All About Tietze's Syndrome

Tietze Syndrome and Crohn’s Disease

andalellc — Tue, 01 May 2012 19:18:40 +0000

Tietze’s syndrome (or Tietze syndrome, as it’s sometimes called) has many causes, many of which are linked to autoimmune diseases. Therefore, it should come as no surprise that many patients with Crohn’s disease — a form of inflammatory bowel disease (IBD) also report issues with costochondritis and Tietze’s Syndrome.

What is Crohn’s Disease?

If you have Crohn’s disease, you suffer from chronic inflammation of your intestinal tract. Crohn’s can affect your small intestine, large intestine the mouth or rectum. Symptoms include constipation, bloody stools, eye inflammation and swollen gums. Not surprisingly, the disease plays havoc with your body.

What is Tietze Syndrome?

Tietze syndrome is a benign inflammation of the costal cartilage — the cartilage that connects the breastbone to the ribs. “Benign” means that it won’t develop into something more serious, like cancer. However, the pain from Tietze’s syndrome can be as intense as a heart attack, disabling many people for years.

The Link Between Crohn’s Disease and Tietze’s Syndrome

The cause of Tietze’s Syndrome isn’t known, and neither is the cause of Crohn’s disease. Tietze’s syndrome has been linked to cases of Crohn’s in many medical journals, but the link isn’t clear. The autoimmune disturbances definitely play a part, but it isn’t known whether Crohn’s disease itself plays a part in developing Tietze’s syndrome or whether it’s the underlying autoimmune disease (the one that caused Crohn’s disease in the first place) is responsible for the subsequent development of Tietze’s Syndrome.

Treatment Options

Treatment options for Tietze’s Syndrome

include many of the same treatments for Crohn’s Disease. Rest, keep stress to a minimum, and work to support your immune system by eating well and ensuring you have adequate vitamins. Physical therapy and massage therapy may also be beneficial. A variety of medications exist to treat Tietze’s syndrome, including prescription pain patches and Non-Steroidal Anti Inflammatory Drugs (NSAIDs) like ibuprofen.

Warning

Consult with your doctor before taking any medication for your Tietze’s syndrome. Interactions can occur between drugs treating Crohn’s disease and drugs treating Tietze’s syndrome.

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Exercise that Makes Tietze’s Syndrome Worse

andalellc — Tue, 19 Apr 2011 17:26:30 +0000

I’ve been struggling with my weight ever since my pregnancies. I’m not overweight, but I’m borderline (I’m always hovering on the normal/overweight mark). I’d love to lose about ten pounds, but every time I try pushups, my Tietze’s Syndrome acts up again. Over the last 20 years, I’ve learned which exercises I can do, and which I can’t. I usually try and post articles with at least a little scientific research, but seeing as there’s currently none on Tietze’s and exercise, here is a thoroughly unscientific report on my personal experiences with Tietze’s and exercise.

Activities to avoid:

Running or jogging, especially if you are a woman with large breasts. I imagine that will, for some, conjur up images of the Monty Python Meaning of Life sketch with topless women rollerskating, or perhaps those old Benny Hill episodes with big-breasted ladies chasing down a pudgy, middle-aged Benny with boobs bouncing everywhere. Trying to jog or run with Tietze’s can lead to pressure between the ribs; you breathe harder, not to mention the pounding from the pavement. If you are a lady, a good sports bra can help. However, you may want to switch to swimming or cycling for exercise–or any other non-impact sport.
Pushups. Pushups don’t just put strain on the arms; they put strain on the entire chest. If I do ten pushups, it guarantees 100% that I will be in agony the next day. After several years of not doing pushups (and forgetting why I never did them), I decided to throw in some pushups into my meager exercise routing. Oh boy, I paid for that the next two days. I had to walk around with a hot water bottle strapped to my chest and a bottle of Tylenol in my hand. No more pushups for me.
Contact sports. I feel like I am stating the obvious here, but if you do contact sports like I do (I take Tae Kwon Do lessons), then you absolutely must wear some form of chest protection otherwise you are risking severe Tietze’s syndrome attacks. The cartilage in your ribs is already damaged; it’s not worth the risk to change it being damaged even more. I wear a chest guard when I spar, and would never spar without it: not even for fun.

Those are the activities that cause me the most difficulty, as far as sports go. There are others that are obvious ones to avoid: weightlifting (chest), racquetball (without a chest guard), tennis (mild tennis would be okay) and any sport where you might risk a fall to the chest (like horseback riding).

In general, anything that strains your upper body should be avoided while you are recovering from Tietze’s syndrome. Start walking, swimming, cycling, or participating in other low impact aerobics so that you can stay physically fit while recovering from the disease. After your symptoms subside, gradually re-introduce those exercises that were giving you trouble. But don’t overdo it at first, or you may regret it the next day!

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All About Tietze's Syndrome

Suicide Molecules: Future Treatment for Tietze’s?

andalellc — Wed, 22 Sep 2010 11:55:46 +0000

If you’ve read my article, What is Tietze’s Syndrome?, then you’ll know that Tietze’s syndrome is an inflammation and swelling of the costal cartilage. It’s similar to rheumatoid arthritis (in fact, the now defunct drug Vioxx was used to treat rheumatoid arthritis and Tietze’s), which is why I was excited to read about a possible cure: a suicide molecule.

In this story posted on Northwestern University’s site, researchers fondly referred to the molecule as Casper the Ghost. The molecule floats in the bloodstream to the site of the inflammation and halts or reverses all of the signs and symptoms of rheumatoid arthritis.

Casper the Ghost cures Tietze's Syndrome

The lead researcher, Harris Perlman, discovered that when you have rheumatoid arthritis, you’re low in a molecule called Bim, which is responsible for telling viral cells to self destruct. Perlman developed BH3 mimetic, a replica of Bim, and injected it into mice. The therapy stopped rheumatoid arthritis in 75 percent of the mice.

Unfortunately, the cure may be a long way off. It relies on nanotechnology to deliver the drug precisely, then of course there’s the long FDA approval process. But at least there’s some hope for the thousands of Tietze’s Syndrom sufferers out there.

All About Tietze's Syndrome

Elevated White Blood Cell Count (WBC) and Tietze’s Syndrome

andalellc — Mon, 18 Jan 2010 17:00:23 +0000

In the majority of Tietze’s syndrome cases reported in the literature, patients have normal blood test results. However, it’s worth bearing in mind that they have only been a few, limited studies of the disease, so no real conclusions can be drawn from that statement. The best information I can draw from the journals is that some cases of Tietze’s Syndrome (most likely, those causes by a virus or other infection) may result in a high white blood cell (WBC) count.

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

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New Research: Diagnosing Tietze’s Requires Multiple Tests

andalellc — Fri, 16 Oct 2009 13:07:59 +0000

I would have thought that as more is known about Tietze’s syndrome, diagnostic tools would improve. However, new research just published in the May-Jun 2009 issue of Clinical Experimental Rheumatology had a surprising conclusion: a combination of X-ray, CT, MRI and nuclear medicine is the best way to diagnose the disease and rule out other disorders.

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.

Tests for Tietze’s Syndrome

All About Tietze's Syndrome

Helping Your Child Deal With Chronic Illness

andalellc — Thu, 10 Sep 2009 15:37:45 +0000

I just wrote an article on my other blog, about how to help children deal with chronic illness (and how to help other adults understand as well!). The message is universal, and is just as applicable for Tietze’s syndrome as it is for reactive hypoglycemia (which is what my ten-year-old son has). You can find the full article at the Reactive Hypoglycemia website.

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All About Tietze's Syndrome

Costochondritis and Tietze’s Syndrome: A Heart Attack Waiting in the Wings

andalellc — Thu, 06 Aug 2009 13:27:45 +0000

My article, Costochondritis and Tietze’s Syndrome: A Heart Attack Waiting in the Wings has just been published by Associated Press:
“You feel a pain in your chest. Upon pressing down on your ribs, you become convinced that something in your bones, or along your ribs is causing the pain. You visit the ER and are relieved to find that the doctors think that the pain you are feeling is costochondritis or Tietze’s syndrome. An examination of your ribs cements the diagnosis–when a resident presses on your ribs, your chest hurts like hot stabbing knives are being twisted into them. Unknown to you and your doctor, a diagnosis of costochondritis does not rule out a more serious condition: two hours later you are in surgery, after suffering from a heart attack.”

Read the rest of this article on the AP website.

Sulfasalazine for Costochondritis and Tietze's Syndrome Treatment

All About Tietze's Syndrome

Why You Shouldn’t Self-Diagnose Sternum Pain

andalellc — Fri, 24 Jul 2009 15:21:00 +0000

Tietze’s syndrome is a rare disorder, and there are a few dozen other ailments that can cause similar sternum pain. While most cases of sternum pain are caused by benign disorders, some cases can be more serious, or even life threatening. Just in case you haven’t been diagnosed yet (or if you’ve diagnosed yourself), here are a few really good reasons why you should see a doctor now:

Sternum 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 sternum 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.

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All About Tietze's Syndrome

Sulfasalazine for Costochondritis and Tietze's Syndrome Treatment

andalellc — Fri, 17 Jul 2009 14:50:20 +0000

I’d never heard of sulfasalazine until I read an article in the Journal of Rheumatology on the management of costochondritis. You can read about the differences between Tietze’s Syndrome and costochondritis in this article, but for treatment purposes they can be treated similarly. That’s why reading about a possible “new” Tietze's syndrome treatmentwas exciting!

The study reported how 11 out of 13 patients initially treated with corticosteroid injections reported recurring symptoms. They were given sulfasalazine, a anti-inflammatory drug commonly given to treat ulcerative colitis and rheumatoid arthritis. Ten of the patients reported success with decreasing their symptoms and stayed on the drug from between six months and 6 years.

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 Tietze's syndrome treatment 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

All About Tietze's Syndrome

Psychological Stress and Tietze’s Syndrome

andalellc — Fri, 03 Jul 2009 16:46:52 +0000

Can Stress Cause Inflamed Cartilage?

Yesterday, I had the first twinge of pain in my ribs due to Tietze’s syndrome 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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