Chest and Rib Pain and Psoriatic Arthritis
Rheumatic ConditionsPsoriatic Arthritis

Do Your Chest and Ribs Hurt? The Culprit Could Be Psoriatic Arthritis

Psoriatic arthritis can sometimes lead to chest or rib pain. Blame costochondritis, an inflammation of the cartilage connecting the ribs and the breastbone.
Do Your Chest and Ribs Hurt? The Culprit Could Be Psoriatic Arthritis
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Updated on March 18, 2024
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Psoriatic arthritis can cause a range of symptoms, from your head down to your toes. One of the more alarming may be pain in your chest and ribs.

While chest pain sometimes indicates heart disease, it may also be related to the inflammation that causes psoriatic arthritis (PsA). Enthesitis, the term for inflammation that occurs where tendons and ligaments attach to bone, is a symptom of PsA, and costochondritis can happen when PsA involves the cartilage connecting the ribs to the breastbone (sternum).

For people with psoriatic arthritis, “perhaps the most common type of chest pain is costochondritis," says Adam Kreitenberg, MD, a rheumatologist in Los Angeles. “This chest or rib pain can be quite severe and cause pain with deep breathing, physical activity, and even coughing or sneezing,” Dr. Kreitenberg says. The pain may feel sharp, aching, or like increased pressure in the area. Your chest may be painful when touched.

 You might think you’re having a heart attack.

While the kind of chest pain caused by PsA is not a heart attack, any chest pain should always be checked out by a medical professional.

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Diagnosis and Treatment of Costochondritis

Costochondritis doesn’t only affect people with inflammatory arthritis. Trauma, illness, or strain, such as severe coughing, can cause the condition as well.

Doctors typically diagnose costochondritis with a physical exam, feeling (palpating) the areas where the ribs attach to the sternum. “While X-rays and bloodwork are often not necessary, they can be helpful in ruling out other and potentially more severe diagnoses, such as heart attack,” says Kreitenberg.

The pain of costochondritis often goes away by itself within a few weeks, but it sometimes can linger for a few months. Treatment focuses on pain relief and may include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), naproxen (Aleve), and diclofenac (Voltaren). Rest and ice or moist heat can also help.

Treatment for costochondritis that’s caused by psoriatic arthritis will likely require proper management of the inflammatory arthritis. This might involve disease-modifying antirheumatic drugs (DMARDs). “It may also include biologics. Ask your doctor about the right medicine for you, and get an accurate diagnosis,” says Rajat Bhatt, MD, a rheumatologist in Richmond, Texas.

RELATED: 8 Surprising Ways Psoriatic Arthritis Can Affect Your Health

Pain Could Be the Result of Heart Disease

If you have psoriatic arthritis and experience chest or rib pain, the problem could in fact be heart disease. People with PsA have an almost doubled risk of heart disease compared with the general population, notes the Arthritis Foundation.

“Patients with chronic autoimmune inflammatory conditions may have high levels of circulating inflammation throughout their bodies, which places them at increased risk of cardiovascular disease,” Kreitenberg explains. “Therefore the classic chest pain associated with a heart attack should be closely monitored.”

According to the American Heart Association, signs of a heart attack include:

  • A senstation of pressure, squeezing, fullness, or pain in the center of your chest that lasts more than a few minutes, or disappears and returns
  • Pain in one or both arms, your back, neck, jaw, or stomach
  • Shortness of breath
  • A cold sweat, nausea, or lightheadedness

While the most common heart attack symptom for both men and women is chest pain, women commonly experience the other symptoms listed above.

Dr. Bhatt points out that cardiac complications, such as thromboembolism (obstruction of a blood vessel by a blood clot) and pulmonary embolism (blood clots in the lungs) can sometimes result from certain PsA medications. Tofacitinib (Xeljanz), baricitinib (Olumiant), and upadacitinib (Rinvoq) all come with a warning about an increased risk of blood clots, per the U.S. Food and Drug Administration.

Signs of pulmonary embolism include chest pain anywhere under the rib cage, as well as shortness of breath or rapid breathing, accelerated heart rate, lightheadedness, and coughing.

Heart Disease Treatment

Again, any chest pain should be checked out by a doctor. If you are diagnosed with heart disease, you might need to start taking aspirin, begin cholesterol lowering therapy, and make dietary changes and other interventions, says Bhatt.

No matter the cause, it’s important to get any chest pain checked out. As Bhatt says, “Chest pain should not be taken lightly. Err on the side of caution and contact your doctor as soon as possible to distinguish the various causes.”

RELATED: Psoriatic Arthritis: 11 Tips for Your Next Doctor’s Visit

Questions to Ask Your Doctor

  • Ask your rheumatologist about your risk of heart disease and whether you might require monitoring or testing to screen for diabetes, high cholesterol, and high blood pressure, all of which are risks for heart disease.
  • If your chest pain is costochondritis, it’s worth discussing your psoriatic arthritis treatment plan with your doctor. It’s possible your inflammation isn’t as well-controlled as it could be and it may be time to try different a medication.
  • If you’re taking non-aspirin NSAIDs for your PsA, be aware that they can increase the risk of heart attack and stroke, according to the FDA. (While NSAIDs are used to treat costochondritis, they're contraindicated for people with heart disease). It may be something to discuss with your doctor.
  • And as noted above, certain PsA drugs have been associated with cardiac complications. Ask your rheumatologist if the benefits of taking certain meds outweigh the risks.
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Samir Dalvi, MD

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Samir Dalvi, MD, is a board-certified rheumatologist. He has over 14 years of experience in caring for patients with rheumatologic diseases, including osteoarthritis, rheumatoid ar...

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Resources
  1. What Is Costochondritis? The Alarming Arthritis Chest Pain You Might Not Know About. CreakyJoints. April 2, 2019.
  2. Costochondritis. Mayo Clinic. May 11, 2022.
  3. Psoriatic Arthritis and Your Heart. Arthritis Foundation. February 14, 2022.
  4. Heart Attack Symptoms in Women. American Heart Association. December 5, 2022.
  5. Janus Kinase (JAK) Inhibitors: Drug Safety Communication – FDA Requires Warnings About Increased Risk of Serious Heart-Related Events, Cancer, Blood Clots, and Death. U.S. Food and Drug Administration. September 1, 2021.
  6. Symptoms and Diagnosis of Venous Thromboembolism. American Heart Association. November 13, 2023.
Additional Sources
  • FDA Drug Safety Communication: FDA Strengthens Warning That Non-Aspirin Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Can Cause Heart Attacks or Strokes. U.S. Food and Drug Administration. February 26, 2018.