If you’re living with psoriatic arthritis (PsA), you’ve probably experienced joint pain and swelling of your fingers, toes, and knees. But did you know that angina (chest pain) can also affect people with inflammatory arthritis? Many MyPsoriasisTeam members have reported experiencing pain in their chest or along their sternum (breastbone).
One member asked, “Does anyone suffer from chest and back pain during, before, or after a flare-up?”
“Having a lot of pain in my sternum and chest today. Anybody else have a lot of tendon pain?” asked another.
In this article, we’ll discuss the common causes of chest pain in PsA along with tips to manage it. We’ll also cover when your chest pain may be a sign of a medical emergency and when to seek treatment.
Chest pain can be concerning and an additional worry on top of your PsA-related skin symptoms and joint pain. Members of MyPsoriasisTeam have looked to one another to discuss chest pain as a symptom of PsA. The two most likely underlying causes are costochondritis and heart disease.
“Is it possible to have arthritis in your chest (sternum area)? When I roll over at night it really hurts. It’s been like that for about two months,” asked a MyPsoriasisTeam member.
One replied, “Yes, the pain in the sternal area of your ribs happens with PsA. It is the inflammation of the cartilage in your ribs.”
Costochondritis involves swelling and inflammation of your costochondral joint, the chest cartilage that connects your ribs and sternum. Costochondritis is a harmless condition, but many people mistake the pain from inflammation for a heart attack. According to one study, 30 percent of emergency room visits for chest pain are actually due to costochondritis.
MyPsoriasisTeam members have shared their experiences with costochondritis pain. “Costochondritis took me to the ER last night. I literally have felt like I was having a heart attack and my bones hurt on the inside for a long time now,” said one member.
You may also notice chest pain spreading or radiating to your back or stomach that gets worse with movement, deep breathing, or coughing.
You may develop costochondritis if you:
Studies show that people with PsA are at a higher risk of developing heart disease. One type of heart disease seen in PsA is coronary artery disease (CAD), which is caused by the buildup of fatty deposits or plaques in the heart’s arteries. Over time, the plaques become thicker and begin to block blood flow.
Angina is the most common symptom of CAD. For people with stable angina, their chest pain comes and goes and is triggered by exercising or stress and anxiety. It typically goes away with rest and medications.
CAD is the leading cause of mortality in the United State and third leading cause worldwide. People with CAD are at a high risk of heart attacks. If you begin experiencing any of the following symptoms in addition to angina, call 911 or seek medical attention immediately:
If you’re uncertain whether your pain is related to costochondritis or a heart issue, it’s best to seek immediate evaluation. Cardiac pain can present differently in people depending upon their comorbidities (other health conditions), gender, and other factors. When in doubt, it’s best to seek medical attention.
To determine what’s causing your symptoms, your doctor will assess your medical history and perform a physical exam — possibly along with other diagnostic tests and procedures. Once your doctor makes a diagnosis, they’ll offer you different treatment options. Sticking to your treatment plan and taking extra steps at home can help you control your chest pain and improve your quality of life.
Here are five tips for managing your chest pain in PsA.
The best way to control bodywide inflammation and treat pain is to stick to your PsA treatment plan prescribed by your rheumatologist. Many of these medications work by targeting the immune system to help dampen inflammation. Examples commonly used to treat PsA include corticosteroids and disease-modifying antirheumatic drugs (DMARDs).
Corticosteroids are laboratory-made (synthetic) hormones that reduce inflammation throughout the body. Your rheumatologist may prescribe a low-dose oral corticosteroid or inject them into an affected joint. Corticosteroid injections are also used to treat costochondritis that doesn’t improve with other treatments.
Conventional DMARDs are systemic (bodywide) treatments that broadly reduce immune system activity. They target inflammation at its source to control PsA and slow or prevent joint damage. Examples include methotrexate (Otrexup), hydroxychloroquine (Plaquenil), and sulfasalazine. (Hydroxychloroquine usually isn’t used in treating PsA, because it can sometimes cause flares of psoriasis.)
Biologic DMARDs are laboratory-engineered antibodies, which are proteins that work by targeting a specific part of the immune system. The most commonly prescribed biologic DMARDs include tumor necrosis factor (TNF) inhibitors, such as adalimumab (Humira), infliximab (Remicade), and etanercept (Enbrel).
Examples of biologic DMARDs that target other parts of the immune system include ustekinumab (Stelara) and secukinumab (Cosentyx).
Both costochondritis and PsA can be managed with over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen (Advil and Motrin) and naproxen sodium (Aleve) help reduce pain, inflammation, and swelling. Acetaminophen (Tylenol) can’t help treat inflammation, but it may alleviate chest pain from costochondritis.
Be sure to follow the dosing instructions carefully — taking too much acetaminophen can cause liver damage. In some cases, you may be able to switch between taking an NSAID and acetaminophen for added pain relief. Ask your doctor how to do so safely.
Research shows that NSAIDs are also associated with an increased risk of cardiovascular disease. If you’re living with heart disease, be sure to talk to your doctor about whether it’s safe for you to take NSAIDs.
If you’re living with CAD and PsA, your rheumatologist will work with your cardiologist to develop a treatment plan for you. Treating both conditions and sticking to your treatment plan can help treat chest pain and prevent your risk of a heart attack and other complications.
If you have high blood pressure or high cholesterol levels, your cardiologist will likely prescribe you medications to control them. Be sure to take them every day as prescribed. Commonly prescribed drugs used to treat CAD include beta-blockers, ACE inhibitors, and statins.
If you have stable angina, you may also be prescribed nitroglycerin to treat chest pain. It works by relaxing your heart’s arteries and widening them to allow more blood flow.
Heat and/or ice can offer temporary relief from sore muscles and joints. If you have costochondritis, apply an ice pack or heating pad on the sore parts of your chest to treat your discomfort. You can also take a warm bath or shower to relax your muscles.
Heat or cold therapy can be done several times throughout the day at short intervals. Don’t apply heat or ice directly to your skin — be sure to use your heating pad or ice pack over a shirt or towel to avoid burns or frostbite.
For some people with heart disease or costochondritis, movement can worsen their chest pain significantly. If you find yourself exercising too hard or straining when reaching for items or performing daily tasks, take breaks to let your body rest. Added stress on your heart and rib cage may make your symptoms worse.
MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 117,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
Have you experienced chest pain while living with PsA? What helped you manage it? Share your experience with this condition in the comments below, or start a conversation by posting on your Activities page.