Costochondritis

Although it was described first by German surgeon Alexander Tietze in 1921, doctors still know very little about the syndrome eighty-eight years later.

Up until very recently it was believed there were two forms of the syndrome: Costochondritis and Tietze's syndrome. They were based upon the same symptoms; benign inflammation of the costal cartilage at the junction of the rib bone and sternum. Doctors believed the difference was swelling of the costal cartilages. Now it's recognized as the same condition and that the swelling represents the severity of the condition.

Various theories have been tossed around as to what causes Tietze's syndrome. Trauma to the sternum, such as a car accident, can result in Tietze's syndrome. Another theory is micro-traumas to the cartilage, building up repeated damages and leading to the syndrome's appearance. Some patients develop Tietze's syndrome after surgical procedures when the ribs are cracked. The condition might also be brought on by upper respiratory infections. Because there is no one single cause, it is harder to pinpoint what brings Tietze's syndrome to manifest in a patient.

Diagnosing Tietze's syndrome can be difficult. Some patients present with tenderness and localized swelling over the ribs and cartilage surrounding the sternum. Usually this pain has persisted for several days or weeks, sending the patient in to have it checked. Most doctors, up until recently, were unfamiliar with the condition and therefore ran batteries of tests to rule out other problems. Other patients have an episode so severe, one with a level of pain that mimics cardiac problems, that they are diagnosed with Tietze's syndrome after the fact. Other forms of diagnosis are blood tests for inflammation levels, although usually the level of inflammation isn't severe enough to indicate Tietze's syndrome. CT contrast scans check for wear and tear on the costal cartilage but usually there is not enough to point to Tietze's syndrome.

Most patients have small episodes of moderate pain that last anywhere from a few hours to a couple of days. The pain is usually worse upon waking up or lying down to sleep. More severe symptoms can last up to a few weeks or more. The standard treatment includes heat and cold packs placed along the sternum, over the counter anti-inflammatory or prescribed medications such as muscle relaxants. In the majority of cases, the symptoms lessen and sometimes disappear over time.

A handful of patients fall into the chronic Tietze's syndrome category. The pain becomes so severe it reaches a level of debilitation. It's enough to make a patient believe they have cardiac problems or are even having a heart attack. The pain lasts for months and can be set off by the slightest of movements, even shallow breaths. When it reaches this level the patient usually sees a rheumatologist who gives them injections of cortisone to the costal spaces to lessen the inflammation to a tolerable level. Sometimes a patient may receive up to four injects a visit and there is no guarantee how long the relief will last.

I have suffered with Tietze's syndrome for over twenty years. My first episode was around the age of seven and the pain was so severe, as though someone had smacked the center of my chest with a rock, that there was no words to describe it. My grandmother found me laying on the floor of her living room, completely gray in color, and was terrified that I might be having a heart attack. I continued to have attacks, sporadically and usually triggered by stress. I can remember attacks that left me gasping for breath, pacing the kitchen nearly in tears from the pain. Every doctor I saw had no idea what could be causing these attacks. It wasn't until my early teens that a physician filling in for my regular doctor took an interest in my complaints. A little research brought her to the conclusion that I indeed had Costochondritis.

Unfortunately so few people in the medical community in my area knew about it and there was little they could tell me to do to relieve the pain. I tried the standard treatments of anti-inflammatory medication, heating pads and ice packs. The crushing pain continued to plague me.

Finally I managed to find a rheumatologist who knew what I had and said he might be able to help me. Four small shots of cortisone later, around the age of 20, I went nearly pain-free for three years. You don't realize how you take breathing for granted until you can't, at least not properly, and feel as if an elephant is sitting directly on your sternum 24/7. In the more recent past, I've had to have shots several times a year, usually after prolonged periods of stress that bring on attacks. During a particularly horrible episode that lasted three months, I literally thought I was having a prolonged heart attack. What is not mentioned in most information on Tietze's syndrome is that it also mimics a particularly strong panic attack. For people who do suffer panic attacks, this can be very confusing. A contrast CT scan revealed I do not have signs of structural wear on my cartilage but only time will tell on that one.

For as common as this syndrome appears to be, or is becoming, very few people ever realize they have it. I have spent time arguing with my rheumatologist over exactly what I have; while he believes I do have the condition, getting him to understand the severity has taken many years. Up until recently when it was decided Tietze's syndrome and Costochondritis were one in the same, I realized I had the more severe form as I have the swelling and the skin over my rib cage radiates heat constantly.

For now, I've learned to take it day-by-day and deal with the pain, as well as try to take preventative measures to lessen the inflammation.

On August 7th, 2009, this lens was accepted into the Sharing Hearts Group! Thank you, mysticmama!