Can axial spondyloarthritis (axSpA or spondylitis for short) cause rib cage pain or chest pain? If you frequently experience chest pain related to spondylitis, you’re not alone. Chest pain is common in spondylitis, and costochondritis is often the cause.

If you’re experiencing chest pain with spondylitis, be sure to talk to your doctor. Chest pain can be related to inflammation from spondylitis, but it can also be a sign of a serious heart or lung problem that needs urgent care.

Here’s what you need to know about chest pain in spondylitis, including what it feels like, what causes it, and how it can be managed.

What Is Costochondritis?

Costochondritis is inflammation of the costochondral joints, where the ribs connect to the sternum (breastbone). It’s also called chest wall pain syndrome or costosternal syndrome. Costochondritis most commonly affects the upper ribs on the left side.

People with spondylitis may develop costochondritis due to enthesitis, which is inflammation where tendons or ligaments attach to bone. Enthesitis is a common symptom and often affects the costochondral joints. It can also show up in other areas of the body, like the back, hip bones, and heels.

What Does Costochondritis Feel Like?

If you have costochondritis, your chest may feel tender. Sometimes, sharp pains can travel to nearby areas like your stomach, back, shoulders, and arms. Coughing, sneezing, or taking deep breaths (like during exercise) can make costochondritis pain worse.

What MySpondylitisTeam Members Are Saying

“I’ve had a pretty bad case of costochondritis for the last few days. It’s tough to cough, sneeze, and breathe deeply. It’s starting to affect my sleep.”

“I’ve had chest pains for years that feel like a hot knife through my chest when I breathe.”

Costochondritis is the most frequently cited cause of chest pain among MySpondylitisTeam members. One member described their symptoms as “terrible chest pain” and difficulty breathing deeply.

Another wrote, “I’ve had a pretty bad case of costochondritis for the last few days. It’s tough to cough, sneeze, and breathe deeply. It’s starting to affect my sleep.”

MySpondylitisTeam members have also described their chest pain as a “crushing,” “stabbing,” or “searing” feeling in their chests that can last for a long time. “I’ve had chest pains for years that feel like a hot knife through my chest when I breathe,” a member wrote.

Other Causes of Chest Pain

Below are other potential causes of chest pain that can be related to spondylitis. Some causes can be serious, including cardiovascular (heart) disease and lung issues. If you’re experiencing chest pain and difficulty breathing, always see your doctor as soon as possible or seek emergency care.

Cardiovascular Disease

Between 2 percent and 10 percent of people with ankylosing spondylitis have heart problems. These may include:

• Inflammation of the aorta, the large artery that carries blood from the heart to the body
• A weak and enlarged heart
• Irregular heartbeats that are either too fast or too slow
• Chest pain caused by restricted blood flow to the heart due to hardened arteries

Lung Complications

Lung problems can also cause chest discomfort. Infections, such as pneumonia or the flu can cause chest pain with coughing or deep breathing. Though rare, some people with spondylitis may develop pulmonary fibrosis (lung scarring) over time, which could also cause chest discomfort when breathing.

Other Conditions May Cause Chest Pain

Musculoskeletal chest pain — pain in the bones, muscles, ligaments, and other connective tissues in the chest — can also occur with fibromyalgia and other autoimmune conditions such as rheumatoid arthritis. In autoimmune disorders, the immune system mistakenly attacks healthy tissues. Having one autoimmune disease, such as spondylitis, is a risk factor for developing other autoimmune conditions.

When To Seek Immediate Medical Attention

Chest pain should always be taken seriously because it can signal a life-threatening problem. If you have chest pain, call your doctor or go to the emergency room immediately to rule out a more serious condition, such as a heart attack. A physical exam and other diagnostic tests (such as an electrocardiogram or chest X-ray) can help determine the cause and severity of your chest pain.

Signs that you may be having a heart attack include:

• Chest pain
• Cold sweats
• Shortness of breath
• Lightheadedness
• Nausea and vomiting
• Pain or numbness that spreads to the back, jaw, left arm, or neck

It can be hard to tell the difference between dangerous chest pain and chest pain from costochondritis in spondylitis. When in doubt, don’t hesitate to contact your healthcare provider for guidance and peace of mind.

Managing Costochondritis With Spondylitis

Sticking with your spondylitis treatment plan and treating flare-ups can help ease chest pain due to costochondritis. Many MySpondylitisTeam members have developed their own strategies for managing costochondritis, but what works for them may not always work for you. Talk to your rheumatologist for medical advice on how best to manage your symptoms.

Heat and Cold Therapy

Hot or cold compresses can help relieve the pain of costochondritis. Heat helps alleviate pain and tension by loosening the muscles around the joints and increasing flexibility and circulation. Cold, on the other hand, helps reduce inflammation and dull pain. You may want to try alternating between the two to find which option provides the most relief.

Heat therapy can be done using hot water bottles and heating pads. MySpondylitisTeam members have also recommended taking hot baths and showers to relieve pain. You can ice areas of chest pain using a cold pack, a bag of ice, or frozen peas wrapped in a dishcloth.

Medication for Spondylitis Chest Pain

To ease chest pain, both prescription and over-the-counter (OTC) medications may help. Common OTC options include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen. Rarely, if pain isn’t improving after a few weeks, a doctor may recommend a steroid injection to lower inflammation.

Talk to your doctor about trying either prescription or OTC medications to better manage costochondritis.

Breathing Exercises

Deep breathing exercises can keep the ribs flexible and the breathing muscles in good condition. However, breathing exercises can be difficult for members with decreased chest expansion.

“My ribs are fused, and I only have 0.8-centimeter chest expansion,” shared one member.

Another, who wrote that their chest is “fully frozen and doesn’t get much movement,” relies on “belly breaths” for exercise.

One member offered the following advice: “Stretch, try breathing exercises to relax, and rest, and then try, try again.”

Another recommended: “Try to find a relaxing place in the house and do some deep breathing exercises.”

A physical therapist can help walk you through how deep rib-expanding breaths should feel.

Physical Activity

If you’re recovering from costochondritis, your physician may recommend limiting heavy lifting or other physical activities that make symptoms worse. But once symptoms go away, you may want to follow a spondylitis exercise program to improve and prevent further changes in posture and flexibility. Just be sure to increase your exercise gradually — doing intense physical exercise without time to rest or jumping into a new regimen too quickly can re-trigger symptoms.

Some members have mentioned exercises that help them, like stationary bikes and tai chi training. Yoga helped one member get moving. “I have to modify some of the moves,” they said. “I also take restorative yoga, and it’s a perfect fit!”

If you’re unsure how to stay active with spondylitis and a history of costochondritis, a physical therapist can suggest exercises that work best for you and help prevent future flare-ups.

Massage

Gently massaging the neck and shoulder area may help you expand your chest and practice deep-breathing exercises more easily. Some members have shared that massage can also alleviate pain and tension associated with chest pain. “I use my percussion massager on my neck, back, arms, and feet for relief,” wrote one member.

If you try massage at home, avoid sore or tender spots that could make symptoms worse or trigger a flare. It may also help to see a physical therapist or massage therapist, who can show you safe techniques.

Talk to Your Doctor

Chest pain is common in people with spondylitis, and costochondritis is often the cause. Even so, don’t ignore chest pain. If you’re unsure what’s causing your symptoms, talk to your doctor. Getting the right diagnosis can help you find relief and rule out more serious problems.

Join the Conversation

On MySpondylitisTeam, people share their experiences with spondylitis, get advice, and find support from others who understand.

How do you manage costochondritis due to your spondylitis? Let others know in the comments below.