COSTOCHONDRITIS - A PROSPECTIVE ANALYSIS IN AN EMERGENCY DEPARTMENT SETTING

Background: Costochondritis (CC) is a common, but poorly understood co ndition among patients with chest wall pain. We have prospectively ana lyzed distinctive features of patients presenting to the emergency dep artment with chest pain and CC. Methods: Patients with a chief complai nt of chest pain, not due to trauma, fever, or malignancy, were prospe ctively evaluated for the presence of CC and compared with another che st pain group without CC. Results: Of 122 consecutive patients studied , 36 had CC (30%) and in 17 the pain induced reproduced the original o ne (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 criteri a for fibromyalgia, while none of the control subjects did. Widespread pain was more common in the CC group (42% vs 5%). The mean sedimentat ion rate in the CC group was 44 +/- 31 mm/h vs 41 +/- 31 mm/h in the c ontrol group. The acute myocardial infarction rate was 6% in the CC gr oup vs 28% in the control group. Rheumatoid arthritis and osteoarthrit is were diagnosed in three and two patients, respectively, of 32 patie nts with CC cases. One year later, 11 (55%) of 21 patients with CC wer e still suffering from chest pain, but only one third still had defini te CC. Conclusions: Costochondritis is common among patients with ches t pain in an emergency department setting, with a higher frequency amo ng women and Hispanics. It is associated with fibromyalgia in only a m inority of cases. Patients with CC appear to have a lower frequency of acute myocardial infarction. Spontaneous resolution is seen in most c ases at 1 year.