Up to 30 percent of people living with psoriasis will develop psoriatic arthritis (PsA) , which causes inflammation and pain in different joints and sometimes the nearby cartilage. When psoriatic arthritis affects the cartilage that connects your ribs to your sternum (breastbone), it can lead to significant rib pain and make day-to-day life difficult.

Several MyPsoriasisTeam members have described their experiences with rib pain from psoriatic arthritis. “Terrible rib pain and back pain — I’ll have to get to the doctor,” wrote one member.

Another member shared, “Having pain in the rib cage area. Has anyone experienced that feeling? I’m worried about the disease.”

Read on to learn more about rib pain in psoriatic arthritis, including what causes it, what it feels like, and how it can be treated.

What Causes Rib Pain in Psoriatic Arthritis?

Psoriasis is a chronic autoimmune disease. This means it’s usually a lifelong condition and that the immune system mistakenly attacks healthy tissues. The resulting inflammation can affect the skin, joints, and other organs. If this inflammation affects the tendons or ligaments that attach to bone, the medical term is enthesitis.

Although some people with psoriasis will have only skin plaques, as many as a third will go on to develop PsA. Health experts don’t know exactly what causes psoriatic arthritis, but it’s thought that the combination of a person’s genetics, immune system, and environment plays a role.

Most psoriatic arthritis affects the small joints, such as those in the fingers and toes. However, some people will experience psoriatic arthritis in the body’s larger joints, including the spine, hips, and chest.

Inflammation from PsA can also affect cartilage — like that in the rib cage — which may be the cause of rib pain. Inflammation of the rib cartilage is also called costochondritis.

Other Possible Causes of Rib Pain

Common causes of rib pain other than psoriatic arthritis include:

• A bruised or broken rib
• Muscle strain, such as from excessive coughing during illness
• A sports injury, car accident, or fall
• Heart conditions (e.g., heart attack)
• Infection
• Acid reflux
• Anxiety
• Cancer
• Other autoimmune conditions (e.g., rheumatoid arthritis, lupus)

One MyPsoriasisTeam member mentioned that their rib pain was due to an infection in their abdomen. “I’ve had rib pain too. When I had an infection of diverticulitis with microperforation, my ribs felt heavy (like someone sitting on my chest). I also felt tenderness in the connective tissue around the ribs,” they wrote.

What Rib Pain in Psoriatic Arthritis Feels Like

Members of MyPsoriasisTeam describe rib pain in a variety of ways. It might feel similar to arthritis in other joints, with stiffness, reduced range of motion, and sharp or aching pain. Sometimes it can feel like breathing trouble. “Have had a psoriasis flare-up in my chest and ribs — it hurts when I breathe,” one member wrote.

Another member noted that their rib pain was so severe that they sought medical care. “The muscle spasms hurt so bad, it feels like I can't breathe,” they wrote. “Just got out of the hospital and was on very strong pain medications, which helped the spasms. ... Those spasms are scary and terrible.”

Severe rib pain can also affect your ability to do daily activities and your quality of life. “I can’t walk because it causes the rib pain to intensify,” one member said. “Like someone punched me in my right side.”

“I’ve had rib pain for about two weeks now,” another reported. “Every deep breath or turn the wrong way — and trying to sleep is no fun.”

Managing Rib Pain in Psoriatic Arthritis

Talk to your rheumatologist or primary care doctor if you are experiencing rib pain. Your doctor will do a physical examination, review or order blood work, and possibly order additional tests to figure out what is causing your pain.

If you’re already living with psoriasis or PsA in other joints, your doctor may order an X-ray of your chest. This imaging test will help determine if your rib pain is the result of psoriatic arthritis or some other well-known cause of rib pain, such as one of the possibilities outlined above.

Your doctor may also order an electrocardiogram of your heart or a different type of imaging, such as a CT scan, to rule out a heart condition. The leading cause of death in patients with psoriatic arthritis is accelerated atherosclerosis, so it’s important to look for any cardiac causes of chest pain.

Medication

Different types of medications are available to treat inflammatory arthritis caused by psoriasis. Which medication is best for you will depend on the severity of your arthritis, your other health conditions, and your doctor’s recommendation.

If your rib pain is mild and occurs once in a while, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may do the trick. These medications, including ibuprofen (Advil) and naproxen sodium (Aleve), may provide short-term pain relief. Sometimes, an oral steroid may be prescribed to reduce inflammation.

If your PsA is severe, alerting your rheumatologist is critical. Specific treatments called disease-modifying antirheumatic drugs (DMARDs) and biologics can be used for more advanced cases of psoriatic arthritis. Commonly prescribed medications include:

• Methotrexate (Otrexup, Rasuvo, and Trexall)
• Apremilast (Otezla)
• Adalimumab (Humira)
• Etanercept (Enbrel)
• Certolizumab pegol (Cimzia)
• Golimumab (Simponi)
• Infliximab (Remicade)
• Ustekinumab (Stelara)

Diet

Because psoriasis and psoriatic arthritis are inflammatory diseases, doing whatever you can to minimize inflammation in your body may help address your symptoms. Certain foods and diets are anti-inflammatory by nature and may be beneficial to you. Plant-based diets and the Mediterranean diet are especially anti-inflammatory. Foods to make part of your daily menu include:

• Fruits and vegetables
• Whole grains
• Lean protein and fish

Reducing sugar, which is known to cause inflammation, also may help. Avoid foods high in cholesterol and saturated fats, and try instead to include healthy oils (e.g., extra-virgin olive oil).

Weight Management

Having a higher body weight can put extra strain on joints that may already be inflamed from psoriatic arthritis. Minimizing additional stress on tender joints by maintaining a healthy weight can help reduce joint pain.

Although rib pain and other joint pain can make movement difficult, regular low-impact exercise may be beneficial if you’re living with psoriatic arthritis. Always speak with your doctor before starting a new exercise plan. Exercise itself can also reduce inflammation by keeping your joints limber and active. Building muscle can decrease the stress on your joints too.

When To Seek Medical Help

Rib pain can sometimes feel like chest pain, depending on its location. Chest pain or tightness, trouble breathing, or painful breathing could signal a heart attack or another serious medical problem that requires immediate attention. People living with psoriasis and psoriatic arthritis are also at higher risk of heart disease and death.

Call 911 or go to nearest emergency room right away if you have chest pain that lasts longer than five minutes or occurs with any of the following symptoms:

• Sweating
• Shortness of breath
• Nausea or vomiting
• Lightheadedness
• Fainting
• Irregular or fast heartbeat
• Pain in your arm, shoulder, back, neck, or jaw

Never ignore chest pain — it could be life-threatening, especially if the pain is new or comes on suddenly. The sooner you get evaluated, the sooner you can be treated and perhaps avert a medical crisis.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 116,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with psoriasis and rib pain? Have you taken steps to manage it? Share your experience in the comments below, or start a conversation by posting on your Activities page.