the breastbone.
• It most commonly affects the upper ribs.
• Tietze syndrome is diagnosed by the presence of tenderness of the costochondral joints, as noted in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain 1.

Differential Diagnosis

• The pain associated with Tietze syndrome can mimic serious cardiac conditions, such as acute coronary syndrome (ACS), pulmonary embolism (PE), and aortic dissection, which are life-threatening and require immediate medical attention 1.
• Other conditions that may cause chest pain and need to be ruled out include pericarditis, myocarditis, esophagitis, peptic ulcer disease, gallbladder disease, pneumonia, pneumothorax, and herpes zoster.

Treatment and Management

• Treatment primarily focuses on pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for 1-2 weeks.
• Local heat application for 15-20 minutes several times daily can help relieve pain.
• For severe cases, a corticosteroid injection into the affected area may be considered.
• Rest and avoiding activities that worsen symptoms are important during the acute phase.
• Most cases resolve spontaneously within weeks to months, though some patients experience recurrent episodes.

Important Considerations

• While Tietze syndrome itself is not dangerous, patients with new chest pain should seek medical evaluation to rule out other causes, as the pain can mimic serious cardiac conditions.
• The presence of visible swelling at the affected joint differentiates Tietze syndrome from costochondritis, as noted in the provided evidence 2.

From the Research

Definition and Characteristics of Tietze Syndrome

• Tietze syndrome is a rare and benign cause of chest pain that may be confused with life-threatening conditions 3.
• It is characterized by painful, localized inflammation of the costosternal, sternoclavicular, or costochondral joints, typically of the second and third ribs 3.
• The syndrome can cause significant chest pain and decline in ability of daily activities 4.

Clinical Presentation and Diagnosis

• Tietze syndrome presents with joint swelling and can mimic more serious conditions, necessitating thorough evaluation and exclusion of differential diagnoses 5.
• The diagnosis is typically based on clinical presentation and physical examination, with imaging studies and laboratory tests used to rule out other conditions 5.

Treatment Options

• Management of Tietze syndrome typically involves non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid therapy 4, 6.
• Local injections of triamcinolone and prilocaine can provide rapid relief from pain in patients with Tietze syndrome 6.
• Prolotherapy has been shown to be an effective therapy for Tietze syndrome, with faster recovery and significantly reduced clinical findings compared to conservative therapy with NSAIDs 7.
• Surgical intervention may be reserved for refractory cases of Tietze syndrome, with complete resection of the involved cartilage and adjacent rib providing symptomatic control in some patients 3.

Efficacy of Treatment Options

• The addition of oral corticosteroids to NSAID treatment has been shown to provide a clear benefit in improving pain and quality of life in patients with Tietze syndrome, with a significant drop in mean pain scores and improvement in quality of life 4.
• Local injections of triamcinolone and prilocaine have been shown to provide a rapid relief from pain, with 75% of patients experiencing more than 70% reduction in pain level after the injection 6.
• Prolotherapy has been shown to be a safe and effective method for the treatment of Tietze syndrome, with favorable long-term outcomes and minimal side effects 7.