Tietze (1921) described a condition of painful non-suppurative swelling of the costochondral or sternoclavicular joints. The following criteria should be met:
- Painful and tender enlargement in the region of one or more of the costosternal junctions;
- This enlargement should not have been present previously, and should regress without therapy.
Tietze found no other abnormal findings, and the condition was self-limiting and of unknown aetiology.
Tietze Syndrome and Costochondritis
|Age||Younger than 40 years||Older than 40 years|
|Number of sites affected||One (in 70 percent of patients)||More than one (in 90 percent of patients)|
|Costochondral junctions most commonly affected||Second and third||Second to fifth|
Differential diagnosis for Tietze syndrome, characterized by painful, tender, but nonswollen chondrosternal joints, is more common. Although these conditions are different, they are commonly mistaken for the same.Tietze syndrome usually presents in young adults (younger than 40 years), both male and female. The cause of this condition is not known, but a traumatic pathogenesis cannot be excluded. There is no causal link between Tietze and profession, ethnicity, or geography; however, clustered cases have been reported. Results vary in the few pathological studies performed, from no abnormal findings to swelling and degradation of costal cartilage with associated minimal perichondrial inflammation. The superior ribs, especially the second and third chondrosternal joints, are affected by Tietze. Joints between ribs and the sternum, manubrium, clavicle, and xiphoid process are mostly unaffected.
More than 70% of lesions are unilateral and affect one joint. Multiple lesions affect same-side neighboring joints. Chest pain is the main complaint, and a history of extreme coughing and respiratory tract infection is not uncommon. The pain varies and is localized around the involved synchondrosis but can cover the whole chest area. Coughing, deep breathing, and lying prone can increase the pain. The involved chondrosternal joint is tender and swollen; but erythema, fever, and malaise are absent. Costochondritis is more common, although not exclusive, in adults older than 40 years. Also for this condition, the cause is unknown. However, there seems to be an association between costochondritis and cervical strain syndrome, coronary heart disease, and fibrositis syndrome. In 90% of cases, more than 1 chondrosternal joint is involved, showing no signs of swelling. Mostly affected are ribs 2 to 5.
Diagnosing Tietze syndrome is based on exclusion of other, potentially life-threatening, conditions that affect chondrosternal joints, such as rheumatoid arthritis, pyogenic arthritis, and tumors, after careful analysis of case history, physical examination, and results of investigations. In the literature, it is recommended to use radiological evaluation to avoid misdiagnosis.
Tietze syndrome is eventually self-limiting; however, it follows a pattern of relapse and remission. The pain can spontaneously disappear after a couple of weeks or can last for months, as does the swelling over the affected joints. Treatment consists of reassurance and prescribing salicylates or nonsteroidal anti-inflammatory drugs (orally or injection).