When Rheumatoid Arthritis Causes Chest Pain

RA can cause a host of different symptoms, but chest pain from costochondritis took me completely by surprise. Here’s what you should know.

I’m always shocked at the ways rheumatoid arthritis (RA) can affect my body. When I was diagnosed, I knew I would be facing a lot of joint pain. But this systemic disease has caused pain in places I could never have imagined.

A couple of years after being diagnosed with RA, I was battling a viral infection that led to weeks of coughing. One morning I woke up to pain and pressure in my chest. It felt taxing to take a deep breath and I wondered if I had pulled a muscle from all the coughing.

I figured that I needed to take it easy so I could fully heal. I rested, but the chest pain did not improve. When I tried to sleep at night, changing positions would cause pain to soar through my entire chest.

I thought to myself: Am I having a heart attack?

After one painful, sleepless night, I looked up some information about chest pain. I felt comforted that I wasn’t experiencing most heart attack symptoms. But this pain was overwhelming. I had to do something about it. It was the weekend and my doctor’s office was closed, so I decided to visit urgent care.

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Getting diagnosed

By the time I was sitting in the waiting room, the pain had become almost unbearable. It radiated from the center of my chest and ran down my arms.

The pressure on my chest felt like an elephant was sitting on my sternum. The urge to cough was persistent, but I did anything I could to avoid it as it exacerbated the pain.

After describing my symptoms to the doctor, I mentioned that I have RA. He immediately nodded as if his diagnosis was confirmed.

He told me I was experiencing costochondritis. This is the medical term for inflammation of the cartilage in the rib cage. In some cases, this pain can mimic a heart attack.

It’s a common reason for people to visit the doctor’s office and emergency department. As costochondritis is caused by inflammation, those already living with a chronic inflammatory condition — such as RA — may be more at risk.

X-rays and lab tests won’t show or confirm the inflammation. So, costochondritis is a clinical diagnosis based on the signs and symptoms someone is having. But, X-rays and lab tests could be used to rule out other causes of chest pain.

The doctor prescribed a steroid to be taken for 5 days to get the inflammation under control, as well as some pain medication. I noticed a difference very quickly, and the chest pain was resolved by the time I had finished taking the steroids.

Costochondritis can also be treated with hot or cold compresses, as well as pain medications such as anti-inflammatory medications or acetaminophen (Tylenol). It can sometimes resolve on its own over time.

This experience was not only painful but stressful. I wish I had known about the correlation between RA and costochondritis before going through this.

Costochondritis and my RA

A few months ago, I began to have some pain along my sternum that reminded me of my previous bout of costochondritis.

But I hadn’t been coughing and couldn’t pinpoint a reason for the sudden onset of pain. I tried taking antacids, but the pain only got worse.

I remembered when I had experienced costochondritis previously, the doctor had pushed along my sternum to check for tenderness. Sure enough, the pressure caused tenderness and shooting pain throughout my chest wall.

It felt like I was dealing with costochondritis again. I was able to treat the inflammation with a steroid for a couple of days, coupled with rest and a heating pad.

As symptoms of RA, costochondritis is not as common as inflammation of the peripheral joints. But it can be a reason for chest pain and is important to be aware of. I’ve learned that it can come and go depending on how my RA changes.

RA and chest pain

Costochondritis isn’t the only thing that can cause chest pain for those of us living with RA.

Lungs

Chest pain accompanied by shortness of breath can be a sign that RA may be affecting the lungs.

According to the Arthritis Foundation, lung complications from RA are the most common symptoms of RA outside the joints. Complications can include:

• Lung nodules: These are small growths in the lungs, also sometimes called pulmonary nodules.
• Pleural disorders: These are conditions that affect the pleura — tissue that covers the outside of the lungs and also lines the inside of your chest cavity. For example, pleurisy is inflammation of the pleura.
• Pulmonary fibrosis: This refers to severe lung scarring.
• Pulmonary emboli: These are blood clots in the lungs. People living with RA have an increased risk of blood clots.
• Damage or obstruction of the airways
• Interstitial lung disease (ILD): This is also called RA-associated ILD, or RA-ILD.

Effects on the lungs can also be caused by medications used to treat RA. For example, some RA medications are immunosuppressive, which can increase your risk of infections — including lung infections like pneumonia or tuberculosis.

Heart

Chronic inflammation from RA may also affect the heart.

Those living with RA have an increased risk of heart disease — it’s almost twice as likely compared to those without RA, according to the Arthritis Foundation. Heart disease can also mean an increased risk of experiencing a heart attack and stroke.

Congestive heart failure has also been shown to happen more in people with RA.

One of the most frequent effects of RA on the heart is pericarditis. This refers to inflammation of the pericardium, a layer of fluid that surrounds the heart. Pericarditis can develop as RA progresses and affects roughly 40% of patients.

Managing RA and chest pain

This information can be overwhelming. It’s a lot to take in. When you’re diagnosed with RA, you don’t expect it to go beyond the joints.

But thankfully, there are many ways to manage RA — through both medication and lifestyle changes, such as eating a healthy diet and staying active. These can help to reduce the risk of lung and heart conditions.

It’s also important to get blood pressure, blood sugar, and cholesterol levels checked regularly to understand what medications and lifestyle changes are most effective for you.

The bottom line

RA is a systemic disease, meaning it affects the entire body.

It never surprises me when RA causes my knuckles to ache and swell or when I suddenly get a stabbing pain in my shoulder or knee.

But I have been alarmed by symptoms such as chest pain from costochondritis.

I’ve realized that I don’t always know how my disease will affect my body, but that keeping track of symptoms for myself and to share with my doctor is an important part of managing my health.