WBC not a lot of help for Tietze’s Syndrome Diagnosis

Because of the low number of reported cases of Tietze’s, we have to go back several decades to find much of the information. Despite it being older information, much of it is still relevant today. For example, the following researchers found increased numbers of white blood cells in blood tests of a few Tietze’s patients: GH Frey, De Haas, and Landon and Maplas: one patient also had a higher than normal erythrocyte sedimentation rate (a common measure of inflammation)
Many later researchers confirmed these earlier findings, but some did not.

Doctors Ines I. Mbaga, John N. Greene, and Ramon L. Sandin, from the H. Lee Moffitt Cancer Center & Research Institute in Tampa, say that a diagnosis must be all-encompassing. For Tietze’s syndrome and related diseases, blood tests may be a factor but they don’t offer much diagnostic help. “Laboratory studies usually are not helpful since an elevated white blood cell count or sedimentation rate is nonspecific, and blood cultures are frequently negative.”

References:
Frey, G. H. (1956). A.M.A. Arch. Surg., 73, 951.
Haas, W. H. D. de (1952). Ned. T. Geneesk., 96, 254. (Quoted by
Kayser, 1956.)
Landon & Malpas. Ann Rheum Dis 1959 18: 249-254

No related posts.

The team of Italian researchers evaluated 30 patients with Tietze’s syndrome, SAPHO syndrome, ankylosing spondylitis and other costal joint disorders. Each test, the researchers found, gave only a partial clue as to the true nature of the disease. Surprisingly, no one test came out on top.

The idea of multiple tests doesn’t completely go against past research in this area. For the past decade or two there has been a lot of debate about which test is the best. In my article on Tests for Tietze’s, you can see that many researchers favor one technique, and three techniques are heralded as “the best” by at least one researcher.

Multiple tests make sense to diagnose Tietze’s Syndrome, but there are risks and benefits with every diagnostic tool–including financial constraints. My advice? Find an excellent rheumatologist at a teaching hospital (an MD PhD)–they should be up on current research and will better be able to advise you on current thinking as it crops up. This is especially true with a newly researched disease like Tietze’s syndrom.

Reference:

Guglielmi G, Cascavilla A, Scalzo G, Salaffi F, Grassi W. Imaging of sternocostoclavicular joint in spondyloarthropaties and other rheumatic conditions. Clin Exp Rheumatol. 2009 May-Jun;27(3):402-8.

Related posts:

1. Tests for Tietze’s Syndrome

• Chest wall pain doesn’t necessarily have to be Tietze’s syndrome. In one study, two patients with chest wall pain that emergency room personnel first thought was due to costochondritis turned out to be a heart attack [1].

There are many causes of chest pain that you cannot diagnose yourself:

• You might have an infection that needs antibiotics such as pseudomonas aeruginosa or staphylococcus aureus which could lead to abcesses and mediastinitis, a serious medical emergency [3].
• Thoracic disc herniations are rare, but may require surgery to correct.
• Your pain could be the first sign of rheumatoid arthritis.
• It could be bone lesions that could lead to sacroiliitis, psoriasis, and palmoplantar pustulosis [2].
• You could also have fibromyalgia (tenderness in the second costal joint is a common complaint in this disease)–eight percent of patients going to the emergency room with chest wall tenderness are found to have fibromyalgia [1].

Your pain could be caused by any one of the above diseases and many more. It could even be a stress fracture or a tumor–but if you try and self-diagnose, how would you ever know until it’s too late?

References:

1. Disla, E, Rhim, HR, Reddy, A, et al. Costochondritis. A prospective analysis in an emergency department setting. Arch Intern Med 1994; 154:2466.

2. Vittecoq, O, Said, LA, Michot, C, et al. Evolution of chronic recurrent multifocal osteitis toward spondyloarthropathy over the long term. Arthritis Rheum 2000; 43:109.

3. Pollack, MS. Staphylococcal mediastinitis due to sternoclavicular pyarthrosis: CT appearance. J Comput Assist Tomogr 1990; 14:924.

No related posts.

I consider myself to be a fairly smart person, and I consider doctors in general to be pretty smart. However, Tietze’s syndrome is a rare disorder, so rare that even your doctor might miss the diagnosis (he’s going to be trying to decide between about three dozen different possibilities for your pain, and Tietze’s is way down on that list). Two general practitioners and two specialists missed my diagnosis of Tietze’s syndrome; it took one year for me to finally get diagnosed–and that made it a lot easier to deal with. This short article will let you know how to tell if you have Tietze’s syndrome–a benign inflammation of the ribs–or something more sinister, like Pleomorphic T-cell lymphoma, a rare cancer.

How to tell if you have Costochondritis or Tietze’s syndrome

(Small disclaimer, I’m going to assume that you’ve already seen a physician to make sure your Tietze’s syndrome pain isn’t caused by heart problems or other serious illness).

Tietze’s syndrome clue #1

Do you have intense pain in the rib cartilage area? That’s at the junction between your sternum and ribs. The pain could be so severe you might even mistake it for a heart attack. The pain may radiate, and you may not even be sure of the central location for the pain–just that it’s somewhere in or on your chest.

Tietze’s syndrome clue #2

Do you have pain in the chest area when rolling over in bed, or trying to get out of bed? This is caused by pressure from the ribs squeezing the inflamed breast plate cartilage. You might feel this pain when otherwise twisting, turning or bending.

Tietze’s syndrome clue #3

Does the pain radiate from the chest to the arms and shoulders? (The pain might be so severe it could feel like it is coming from everywhere).

Tietze’s syndrome clue #4

Is the pain worse when breathing? Sometimes even a little movement of the rib cage will cause intense pain.

Tietze’s syndrome clue #5

Tietze's syndrome pain locator

Lightly press down on the cartilage area between your sternum (breast plate) and ribs. Is it is tender and painful in at least one area highlighted in red?

These questions are the most common observations about Tietze’s syndrome and costochondritis. If you can answer yes to all five of these questions (or most of these questions–as you can tell, a diagnosis at this stage isn’t an exact science!), it is probably Tietze’s syndrome…but it could also be about one of dozens of other diseases (see my other articles here and here for other diseases that are often mistaken for Tietzes).

The Definitive Hallmark for Tietze’s Syndrome

The hallmark for Tietze’s syndrome is that in addition to the pain described above, usually only one rib is affected–the second or third rib down. There are rare exceptions–for example, if the swelling is in the first joint, it may be hidden under your clavicle and you won’t be able to feel the swelling. Feel the connections around your other ribs to see what’s normal for you. If you feel swelling at the first, second, or third junctions, you most probably have Tietze’s syndrome (according to Harrison’s Rheumatology). However, make sure you see a doctor: there are a couple of cancers that can cause one costal junction to be swollen and painful–namely skin cancer that has invaded the chest area and Pleomorphic T-cell lymphoma.

Can a Tumor be causing my Tietze’s Syndrome?

The chances of a tumor causing your pain are about as rare as Tietze’s syndrome itself (only a few hundred cases have ever been documented in the medical literature). However, the same tests that check for Tietze’s syndrome (an MRI or CT-scan) will also be able to definitively tell if you have a tumor. See this article for more information on cancers and other rare causes of Tietze’s syndrome, and this article for more information on tests.

Tietze’s syndrome(unlike cosotchondritis) can turn into a chronic condition lasting years, or even decades. Why should you get a diagnosis instead of waiting for the pain to go away? If your doctor tells you that you have “costochondritis,” you might expect the pain to disappear in a few weeks. If it doesn’t, you should insist on a test to rule out other causes.

Related posts:

1. Sulfasalazine Treatment for Costochondritis and Tietzes Syndrome?

Check out my article on Tietze’s Syndrome’s Causes to find out about other disorders that can mimic Tietze’s. Your doctor may recommend one of the following techniques to rule out other disorders:

• Computed tomography

  (sometimes known as a CT or CAT scan) is one of the most exact ways to diagnose Tietze’s Syndrome, according to this article in the Journal of Computed Tomography.

• Xeroradiography

  (a technique commonly used for mammograms) allows a doctor to see a complete picture of the chest wall and rule out other cause of your pain, such as tumors. According to this article, Xeroradiography is a “first choice” diagnostic technique for Tietzes.

• Ultrasound

  Researchers Kamel and Kotob report that ultrasound should be the “first choice” screening procedure for Tietze’s Syndrome. the researchers followed 9 patients with Tietze’s and were able to show improvement in the condition after an injection of steriods. (For more information on treatment see this post).

• Blood tests

  A sedimentation rate or C-reactive protein test can detect inflammation in Tietze’s which would be absent with costochondritis.

• MRI

  (Magnetic resonance imaging) can also be used to diagnose Tietze’s syndrome, according to this research which studied the disorder in 12 patients. It’s an excellent way to diagnose both bone and cartilage disorders.

It’s clear from the research that there isn’t just one way to diagnose Tietze’s sydrome, but what is clear is that you should have at least one diagnostic imaging technique done to rule out other causes of your bone pain and swelling. The odds of your Tietze’s Syndrome being a tumor or skeletal tuberculosis might be small, but no one should suffer the anguish of not knowing exactly what is causing the pain. Insist that your doctor order one of the tests (an ultrasound can often be done in-office!), and get the peace of mind that you deserve!

Related posts:

1. New Research: Diagnosing Tietze’s Requires Multiple Tests