How does Tietze syndrome differ from costochondritis?
Tietze syndrome is a syndrome of pain, tenderness, and swelling of joints of the chest wall, usually the costochondral joints (second or third most commonly). In comparison, costochondritis is a much more common syndrome characterized by costochondral joint pain and tenderness without objective signs of inflammation. Tietze syndrome occurs in both men and women aged usually <40 years. It usually (80%) involves a single joint and is rarely bilateral. Polyarticular disease can affect neighboring articulations on the same side of the sternum. The etiology is unknown but an attack may be precipitated by trauma, coughing, vomiting, or a viral syndrome. In older patients, it is seen more frequently in those with costal cartilage calcification, suggesting that hydroxyapatite may play an etiologic role. Attacks usually resolve within 12 weeks. NSAIDs, toradol, glucocorticoid injections, and local therapy with heat or ice may help symptoms. Other causes of costochondral joint swelling such as infection, spondyloarthropathies, SAPHO, and relapsing polychondritis must be excluded before diagnosing a patient with Tietze syndrome.