Yes, psoriatic arthritis (PsA) can indeed cause chest pain. This discomfort typically arises from two primary sources: costochondritis or an increased risk of cardiovascular disease. Recognizing the nature and potential causes of chest pain in PsA is crucial for appropriate management and seeking timely medical attention.
Understanding Chest Pain in Psoriatic Arthritis
Psoriatic arthritis is a chronic inflammatory condition that affects joints, skin, and other body systems. Given its systemic inflammatory nature, PsA can impact areas beyond the commonly recognized joints, including the chest wall and the cardiovascular system.
Costochondritis: An Inflammatory Connection
One of the most common causes of chest pain in individuals with PsA is costochondritis. This condition involves the inflammation of the cartilage that connects your ribs to your breastbone (sternum). Since PsA is an inflammatory disease, it can directly trigger or exacerbate this inflammation.
What is Costochondritis?
Costochondritis manifests as localized chest wall pain, often described as sharp, aching, or pressure-like. It typically affects the area where the ribs meet the sternum.
Key Characteristics of Costochondritis Pain:
- Localized Pain: Often felt on the left side of the breastbone, though it can affect multiple areas.
- Tenderness: The pain typically worsens when you press on the affected cartilage.
- Movement-Related: Pain may intensify with deep breaths, coughing, sneezing, physical activity, or certain arm movements.
- Relief with Rest: Symptoms often improve with rest and anti-inflammatory medications.
Cardiovascular Disease: A Systemic Risk
Individuals with PsA have a higher risk of developing cardiovascular diseases (CVD) compared to the general population. This increased risk is largely due to the chronic systemic inflammation characteristic of PsA, which can contribute to the development of atherosclerosis (the hardening and narrowing of arteries).
Cardiovascular Conditions That Can Cause Chest Pain in PsA:
- Coronary Artery Disease (CAD) / Angina: This occurs when the blood vessels supplying the heart become narrowed, reducing blood flow. Angina is the chest pain that results from reduced blood flow to the heart muscle.
- Pericarditis: Inflammation of the pericardium, the sac-like tissue surrounding the heart.
- Myocarditis: Inflammation of the heart muscle itself.
Key Characteristics of Cardiovascular Chest Pain:
- Pressure/Tightness: Often described as a squeezing, pressure, fullness, or pain in the center of the chest.
- Radiation: Pain may radiate to the arms (especially the left), neck, jaw, back, or stomach.
- Associated Symptoms: May be accompanied by shortness of breath, sweating, nausea, dizziness, or lightheadedness.
- Exertion-Related: Often triggered by physical exertion or emotional stress, and may subside with rest.
- Emergency: Chest pain related to cardiovascular issues is a medical emergency and requires immediate attention.
Differentiating Chest Pain: Costochondritis vs. Cardiac Pain
Distinguishing between chest pain from costochondritis and cardiac pain is critical. While a healthcare professional should always make the definitive diagnosis, understanding typical differences can guide your actions.
| Feature | Costochondritis | Cardiac Pain (Angina/Heart Attack) |
|---|---|---|
| Pain Quality | Sharp, aching, localized, pressure-like | Squeezing, tightness, pressure, burning, heavy |
| Pain Location | Specific spot on chest wall/ribs, tender to touch | Mid-chest, may radiate to arms, jaw, neck, back |
| Triggers | Deep breaths, coughing, movement, direct pressure | Exertion, stress, cold weather |
| Relief | Rest, NSAIDs, heat/cold packs, absence of pressure | Rest (angina), nitroglycerin; no relief is a red flag |
| Associated Symptoms | Rarely other symptoms besides local tenderness | Shortness of breath, sweating, nausea, dizziness, lightheadedness |
| Urgency | Typically not life-threatening (but can mimic serious issues) | Potentially life-threatening; requires immediate medical attention |
When to Seek Medical Attention
Any new, severe, or unexplained chest pain warrants immediate medical evaluation. Do not attempt to self-diagnose chest pain.
- Call emergency services immediately if you experience chest pain accompanied by:
- Shortness of breath
- Sweating
- Nausea or vomiting
- Dizziness or lightheadedness
- Pain radiating to your arm, jaw, neck, or back
- A feeling of crushing pressure or tightness in your chest
- Consult your doctor promptly if you experience chest pain that:
- Is persistent or recurring.
- Worsens over time.
- Does not respond to usual pain relief measures for PsA.
- Raises any concerns for you.
Managing Chest Pain Related to PsA
Managing chest pain linked to PsA involves addressing the underlying cause.
For Costochondritis:
- Anti-inflammatory Medications: Over-the-counter NSAIDs like ibuprofen or naproxen can help reduce inflammation and pain. Your doctor may prescribe stronger NSAIDs or local corticosteroid injections if necessary.
- Heat and Cold Therapy: Applying warm compresses or ice packs to the affected area can provide relief.
- Rest: Avoiding activities that worsen the pain can help reduce inflammation.
- Gentle Stretching: Once the acute pain subsides, gentle stretches can help maintain flexibility in the chest wall.
For Cardiovascular Disease Risk:
- Manage PsA Effectively: Keeping PsA inflammation under control with disease-modifying antirheumatic drugs (DMARDs), biologics, or other prescribed treatments can help reduce systemic inflammation and, consequently, cardiovascular risk.
- Lifestyle Modifications:
- Healthy Diet: Emphasize fruits, vegetables, whole grains, and lean proteins American Heart Association.
- Regular Exercise: Engage in moderate-intensity physical activity as recommended by your doctor.
- Smoking Cessation: Quitting smoking is crucial for reducing cardiovascular risk.
- Weight Management: Maintaining a healthy weight reduces strain on your heart.
- Regular Screenings: Discuss with your doctor about monitoring blood pressure, cholesterol levels, and blood sugar, as these are important for managing cardiovascular health.
Understanding that PsA can be a factor in chest pain is important, but careful evaluation by a healthcare professional is always the most responsible approach to ensure an accurate diagnosis and appropriate treatment.
