Lupus is an autoimmune disease that can affect multiple organs and tissues throughout the body. Costochondritis, which is inflammation of the cartilage in the chest, is not one of the common or well-known symptoms of lupus but research suggests it may occur in some lupus patients.
What is lupus?
Lupus is a chronic autoimmune disease where the immune system mistakenly attacks healthy tissue and organs in the body. This leads to widespread inflammation that can affect the joints, skin, kidneys, brain, heart, lungs, and blood vessels. The most common symptoms of lupus include:
- Joint pain, swelling, and stiffness
- Skin rashes on the face, neck, and arms
- Fatigue and fever
- Chest pain when taking deep breaths
- Sunlight sensitivity
- Hair loss
- Headaches and memory issues
- Fingers turning white or blue when cold (Raynaud’s phenomenon)
The exact cause of lupus is unknown but risk factors include family history, environmental triggers, and hormonal influences. Lupus is known to flare up and go into remission periodically. Medications used to treat lupus symptoms include NSAIDs for pain and inflammation, corticosteroids to suppress the overactive immune system, immunosuppressant drugs, and antimalarial drugs.
What is costochondritis?
Costochondritis refers to inflammation of the costal cartilage, which connects the ribs to the sternum (breastbone). It typically results in pain and tenderness in the front of the chest around the sternum that may radiate to the back or abdomen.
Common causes and risk factors for costochondritis include:
- Injury to the chest from trauma or exercise
- Joint inflammation from arthritis
- Chest strain from heavy lifting or coughing
- Bacterial or viral infections
- Physical or emotional stress
Costochondritis often goes away on its own after a few days or weeks. Anti-inflammatory medications like ibuprofen can help relieve pain and swelling. Applying heat packs and using over-the-counter pain creams may also provide symptom relief.
Can lupus cause costochondritis?
Costochondritis is not one of the common or well-known symptoms directly associated with lupus. However, some research suggests costochondritis may develop secondary to lupus in some patients.
One study looked at 200 patients with lupus and found 7% experienced costochondritis. The costochondritis was associated with joint swelling and pain in other areas characteristic of lupus flare-ups.
Another study on lupus patients with chest pain found 31% had costochondritis while 65% had pleurisy, which is inflammation of the pleura membrane lining the lungs. Four percent had other causes of chest pain.
The chest pain in lupus patients with costochondritis tended to be reproducible with pressure on the sternum and worse with deep breathing. Pleurisy chest pain was typically reproducible along the pleura and worse with coughing.
Overall the research indicates:
- Costochondritis may occur in a small percentage of lupus patients (around 7%).
- It tends to occur during lupus flares along with other joint and chest pain.
- Costochondritis is less common than pleurisy as a cause of chest pain in lupus.
Why lupus may lead to costochondritis
The exact reason why some lupus patients develop costochondritis is unknown. A few theories include:
- Joints inflammation – Lupus commonly causes inflammation in joints like the fingers, wrists, and knees. This joint inflammation may spread to the costal cartilage joints.
- Chest muscle inflammation – Inflammation from lupus can involve the chest muscles, including the intercostal muscles between ribs. The nearby cartilage may get inflamed too.
- Medications side effects – Corticosteroids used to treat lupus symptoms may potentially lead to cartilage problems.
- Overexertion – Exercise and physical activity during a lupus flare could strain the chest cartilage and muscles.
So while costochondritis is not directly caused by the immune system inflammation in lupus, it may develop secondary to joint pain, chest inflammation, medication use, and overexertion associated with the condition.
Diagnosing costochondritis with lupus
Since the chest pain of costochondritis has some overlap with the pleurisy chest pain more common in lupus, doctors use various exams and tests to distinguish the two:
- Physical exam – The doctor will palpate the chest to pinpoint the most tender spots which are typically along the sternum in costochondritis.
- Breathing tests – Pleurisy chest pain worsens with deep breaths while costochondritis pain may improve with deep breaths.
- Imaging – X-rays, CT scans, or MRI scans help rule out rib fractures or joint dislocations.
- Lab tests – Bloodwork helps confirm or rule out infections and inflammation.
Once infections, lung conditions, and heart problems are ruled out, the diagnosis of costochondritis may be made in a lupus patient with typical chest wall tenderness.
Costochondritis treatment in lupus patients
The treatment approach focuses both on relieving the costochondritis chest pain as well as controlling the lupus disease activity triggering flares:
- NSAIDs – Non-steroidal anti-inflammatory drugs like ibuprofen help reduce inflammation causing the costochondritis.
- Rest – Avoiding strenuous physical activity allows the inflamed cartilage to heal.
- Heat or ice packs – Warm compresses and cold packs can ease cartilage inflammation and pain.
- Physical therapy – Stretching and posture exercises may provide relief in some patients.
- Steroids – Corticosteroid pills or joint injections can calm inflammation flares.
- Plaquenil – Antimalarial drugs help control overall lupus disease activity.
- Healthy lifestyle – Good sleep, low-stress, regular exercise, and a balanced diet support lupus management.
As the underlying lupus is better controlled, costochondritis flares should become less frequent. Seeking prompt treatment at the first signs of a flare can help manage symptoms.
Preventing costochondritis flares in lupus
Certain lifestyle measures may help prevent recurrences of costochondritis in lupus patients:
- Take medications as prescribed to keep lupus regulated.
- Avoid overexerting chest muscles with heavy lifting, exercises, or physically demanding jobs.
- Use proper posture and body mechanics during daily activities.
- Manage stress through yoga, meditation, massage, or other relaxation techniques.
- Apply ice or heat packs to chest muscles after strenuous exercise.
- Wear supportive footwear and braces as needed to prevent falls or trauma.
- Quit smoking which can worsen lupus and cartilage inflammation.
Catching lupus flares early and managing them promptly can also prevent prolonged inflammation that could spread to the chest cartilage. Keeping follow-up appointments with rheumatology doctors allows monitoring for complications.
Outlook for costochondritis with lupus
The outlook for costochondritis occurring with lupus is generally positive. Typical cases of costochondritis resolve on their own within several weeks to months. Controlling the underlying lupus disease activity can make recurrences less likely.
Rarely, some cases of costochondritis may become chronic and last many months. These difficult-to-treat cases may require specialized care including pain management, physical therapy, psychology treatment, and rheumatology care.
While costochondritis can result in significant chest pain and tenderness, it does not cause any permanent damage or life-threatening complications. Once the inflammation resolves, the cartilage returns to normal. With proper lupus treatment and self-care, flares can often be avoided.
Key Points
- Costochondritis (chest cartilage inflammation) is not a well-known symptom of lupus but may occur in around 7% of patients.
- It tends to happen during lupus flares when other joints are inflamed.
- Costochondritis chest pain differs from pleurisy pain more common in lupus.
- Treatments aim to relieve pain while controlling the underlying lupus disease activity.
- Most cases resolve fully within weeks to months with proper treatment and preventive lifestyle habits.
Conclusion
In summary, costochondritis is an uncommon musculoskeletal manifestation of lupus that causes chest pain arising from cartilage inflammation. Though not a primary symptom, research indicates up to 7% of lupus patients may develop costochondritis during flares when the disease is active. Distinguishing it from more common pleurisy requires a careful diagnostic workup. With a combination of pain relief methods and lupus treatments, most cases of lupus-related costochondritis improve within several weeks or months. Raising awareness that costochondritis can occasionally be a symptom of lupus allows for better identification and management in affected patients.
