Read the rest of this article on the AP website.

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Tietze’s Syndrome and Costochondritis Treatment Options

Historically, patients suffering with Tietze’s syndrome or costochondritis were presented with few treatment options, including: rest, ibuprofen, heating pads, and ice-packs. Advances in the last few decades in understanding this chronic disorder have resulted in…[read the rest of this article]

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1. Sulfasalazine Treatment for Costochondritis and Tietzes Syndrome?

Tsetse Syndrome Attack!

Kai Shan in Singapore blogs about his Tietze Syndrome pain, which he (tongue-in-cheek) calls Tsetse, which is often confused with Tietze’s.

My Tietzes Blog

Charlie from England blogs about her Tietze’s in an effort to disseminate correct info about Tietze’s. A dedicated Tietze’s blog–awesome!

Standing Silent on Tietzes syndrome

This blog post by Standing Silent really struck a chord with me. I think it’s because when I first got Tietze’s, I felt so alone–just like her. And there’s so much garbage out on the web about the syndrome, the advice is often confused and outdated, adding to misery!

Costochondritis, Tietze’s syndrome, and Chronic Fatigue Syndrome

I found this blog by Fiona interesting because of her issues with Chronic Fatigue Syndrome (CFS). I’m not sure if she has Tietze’s syndrome or costochondritis, but seeing as the two diseases are treated similarly it probably doesn’t matter much

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Yesterday, I had the first twinge of pain in my ribs that I’ve had in about a year. Immediately I laid down and meditated for about a half hour. I also took a couple of Tylenol. The pain went away later in the afternoon and I realized that the previous day I had been under a lot of stress. I began to wonder how much the stress had to do with my sudden attack of chest pain.

Breast Bone Pain Caused by Insurance Company?

The cause of my stress was an insurance company. To be more precise, I’d had a small grease fire in 2002. It’s funny how in some stressful situations, the brain seizes up; I couldn’t remember for the life of me how to put out a grease fire. So I called 911 and asked them. “Ma’am,” the operator said. “You should get out of the house and let the firefighters deal with it–grease fires can explode without warning.” Well, I exited the house and lucky for me I did, because the pan exploded after I stepped out of the kitchen. The resulting fire caused $8,000 worth of damage. The insurance company paid for the damage and that was the end of the story. Or so I thought.

Fast forward a few years. In the meantime, the insurance company sold the claim to a subrogation company who sued me for the $8,000 for “negligence,” which of course wasn’t true (I’d done all the right things, including calling 911). To cut a long story short, they sent all of the notices of the court hearings to an old address and received a default judgment against me for $14,000 (including lawyer’s fees and court costs) because I didn’t show up for court. Of course I didn’t show up: I never received a notice! I only found out about the judgment when I checked my credit report.

Perhaps you can imagine why I felt a little stressed–I am now on the hook for $14,000 only because a law firm sent notices to an old mailing address and didn’t give me the opportunity to appear in court.

“Psychological Stress is a Cause of Tietze’s Syndrome”?

Wikipedia stated that psychological stress is a cause of Tietze’s Syndrome:  “Preceding stressful events such as relationship problems, family issues or work related stress are very commonly associated with this syndrome.” I’m always skeptical of anything I read on Wikipedia–I think because it got drummed into me in grad school that I could not, under any circumstances, list Wikipedia as a resource for anything–not even in a paper debating the merits of Wikipedia. So I decided to do a little research to find out why that statement on Wikipedia might be true.

Now, I’ve got no doubt that stress can worsen Tietz’es Syndrome. But cause it? That’s like saying that stress can cause arthritis (because Tietze’s and arthritits are closely related). I am fully aware that I have to avoid stress, because tension in my chest is going to affect my costal joints and cause pain. But I’d hate to think there are people out there with Tietze’s syndrome who are living with debilitating pain because of a little stress fifteen years ago. As far as I am aware, there are many causes of Tietze’s syndrome like genetics and viruses (you can read a full summary of known causes of Tietze’s syndrome here). But “stress”? It just doesn’t seem likely to me that stress can cause a joint to swell. Or could it?

Tietze’s Syndrome: Searching for Answers

I looked for answers starting with a Google search for stress & Tietze’s syndrome. Of course, the top article was Wikipedia, followed by a lot of opinion sites like “Jim’s health site” and “Sue’s pain blog.” There was nothing to substantiate that Wikipedia statement from a verifiable source (i.e. something that referenced a medical journal or other good source). I went to PubMed next and performed a search there.

I found one article stating that chest pain can cause anxiety, but not the other way around. Another article said that chest pain can be caused by stress fractures, but not “stress”. Another article talked about chest-related musculoskeletal pain after heart surgery, referring to it as “mechanical stress” i.e. trauma to the chest wall. But not one article mentioned stress itself as a cause.

Tietze’s Syndrome: Wikipedia Corrected

My conclusion is that I have no idea where that statement in Wikipedia came from. It wasn’t referenced, and I could not find anything in PubMed to substantiate it (PubMed is perhaps the most comprehensive medical database there is) to indicate that stress is a cause of Tietze’s syndrome. So for those of you who are wondering if you somehow caused your Tietze’s syndrome by being too high strung or if you brought it on yourself by “stressing out” then relax: you didn’t.

I changed the Wikipedia article to read “Psychological stress can exacerbate Tietze’s Syndrome, but it is not a direct cause.” Of course, someone will probably jump in and change it back. We’ll see if that happens.

References

Gregory PL, Biswas AC, Batt ME. Musculoskeletal problems of the chest wall in athletes. Sports Med. 2002;32(4):235-50.

Jensen, S. Musculoskeletal causes of chest pain. Aust Fam Physician. 2001 Sep;30(9):834-9

Szántó D, Szücs G, Bíró BP, Priska M. [Degenerative chondroarthropathy of the sternocostal joint following heart surgery]

[Article in Hungarian] Orv Hetil. 1994 Nov 27;135(48):2639-42.

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Tietze’s syndrome is sometimes confused with costosternal chondrodynia but according to this article by Carabasi et. al, the two conditions are exact opposites! Costosternal Chondrodynia often effects several ribs, and rarely the second costal joint. Most cases of Tietze’s syndrome affect only the second costal joint. There are only a few similarities between Tietze’s syndrome and Costosternal Chondrodynia: an unknown origin of the disease, the disease’s benign (not harmful) nature, and the fact that both disease can last for years.
You may also find Tietze’s syndrome called many other names—it may be impossible for you to figure out which disease you have unless you have a diagnostic technique (such as an ultrasound) performed. This article on tests for Tietze’s syndrome could help you decide which test might be right for you.

Some other names that Tietze’s might be called (or mistaken for!):

Chest wall Syndrome

Condropathia Tuberosa

Costal chondritis (same as costochondritis)

Costochondrial junction syndrome

Costochondritis

Cyriax’s syndrome (slipping rib syndrome)

Parasternal chondrodnia

Peristernal perichondritis

Thoracochondralgia

Tietze Disease

Tietze’s Disease

Xiphoidalgia

Tietze’s syndrome was so frustrating in the beginning…if only I had had a correct diagnosis, so much stress and anguish would have been avoided! I hope that these blog posts will help fellow sufferers out there understand what Tietze’s syndrome is and how to treat it–and that starts with knowing what Tietze’s syndrome is and what it isn’t!

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Why Tietze’s Syndrome is not Costochondritis

Tietze’s syndrome is where the costochondral (rib) cartilage is inflamed and swells, causing mild to intense pain that can mimic a heart attack.  Costochondritis and Tietze’s syndrome affects the same region of the chest–the cartilage that connects the ribs to the breast bone–but unlike costochondritis, Tietze’s syndrome has several differences:

• Tietze’s syndrome causes inflammation, tenderness, and swelling. According to the Mayo clinic, swelling is absent with costochondritis.
• Tietze’s syndrome affects men and women equally, but according to this radiology manual usually occurs in the 20-40 year-old age range bracket.  Costochondritis tends to affect women over the age of 40.
• According to Harrison’s Rheumatology, costochondritis affects the third, fourth, and fifth joints down in between the breast bone and ribs (you can feel these joints with your fingers). Tietze’s syndrome tends to affect only one joint, although the pain may radiate out, making it near-impossible for a sufferer to tell which rib is causing the pain.
• Costochondritis is usually short-lived, whereas Tietze’s syndrome can last for years, turning into a chronic condition.

It used to be thought that not much could be done for sufferers of Tietze’s Syndrome apart from pain management. This is no longer true: see my article on Treatments for a full discussion of the many options available.

Costochondritis might also be referred to as:

Costalgia

Costal Chrondritis

Costal Chondritis

Costal Condritus

Or many other variations on the name. I’ve ever seen it referred to (mistakenly) as tsetse syndrome or tsetse disease. There are also other conditions that can mimic costochondritis or Tietze’s syndrome. For a run down on common conditions, see this article.

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Tietze’s Syndrome was named after a German surgeon called Alexander Tietze (1864-1927), who discovered the disease in 1921.

With Tietze’s syndrome, the cartilage in between the ribs and breastbone (the costal cartilage) is inflamed and swells, causing mild to intense pain that can mimic a heart attack. Tietze’s syndrome is not costochondritis; you can read why not here. This researcher found that in half the patients afflicted with Tietze’s syndrome, the pain lasts more than one year.

Fifteen years ago, I had never heard of it. If you’d have asked me what it was, I would have said it had something to do with mosquitoes (it has nothing to do with mosquitoes).

Tietze’s Syndrome Symptoms Make an Entrance

It started when I was taken to the ER in 1992 with symptoms of a heart attack at age 26—a crushing feeling on my chest like an elephant was sitting on top of me, intense pain like nothing I had ever experienced, and the panic that was accompanying the pain in my ribs.

This is What Tietze's Syndrome Pain Feels Like!

“There’s nothing wrong with you,” an impatient chest specialist told me after two months of trying to diagnose the excruciating pain in my chest. I’d had tests for heart problems, blood disorders, stomach disorders…all to no avail. “You should consider seeing a psychiatrist,” he told me. I took him up on it, but a year later, I still had the pain (and a prescription for Valium).

The large amounts of ibuprofen I was consuming were doing a number on my stomach, and no over-the-counter medicine could stop the acid reflux that had become part of my daily life. I went to a new doctor to ask him for prescription strength Zantac. Being a new patient, he performed a thorough exam, listening to me as I asked him not to tap my chest. He did, anyway. “You’ve got Tietze’s Syndrome,” he said.

I’d never heard of it, I said. The doctor explained that he’d only heard of it in passing, and that all he knew about it was that it was a rare disorder, characterized by crushing pain when the chest is pressed on. Tietze’s syndrome, he explained, was like costochondritis–only unlike costochondritis, with Tietze’s syndrome the rib cartilage swells and the condition can be chronic–sometimes lasting decades. For more information on the major differences between Tietze’s Syndrome and Costochondritis, see this post.

That is how my year-long journey into understanding Tietze’s syndrome happened. I wasn’t crazy or stressed. I had a legitimate disease that was caused by a virus (how do I know it was a virus? See my post Shipboard Virus Causes Tietze’s Syndrome. Two decades later, I still have Tietze’s syndrome, but I’ve learned ways to manage it. Unfortunately, there’s a lot of misinformation on the web about the condition; it’s almost impossible to find good information out there–that is the reason I started this blog.

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1. Sulfasalazine Treatment for Costochondritis and Tietzes Syndrome?