E. Disla et al., COSTOCHONDRITIS - A PROSPECTIVE ANALYSIS IN AN EMERGENCY DEPARTMENT SETTING, Archives of internal medicine, 154(21), 1994, pp. 2466-2469
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.