From the Guidelines
Tietze syndrome should be managed with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for pain relief and to reduce inflammation, as it is a benign inflammatory condition that causes painful swelling of the costal cartilage. According to the American College of Cardiology/American Heart Association task force on clinical data standards 1, musculoskeletal chest pain due to costochondral junction syndrome (Tietze) is a condition characterized by localized inflammation of at least one joint between the rib and the costal cartilage. The symptoms of Tietze syndrome typically include localized pain and tenderness that may worsen with movement, deep breathing, or coughing.
Some key points to consider in the management of Tietze syndrome include:
- The use of NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain relief and to reduce inflammation
- Local heat application and rest can also help alleviate symptoms
- For persistent cases, a corticosteroid injection into the affected cartilage may be considered
- Most cases of Tietze syndrome resolve spontaneously within several weeks to months without causing permanent damage
- The condition is distinguished from costochondritis by the presence of swelling, though both involve chest wall pain
It is essential to note that while the exact cause of Tietze syndrome remains unknown, it may result from physical strain, respiratory infections, or trauma to the chest wall 1. Patients should seek medical evaluation to rule out more serious conditions like cardiac issues, as chest pain can have multiple causes.
From the Research
Definition and Characteristics of Tietze Syndrome
- Tietze syndrome is a benign, self-limiting arthropathy, without purulent character 2
- The disease most often involves articulations: sternocostal, sternoclavicular, or costochondral joints 2
- Characteristic symptoms are tenderness, pain, and edema involving one of the aforementioned joints on one side 2
- Characteristic findings are painful, localized inflammation of the costosternal, sternoclavicular, or costochondral joints typically of the second and third ribs 3
Diagnosis of Tietze Syndrome
- Diagnosis of Tietze's syndrome is based on physical examination (increase of palpation tenderness in the affected joint), laboratory tests (increase of inflammatory parameters), and imaging studies (USG, MRI) 2
- Differential diagnosis of Tietze's syndrome is based on exclusion of costal cartilage inflammation, coronary syndrome, and inflammatory changes in the lung and pleura 2
Treatment of Tietze Syndrome
- Most commonly the treatment is conservative, in resistant cases surgical 2
- Surgical management is not the typical treatment course, but symptomatic control was eventually achieved with complete resection of the involved cartilage and adjacent rib in some cases 3
- Addition of short-term oral corticosteroids showed a clear benefit for use at 1,2, and 3 weeks in improvement of pain and quality of life in patients with Tietze syndrome 4
- Non-steroidal anti-inflammatory drugs (NSAIDs) are also used to reduce pain and inflammation, but they can have adverse effects on various organs 5