From the Guidelines
Tietze's disease 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. The diagnosis of Tietze's disease is primarily based on clinical presentation, including 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. Key characteristics of Tietze's disease include:
- Sudden onset of chest pain and tenderness
- Noticeable swelling at the affected area, typically the upper ribs, especially the second and third costal cartilages
- Tenderness of the costochondral joints, which is a key diagnostic feature Treatment options for Tietze's disease include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain relief and to reduce inflammation
- Local application of heat or ice packs for additional comfort
- Corticosteroid injection directly into the affected cartilage for severe cases
- Rest and avoiding activities that worsen symptoms during recovery It is essential to differentiate Tietze's disease from other conditions that cause chest pain, such as cardiac issues, and to seek medical attention to rule out more serious conditions, as noted in the guideline 1.
From the Research
Definition and Symptoms of Tietze's Disease
- 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 are painful, localized inflammation of the costosternal, sternoclavicular, or costochondral joints typically of the second and third ribs 3.
- The disease most often involves articulations: sternocostal, sternoclavicular, or costochondral joints, with symptoms including tenderness, pain, and edema involving one of the aforementioned joints on one side 4.
Diagnosis of Tietze's Disease
- Diagnosis of Tietze's syndrome is based on physical examination, laboratory tests, and imaging studies (USG, MRI) 4.
- Differential diagnosis of Tietze's syndrome is based on exclusion of costal cartilage inflammation, coronary syndrome, and inflammatory changes in the lung and pleura 4.
- 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 5.
Treatment of Tietze's Disease
- There is no standardized treatment protocol for Tietze's syndrome, but traditional practice is to treat with acetaminophen or anti-inflammatory medications where safe and appropriate 5.
- Addition of short-term oral corticosteroids has shown a clear benefit for use at 1,2, and 3 weeks in improvement of pain and quality of life in patients with Tietze syndrome 2.
- Surgical management may be considered in patients with debilitating cases of Tietze syndrome that are resistant to conservative therapies 3.