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

No related posts.

Read the rest of this article on the AP website.

No related posts.

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]

No related posts.

• 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.

Can sulfasalazine help with Tietze's syndrome?

Personally, I won’t be trying sulfasalazine (or any other prescription drug for my Tietze’s syndrome). I’ve avoided prescription drugs ever since I tried Vioxx a decade ago (for those of you unfamiliar with the Vioxx fiasco, you can read about it–and the questions it raised about other drugs on the market–here). A recent stress test confirmed all is well with my heart but there’s still a voice in my head that tells me I had a very close call and I don’t want that kind of stress again! I’ve learned to manage my Tietze’s syndrome in other ways, including dietary changes and wearing sports bras. My pain is practically non-existent now, but I remember those years when the pain was excruciating!

You can find all the different kinds of treatments for Tietze’s syndrome at my Treatments for Tietze’s syndrome articles page.

Reference:

FREESTON J, KARIM Z, LINDSAY K, and GOUGH A. Can Early Diagnosis and Management of Costochondritis Reduce Acute Chest Pain Admissions? Retrieved July 16, 2009 from http://www.jrheum.com/subscribers/04/11/2269.html

No related posts.

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

No related posts.

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.

No related posts.

I recently came across an article in the Japanese Journal of Anesthesia called stellate ganglion block therapy for a patient with Tietze’s syndrome.” The article, which can be found here, describes a patient who had severe Tietze’s syndrome for more than six years. Her pain (on a scale from 1 to 10) was a full 10; anyone who has ever had Tietze’s syndrome knows that kind of pain. But after this specific kind of therapy, the woman’s pain diminished to 3 out of 10.

The researchers treated the 45-year old patient with SGB therapy. When the woman first arrived, she had the classic signs of Tietze’s syndrome–excrutiating pain radiating toward her left shoulder and swelling of one costal cartilage. The researchers performed an ultrasound and saw that the first costal cartilage was swollen (as shown in the following pictures).

Ultrasound Images of Tietze’s Syndrome

Image from the Journal of Anesthesia of Tietze's syndrome

The stellate ganglion is found at the 7th cervical vertebrae, just behind the first rib. Stellate ganglion blocks  (injections of local anesthetic) around this area has been shown in the past to help with the pain caused by other chronic diseases, such as complex regional pain syndrome. The stellate ganglion is also a site targeted in acupuncture to alleviate pain.

Image from Northwestern University

Series of Stellate Ganglion Blocks Reduce Tietze’s Syndrome pain

The researchers injected 5ml of mepivacaine (a local anesthetic) into the stellate ganglion, which reduced the Tietze’s syndrome pain for six hours. After the fifth injection (she received one per week), her pain had lessened to 3 out of 10, and she was able to sleep through the night. Stellate ganglion blocks are known to have this effect–the more you have of them, the longer the pain relief lasts.

Stellate ganglion block to treat Tietze’s syndrome is performed under local anasthesia and only takes a few minutes. Side effects are rare. A full description of stellate ganglion block, how it’s performed and what you should expect can be found here, at the Redding Anesthesia Associate website.

No related posts.