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

Several MyPsoriasisTeam members have described their experiences with rib pain from PsA. “Terrible rib pain and back pain — I’ll have to get to the doctor,” said 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 PsA, 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 where the immune system mistakenly attacks healthy tissues. The inflammation caused by the disease can affect the skin, joints, and other organs. If this inflammation affects the entheses — the structure where the tendons or ligaments attach to bone — it’s called enthesitis.

Although some people with psoriasis will have only skin plaques, up to one-third will develop PsA. Researchers don’t know the exact cause of PsA, but they believe it results from a mix of genetics, immune system, and environmental factors.

Most PsA affects the small joints, such as those in the fingers and toes. However, some people experience PsA 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 called costochondritis.

Other Possible Causes of Rib Pain

Common causes of rib pain other than PsA include:

• A bruised or broken rib
• Muscle strain, such as from excessive coughing during illness
• A sports injury, car accident, or fall
• Heart conditions (such as a heart attack, angina, or pericarditis)
• Pulmonary conditions (such as pneumonia or pleuritis
• Infection
• Acid reflux
• Anxiety
• Cancer
• Other autoimmune conditions (such as rheumatoid arthritis or 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 several different ways. PsA in the ribs might feel similar to arthritis in other joints, with stiffness, reduced range of motion, and sharp or aching pain. It can sometimes feel like you’re struggling to breathe. “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.”

PsA chest pain or rib pain can also interfere with your daily activities and affect 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 shared. “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 healthcare provider if you’re experiencing rib pain. Your doctor will do a physical exam, review or order blood tests, and possibly order other tests to figure out what’s causing your pain.

If you already have psoriasis or PsA in other joints, your doctor may order an X-ray of your chest. Your doctor won’t be able to see costochondritis on an X-ray, but they can use it to eliminate other causes of rib pain.

Based on your symptoms and the type of pain you’re experiencing, your doctor may also order more bloodwork, an electrocardiogram of your heart, or a different type of imaging, such as a CT scan, to rule out a heart condition.

Medication

There are different types of medications available to treat inflammatory arthritis caused by psoriasis. The best medication for you depends on how severe your arthritis is, your other health conditions, and your doctor’s advice.

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

Let your rheumatologist know if your PsA is severe. Specific treatment options called disease-modifying antirheumatic drugs and biologics (DMARDs), such as biologics, can be used for more advanced cases of PsA.

Diet

Because psoriasis and PsA are inflammatory conditions, taking steps to reduce inflammation may help ease your symptoms. Certain foods and diets are anti-inflammatory by nature and may be helpful. Plant-based diets and the Mediterranean diet are especially anti-inflammatory. To help lower inflammation, try to include these foods as part of your daily menu:

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

Reducing sugar, which is known to cause inflammation, may also help. Avoid foods high in cholesterol and saturated fats, and try instead to include healthy oils, such as extra-virgin olive oil. Consider quitting smoking and alcohol use too, as both can increase inflammation.

Weight Management

Having a higher body weight can put extra strain on joints that may already be inflamed from PsA. Reducing stress on tender joints by keeping a healthy weight can help reduce joint pain.

Although rib pain and other joint pain can make moving difficult, regular low-impact exercise may be helpful if you’re living with PsA. Physical activity helps with weight management and can lower inflammation. It keeps your joints moving, which helps prevent stiffness. Building muscle also reduces stress on your joints. Always talk with your doctor before starting a new exercise plan.

When To Seek Medical Help

Depending on where you feel it, rib pain can sometimes feel like chest wall pain. Chest pain or tightness, trouble breathing, or painful breathing could signal a heart attack or another serious medical problem that requires immediate attention.

Call 911 or go to the nearest emergency room right away if you have chest pain that lasts longer than five minutes or happens with any of these 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 seek medical attention, the sooner you can be treated and perhaps avoid a medical crisis.

Join the Conversation

On MyPsoriasisTeam, people share their experiences with psoriasis, get advice, and find support from others who understand.

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