Arthritis in the chest

Rheumatoid Arthritis and Chest Pain: What You Need to Know

The RA inflammation may cause a sharp, stabbing chest pain that can be mistaken for a heart attack. But there are key differences between the two conditions, says Dr. White.

Heart attack pain is usually widespread and felt in other parts of the body. You might feel pain in your jaw, shoulder, arms, or neck. You also may become sweaty and light-headed.

Costochondritis pain, on the other hand, is usually only felt in a small area near the center of your chest, around the breastbone. You may also experience pain in more than one rib, or pain that increases as you take deep breaths.

“Costochondritis tends to be around your chest, while pain from a heart attack tends to be around your heart or in your shoulder or up in your neck and jaw,” White says.

The way the pain responds to movement is another way to distinguish RA chest pain from a heart attack. “Costochondritis hurts most when you take a deep breath because it involves the joints that flex when you breathe,” White says. Anything that causes those joints to move — coughing, twisting, or placing pressure on the ribs — will cause your chest pain to increase. On the other hand, if you take a deep breath during a heart attack, you won’t feel any increase in pain.

Diagnosing and Treating RA Chest Pain

Because this is chest pain, you probably will be given an electrocardiogram to rule out the possibility of a heart attack. Your doctor also might perform blood tests or give you a chest X-ray.

If you’re diagnosed with costochondritis, you may have to put up with the chest pain for a few days or weeks. The condition is harmless to your health and will go away on its own over time.

Some treatment options for the pain are available. Hot or cold compresses placed on the affected joints should help — try ice packs, heating pads, or a hot water bottle. Experiment with both heat and cold to see which is most effective in reducing your pain.

Over-the-counter pain relievers like aspirin, Tylenol (acetaminophen), Advil or Motrin (ibuprofen), and Aleve (naproxen) may help, but talk with your doctor first before taking them. If your rheumatoid arthritis chest pain isn’t responding to other treatments, your doctor might be able to give you a cortisone injection into the affected joints.

And, while waiting for the costochondritis to dissipate, it’s important to get plenty of rest and avoid activities that exacerbate your pain.

Complications of Psoriatic Arthritis

Having PsA can make you more likely to develop other conditions over time, some of the most common are:

  • Cancer. People with PSA may be more likely to get lymphoma and nonmelanoma skin cancer. Your treatment plan should include regular cancer screenings.
  • Cardiovascular disease. Psoriatic arthritis can boost your risk for cardiovascular disease like a heart attack or stroke. Talk to your doctor about your risk and treatments that can help.
  • Crohn’s disease. People with psoriatic arthritis and Crohn’s share similar changes to their genes, called mutations. That’s why there’s a link between psoriasis, psoriatic arthritis, and inflammatory bowel disease like Crohn’s disease or ulcerative colitis. If you have both psoriasis and psoriatic arthritis, your odds are even higher.
  • Depression. Psoriasis and psoriatic arthritis can make you more likely to have low self-esteem and mood disorders like depression. Depression is even more likely If you have both psoriatic arthritis and psoriasis. But treating the psoriasis can help with your depression.
  • Diabetes. Having psoriasis and psoriatic arthritis raises your risk of type 2 diabetes. Having severe psoriasis boosts it even higher. Tell your doctor if you have symptoms of type 2 diabetes, such as heavy thirst, hunger, blurry vision, or fatigue.
  • Eye inflammation and vision problems. Inflammation in the colored part of your eye, the iris, can cause pain that gets worse in bright light. This can cause vision problems. You’ll probably need to see an eye doctor to treat this condition, which is known as uveitis.
  • Gout. You get this form of inflammatory arthritis when uric acid crystals form in your joints. Though you can get uric acid from food, doctors also think it’s a byproduct of psoriasis and psoriatic arthritis.
  • Joint damage. Arthritis mutilans, a rare but destructive condition that sometimes happens with psoriatic arthritis, rapidly damages joints at the ends of your fingers and toes. Severe damage can interfere with activities of daily living such as walking or dressing.
  • Metabolic syndrome. Researchers have found a link between psoriasis, psoriatic arthritis, and metabolic syndrome — a cluster of conditions that include heart disease, obesity, and high blood pressure. Women with psoriasis and anyone with severe psoriatic arthritis may be almost twice as likely to get it as others.

PMC

Discussion

Osteoarthritis of MSJ is an uncommon cause of chest pain, and hence, awareness and high index of awareness about this rare condition is crucial in reaching a diagnosis. However, other major underlying medical conditions must be ruled out before making the diagnosis and planning the operative treatment for OA of the MSJ.

An early onset of OA of the MSJ can be attributed to repetitive stress on this joint. In this patient, the repetitive stress was caused due to the lifting of heavy weights due to his profession (manual labourer) and may be the cause of the localized osteoarthritis of the MSJ. Localized symptoms and physical signs, in addition to imaging findings, often give clues to its diagnosis. Radiographic findings are often difficult to interpret, especially in early stages, and higher imaging modalities, such as CT or MRI scan, may be able to help in early diagnosis of OA of the MSJ.

The manubriosternal joint is a cartilaginous joint (symphysis) where only a thin layer of hyaline cartilage covers the articular surfaces with an intervening fibrocartilage disc. Cavitation in the disc is a common phenomenon (30%); therefore, although this joint may degenerate like a synovial joint, this joint remains a symphysis . It is more commonly involved in inflammatory arthritides, including rheumatoid arthritis (RA) and gouty, psoriatic arthritis among others . The symphysis at the MSJ limits anteroposterior displacement and allows only a small range of angulatory movement between longitudinal axes of the body of the sternum and manubrium. Hence, arthrits of the MSJ rarely gives rise to symptoms .

Arthrodesis of a joint is a known treatment option for advanced OA by various different techniques. Litchman, et al. had performed an arthrodesis in a case of post-traumatic OA of the MSJ, where they did a resection of the joint and performed a reverse sliding bone graft to fix the joint across and claimed to achieve a ‘satisfactory outcome’. However, their patient could not return to heavy manual work postoperatively . Shewring and Carvell performed an arthrodesis of MSJ for a patient with gouty arthritis, using cancellous bone grafts only (without joint fixation) . Al-Dahiri and Pallister were the first to publish a case report of an arthrodesis of the MSJ for OA using double locking compression plates with good results . The potential complications in the use of implants for arthrodesis of this joint include implant prominence due to the subcutaneous nature of the joint. Also, the MSJ is in close proximity to vital structures in the mediastinum and, hence, care needs to be taken to avoid injury to these structures and also ensure no possibility of implant migration.

A locking plate provides good stability to the construct as the screws lock in the plate. Since, the MSJ cannot be immobilized firmly by a cast or a brace, the plate fixation, therefore, seems to be an excellent option of fixing the MSJ. The locking plates offer specialized advantages over normal compression plates as they have minimal chances of implant migration. Also, since the screws are locked on the plate and need not have purchase at the far cortex, smaller screws can be used for fixation. This helps in decreasing the possibility of damage to important neurovascular structures behind the far cortex, especially in places like the MSJ. These plates offer further advantages such as the very little likelihood of loosening and migration of the metal work. We preferred to use a cervical locking plate because of its thin profile to avoid hardware prominence over the sternum. Bone grafting further enhances the chance of fusion in such cases and, hence, is a preferred choice along with locking plate. Preoperative planning using the CT scan images to measure screw length and drill stop depth in order to provide safety to the underlying vital structure in this surgery was crucial.

Preoperative images of the CT scan helped us to measure the thickness of the bone and the screw length. We believe that OA of the MSJ can be treated successfully by arthrodesis when the conservative treatment fails. We believe that a cervical locking plate may be a satisfactory and safe technique for fusion, but requires good preoperative planning. The cervical locking plate provides durable pain relief and bony fusion of the MSJ.

Summit Medical Group Web Site

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a disease that causes pain, stiffness, swelling, and loss of motion in the joints between your bones. It happens most often in the fingers, wrists, elbows, shoulders, jaw, hips, knees, and toes. In some cases it may affect other parts of the body.

RA is an autoimmune disease. This means the body is attacking its own tissues. Doctors don’t know why this happens.

How does rheumatoid arthritis affect the heart?

RA appears to increase the risk of heart disease. This makes it especially important for people with RA to quit smoking and control high blood pressure and high cholesterol.

In rare cases RA causes inflammation of the sac around the heart, a problem called pericarditis. (This sac is called the pericardium.) Pericarditis may cause chest pain or a buildup of fluid around the heart. Pressure from the fluid may make it harder for the heart to pump blood. The fluid may need to be drained so the heart can work normally.

RA may also cause growths on the surface of the heart valves. These growths, called vegetations, usually cause no problems. They tend to heal in time. However, this healing may cause scarring that changes the shape of the valve and cause it to leak. Most of the leaks are tiny and don’t affect the way the heart works.

How are the heart problems diagnosed?

Your healthcare provider will listen to your heart with a stethoscope. An echocardiogram, which is an ultrasound picture of the heart, will show if there is fluid in the sac around your heart.

How are they treated?

Doctors don’t know how to keep rheumatoid arthritis from affecting your heart. If you have pericarditis, it can be treated with anti-inflammatory drugs. If you have fluid around your heart, the fluid may need to be removed. Valve problems may be treated with surgery.

How does RA affect different parts of the body?

RA is an autoimmune disease. Doctors also classify it as a systemic disease because of the extensive changes it can make to different parts of the body.


Image credit: Stephen Kelly, 2018

The joints

RA can affect any joint in the body, and it commonly develops in the fingers, hands, and feet.

The condition can also affect joints in the:

  • neck and its vertebrae
  • spine
  • knees
  • ankles
  • hips
  • shoulders

RA primarily targets the lining of the joints, called the synovium. The condition causes the synovium to become inflamed and swollen.

When the lining of a joint swells, it can lead to stiffness, pain, and a loss of mobility. People often experience joint pain and stiffness in the mornings, and this can be one of the first signs of RA.

The skeleton

The joints contain cartilage, which prevents the bones from rubbing together. Over time, inflammation from RA can cause the cartilage to break down.

If the bones rub against one another, it can permanently damage the joint. This is a significant cause of pain and stiffness in people with advanced RA.

Rheumatoid arthritis can also cause the bones to lose density, becoming thinner and more brittle. This increases the risk of breaks and fractures.

The skin

In as many as 20 percent of people with RA, rheumatoid nodules form near the joints. These are small, firm bumps made of inflammatory tissue.

Rheumatoid nodules develop under the skin, over bony areas. While they are often painless and are generally not a cause for concern, they can cause discomfort if a person places pressure on them, such as when kneeling.

RA can also cause inflammation in the skin, sometimes leading to:

  • red patches
  • swelling
  • ulcers or lesions

When RA affects the skin, a person may notice symptoms ranging from harmless red dots to ulcers on the legs or under the nails.

They may also notice that wounds heal more slowly than usual. Many factors can cause longer healing times in people with RA, including vasculitis, or inflammation of the small blood vessels in the skin.

Some RA medications can also cause skin rashes.

The mouth

People with RA are more likely than others to experience dry mouth, or xerostomia.

Having RA increases a person’s risk of developing Sjogren’s syndrome, which causes dryness in the eyes and mouth. Like RA, Sjogren’s syndrome is an inflammatory autoimmune disorder.

RA can also cause saliva ducts to narrow or close, leading to an uncomfortable feeling of dryness in the mouth and difficulty eating and swallowing.

Chronic dry mouth can also contribute to gingivitis and tooth decay.

The eyes

RA can also cause inflammation in the eyes, as well as dry eye syndrome, which can lead to ongoing irritation and eventually damage the cornea.

The effects of RA on the eyes can include:

  • keratitis sicca, or dry eye syndrome
  • scleritis, or inflammation of the whites of the eyes
  • uveitis, or inflammation of the inner eye
  • retinal vascular occlusion, or blocked blood vessels in the eye
  • glaucoma, which damages the optic nerve
  • cataracts, which results from inflammation in the optic lens

The lungs

In around 80 percent of people, RA affects the lungs. The effects are usually not severe enough to cause symptoms. However, prolonged inflammation in the lungs can lead to pulmonary fibrosis, which can cause scarring and breathing difficulties.

Rheumatoid nodules can also form in the lungs, though these are not usually a cause for concern.

Some RA medications can make the immune system less effective. This can make people more vulnerable to respiratory infections, including pneumonia and tuberculosis.

The heart

Inflammation from RA can damage the heart and blood vessels. In some cases, the consequences are life-threatening.

RA can cause the following complications:

  • Anemia: Unchecked inflammation can lead to iron-deficiency anemia. This refers to a low level of red blood cells, and it can cause headaches and fatigue.
  • Atherosclerosis: Chronic inflammation can damage the walls of the blood vessels. This can cause the body to absorb more cholesterol, which can cause plaque to build up inside the arteries. The medical term for this is atherosclerosis.
  • Heart attack or stroke: If plaque builds up and blocks an artery or another blood vessel, a heart attack or stroke can result.
  • Pericarditis: RA can cause inflammation in the lining of the heart (the pericardium), and this can lead to chest pain.

The nerves

RA causes inflammation and swelling, which can compress the nerves in the area. When this occurs, a person may notice numbness or tingling in the hands or feet.

When RA develops in the wrist, it can lead to carpal tunnel syndrome. This occurs when inflamed tissue in the wrist squeezes a nerve that extends from the forearm.

The feet

Share on PinterestRA can develop in the joints of the toes.

If RA affects the feet, it can limit a person’s mobility. Because the feet bear the entire weight of the body, the pain from RA can become severe.

The condition often develops in the joints of the toes and, less commonly, the ankles.

RA in the feet can also lead to:

  • Inflamed bursae: These fluid-filled sacs often appear on the balls of the feet and can cause chronic pain.
  • Nodules: These small, firm lumps can form on the pad of the heel, the Achilles tendon, and other bony areas.
  • Corns and calluses: These patches of hard, thick skin tend to develop as the shape of the foot changes. They can lead to ulcers if a person does not receive treatment.
  • Nerve compression: When RA damages a joint, this can compress the surrounding nerves and cause numbness and tingling.
  • Circulation problems: Inflammation in the blood vessels and joint damage can block the flow of blood to the feet. The feet or toes may become numb easily or develop a bluish tinge.

The mind and brain

Many people with RA may experience psychological or neural symptoms, including:

  • brain fog
  • depression
  • cognitive issues
  • changes in behavior

These symptoms may arise:

  • as side effects of medication
  • as a result of body-wide inflammation
  • when damage to the bones in the joints leads to a compression of nearby nerves

The kidneys and liver

Prescription medications for RA can cause complications, including liver and kidney damage. This can result from long-term use of painkillers or anti-inflammatory medications.

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