Tietze Syndrome - Pictures, Symptoms, Diagnosis & Treatment

Tietze Syndrome - Symptoms, Diagnosis & Treatment

Let us first understand the anatomy of the rib cage. The rib cage is actually formed not only of bones (ribs and sternum). Cartilages are a very important part of the formation of the rib cage. It is due to cartilage only that our Rib cage is mobile which is a must for respiratory movement, inspiration, and expiration.

So ribs are attached to the sternum (middle bone) via cartilages. So cartilage is having a rib on one side and sternum on the other side. The joint between ribs and cartilage is known as the costochondral joint. While joint between cartilage and sternum is known as a chondrosternal joint.


What Is Tietze Syndrome?

Tietze Syndrome is inflammation and swelling of Upper costochondral joints in the front part of the chest. Three most important factors to consider for the diagnosis of Tietze Syndrome are;

  1. Inflammation and swelling
  2. Upper costochondral joints
  3. Front of chest

Differences Between Tietze Syndrome And Costochondritis

  • Costochondritis is an inflammation of the costochondral joints (without swelling). This can be seen in both upper and lower chest as well as front and back chest. So the main differentiating point between these two is the absence of swelling in costochondritis.
  • Another practical difference is costochondritis usually involves more joints (more than 2 – 3 costochondral joints).

Causes And Risk Factors For Tietze Syndrome

As such, there is no identification of causative factors in many cases. But common causes are;

  • Hereditary
  • Chest trauma
  • viral infections.

Tietze Syndrome can appear as an isolated disease or sometimes present as an associated illness to autoimmune diseases like lupus, rheumatoid arthritis, ankylosing spondylitis, etc.

[Also Read: Diet For Ankylosing Spondylitis]


Symptoms Of Tietze Syndrome

  • The most common symptoms of Tietze Syndrome is pain and swelling in the front part of the chest. It is usually localized in 1-2 ribs. Pain is constant, dull aching, worsening by movements, weight lifting, sudden change of posture, specific sleeping positions, etc. In severe cases, overlying skin can also be red and feels warm on touch.
  • Pain can be felt at night and because of this many patients complain about interrupted sleep, frequent awakening, etc.
  • Some patients can show symptoms of stress, anxiety, and depression.

Diagnosis Of Tietze Syndrome

There is no specific test available which can stamp the diagnosis of Tietze Syndrome. Hence diagnosis is mostly clinical, based on history and description by the patient, local examination (pain, swelling, warm, tender area) and ruling out other diseases like heart diseases, lung issues, rib fracture, etc. So doctors usually ask for a chest x-ray and ECG (electrocardiogram). Normal chest x-ray and ECG rule out heart and lung diseases. It is always advised to consult an expert rheumatologist to get better treatment.


Treatment Of Tietze Syndrome

After ruling out heart diseases and lung diseases, treatment for Tietze Syndrome should be started. First should be an assurance that nothing is serious.

  • Simple painkillers, anti-inflammatory drugs like paracetamol or ibuprofen is the treatment of choice for Tietze Syndrome.
  • Local application of ice packs, pain relief gel or spray can also be given.
  • The patient should avoid heavy weight lifting and strenuous exercise.
  • Avoid sleeping in bad posture, avoid sudden jerky movements of the chest, etc.

Usually, recovery is seen in 2-3 weeks. In some patients, relapse or recurrence is also seen. Particularly, patients with autoimmune disease history are more likely to show recurrence.


Long Term Effects Of Tietze Syndrome

Usually, no deformity or adverse effects are seen. But patients may end up in psychological issues like stress and anxiety because of relapse.


Is Tietze Syndrome An Autoimmune Disease?

Well, it is not 100% proven but many autoimmune diseases like lupus, rheumatoid arthritis, ankylosing spondylitis, etc can not only cause but also cause a relapse of Tietze Syndrome. So autoimmune disease connection with Tietze Syndrome cannot be neglected.

Another point establishing an autoimmune connection with Tietze Syndrome is elevated inflammatory markers like CRP (C Reactive Protein) and ESR (erythrocyte-sedimentation-rate). In the majority of Tietze Syndrome patients, CRP and ESR are elevated which are also elevated in Autoimmune diseases.

Author:

DR. Kaushal Bhavsar

Dr. Kaushal M Bhavsar pursued his MD in Pulmonology. He is an Assistant Professor in Pulmonary Medicine, GMERS Medical College, Ahmedabad.