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Costochondritis: A Prospective Analysis in an Emergency Department Setting

Costochondritis: A Prospective Analysis in an Emergency Department Setting Abstract Background: Costochondritis (CC) is a common, but poorly understood condition among patients with chest wall pain. We have prospectively analyzed distinctive features of patients presenting to the emergency department with chest pain and CC. Methods: Patients with a chief complaint of chest pain, not due to trauma, fever, or malignancy, were prospectively evaluated for the presence of CC and compared with another chest pain group without CC. Results: Of 122 consecutive patients studied, 36 had CC (30%) and in 17 the pain induced reproduced the original one (15%). Women made up 69% of the patients with CC (vs 31% of control subjects) and Hispanics 47% (vs 24% of control subjects). Only three patients (8%) with CC met the American College of Rheumatology criteria for fibromyalgia, while none of the control subjects did. Widespread pain was more common in the CC group (42% vs 5%). The mean sedimentation rate in the CC group was 44±31 mm/h vs 41±31 mm/h in the control group. The acute myocardial infarction rate was 6% in the CC group vs 28% in the control group. Rheumatoid arthritis and osteoarthritis were diagnosed in three and two patients, respectively, of 32 patients with CC cases. One year later, 11 (55%) of 21 patients with CC were still suffering from chest pain, but only one third still had definite CC. Conclusions: Costochondritis is common among patients with chest pain in an emergency department setting, with a higher frequency among women and Hispanics. It is associated with fibromyalgia in only a minority of cases. Patients with CC appear to have a lower frequency of acute myocardial infarction. Spontaneous resolution is seen in most cases at 1 year.(Arch Intern Med. 1994;154:2466-2469) References 1. Spinals RS. Tietze's syndrome . In: McCarty DJ, Koopman WJ eds. Arthritis and Allied Conditions . 12th ed. Philadelphia, Pa: Lea & Febiger; 1993:1526-1527. 2. Fam AG. Approach to musculoskeletal chest wall pain . Primary Care . 1988; 15:767-782. 3. Wolf E, Stern S. Costosternal syndrome . Arch Intern Med. 1976;136:189-191.Crossref 4. Epstein SE, Gerber LH, Borer JS. Chest wall syndrome: a common cause of unexplained cardiac pain . JAMA . 1979;241:2793-2797.Crossref 5. Calabro JJ, Jeghers H, Miller KA, Gordon BD. Classification of anterior chest wall syndromes . JAMA . 1980;243:1420-1421.Crossref 6. Kadzombe EA, Robson WJ. Perichondritis . Lancet . 1988;2:1010-1011.Crossref 7. Levine PR, Mascette AM. Musculoskeletal chest pain in patients with 'angina': a prospective study . South Med J. 1989;82:580-591.Crossref 8. Wise CM, Semble EL, Dalton CB. Musculoskeletal chest wall syndromes in patients with noncardiac chest pain . Arch Phys Med Rehabil. 1992;73:147-149. 9. Pellegrino MJ. Atypical chest pain as an initial presentation of primary fibromyalgia . Arch Phys Med Rehabil. 1990;71:526-528. 10. Semble EL, Wise CM. Chest pain . South Med J. 1988;81:64-68.Crossref 11. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromylagia: report of the multicenter criteria commitee . Arthritis Rheum. 1990;33:160-172.Crossref 12. An exploratory report of chest pain in primary care . J Am Board Fam Pract. 1990;3:143-150. 13. Hazes JMW, Hayton R, Silman AJ. A reevaluation of the symptom of morning stiffness . J Rheumatol. 1993;20:1138-1142. 14. Miller JH. Accumulation of gallium-67 in costochondritis . Clin Nucl Med. 1980; 5:362-363.Crossref 15. Tom PF, Long TJ, Fitzpatrick SB. Coccidioidomycosis in adolescents presenting as chest pain . J Adolesc Health Care. 1987;8:365-371.Crossref 16. Caruana V, Swayne LC. Gallium detection of Salmonella costochondritis . J Nucl Med. 1988;29:2004-2007. 17. Hannan MT, Anderson JJ, Pincus T, Felson DT. Educational attainment and osteoarthritis . J Clin Epidemiol. 1992;45:139-147.Crossref 18. Croft P, Rigby AS, Boswell R, Scholium J, Silman A. The prevalence of widespread pain in the general population . J Rheumatol. 1993;20:710-713. 19. Arthrology . In: Clemente CD, ed. Gray's Anatomy . 30th American ed. Philadelphia, Pa: Lea & Febiger; 1985:354-358. 20. Prinzmetal M, Massumi RA. The anterior chest wall syndrome: chest pain resembling pain of cardiac origin . JAMA . 1955;159:177-184.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Costochondritis: A Prospective Analysis in an Emergency Department Setting

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420210106012
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Costochondritis (CC) is a common, but poorly understood condition among patients with chest wall pain. We have prospectively analyzed distinctive features of patients presenting to the emergency department with chest pain and CC. Methods: Patients with a chief complaint of chest pain, not due to trauma, fever, or malignancy, were prospectively evaluated for the presence of CC and compared with another chest pain group without CC. Results: Of 122 consecutive patients studied, 36 had CC (30%) and in 17 the pain induced reproduced the original one (15%). Women made up 69% of the patients with CC (vs 31% of control subjects) and Hispanics 47% (vs 24% of control subjects). Only three patients (8%) with CC met the American College of Rheumatology criteria for fibromyalgia, while none of the control subjects did. Widespread pain was more common in the CC group (42% vs 5%). The mean sedimentation rate in the CC group was 44±31 mm/h vs 41±31 mm/h in the control group. The acute myocardial infarction rate was 6% in the CC group vs 28% in the control group. Rheumatoid arthritis and osteoarthritis were diagnosed in three and two patients, respectively, of 32 patients with CC cases. One year later, 11 (55%) of 21 patients with CC were still suffering from chest pain, but only one third still had definite CC. Conclusions: Costochondritis is common among patients with chest pain in an emergency department setting, with a higher frequency among women and Hispanics. It is associated with fibromyalgia in only a minority of cases. Patients with CC appear to have a lower frequency of acute myocardial infarction. Spontaneous resolution is seen in most cases at 1 year.(Arch Intern Med. 1994;154:2466-2469) References 1. Spinals RS. Tietze's syndrome . In: McCarty DJ, Koopman WJ eds. Arthritis and Allied Conditions . 12th ed. Philadelphia, Pa: Lea & Febiger; 1993:1526-1527. 2. Fam AG. Approach to musculoskeletal chest wall pain . Primary Care . 1988; 15:767-782. 3. Wolf E, Stern S. Costosternal syndrome . Arch Intern Med. 1976;136:189-191.Crossref 4. Epstein SE, Gerber LH, Borer JS. Chest wall syndrome: a common cause of unexplained cardiac pain . JAMA . 1979;241:2793-2797.Crossref 5. Calabro JJ, Jeghers H, Miller KA, Gordon BD. Classification of anterior chest wall syndromes . JAMA . 1980;243:1420-1421.Crossref 6. Kadzombe EA, Robson WJ. Perichondritis . Lancet . 1988;2:1010-1011.Crossref 7. Levine PR, Mascette AM. Musculoskeletal chest pain in patients with 'angina': a prospective study . South Med J. 1989;82:580-591.Crossref 8. Wise CM, Semble EL, Dalton CB. Musculoskeletal chest wall syndromes in patients with noncardiac chest pain . Arch Phys Med Rehabil. 1992;73:147-149. 9. Pellegrino MJ. Atypical chest pain as an initial presentation of primary fibromyalgia . Arch Phys Med Rehabil. 1990;71:526-528. 10. Semble EL, Wise CM. Chest pain . South Med J. 1988;81:64-68.Crossref 11. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromylagia: report of the multicenter criteria commitee . Arthritis Rheum. 1990;33:160-172.Crossref 12. An exploratory report of chest pain in primary care . J Am Board Fam Pract. 1990;3:143-150. 13. Hazes JMW, Hayton R, Silman AJ. A reevaluation of the symptom of morning stiffness . J Rheumatol. 1993;20:1138-1142. 14. Miller JH. Accumulation of gallium-67 in costochondritis . Clin Nucl Med. 1980; 5:362-363.Crossref 15. Tom PF, Long TJ, Fitzpatrick SB. Coccidioidomycosis in adolescents presenting as chest pain . J Adolesc Health Care. 1987;8:365-371.Crossref 16. Caruana V, Swayne LC. Gallium detection of Salmonella costochondritis . J Nucl Med. 1988;29:2004-2007. 17. Hannan MT, Anderson JJ, Pincus T, Felson DT. Educational attainment and osteoarthritis . J Clin Epidemiol. 1992;45:139-147.Crossref 18. Croft P, Rigby AS, Boswell R, Scholium J, Silman A. The prevalence of widespread pain in the general population . J Rheumatol. 1993;20:710-713. 19. Arthrology . In: Clemente CD, ed. Gray's Anatomy . 30th American ed. Philadelphia, Pa: Lea & Febiger; 1985:354-358. 20. Prinzmetal M, Massumi RA. The anterior chest wall syndrome: chest pain resembling pain of cardiac origin . JAMA . 1955;159:177-184.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 14, 1994

References