Chest pain?

Hi all,

I have a fairly definite diagnosis of PA. Its mild but extensive. The skin symptoms are fairly mild with typically only small plaques on the elbows, but I get inverse psoriasis in the fletches fairly frequently. The arthritis is farily mild but basically affects every major joint in my body (the spine is not funny!) and most of the minor ones. There is psoriasis in the family but no one has had PA before; hence no one has had chest symptoms before and I don't know what to make of them. The following sequence has happened twice now.

I get a sudden very sharp pain when breathing in on the left side of my chest, I breath through the pain expanding my chest and finally something gives and the sharp pain subsides to become a dull ache that lasts weeks to months. The ache is spread over the whole left side of the chest but is focused a little under the armpit where the ribs are tender. The medics check out my heart and find nothing, they do an xray and see nothing. The doc tells me its either inflammation in the ribcage or pleurisy because of the PA, but he's not worried and just keeps me on my 2x400mg ibuprofen.

1. Can PA really cause Pleurisy?
2. Does this sound like pleurisy?
3. Any body out there who has experienced this themselves?
4. How do I tell Pleurisy from inflammation in the rib cage (perhaps I have both?)?
5. How serious is PA related Pleurisy?
6. What should I do about this?

The doc doesn't seem to be that concerned but its disconcerting to feel dull pain in your chest 24/7.

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geoma, I think you need a second opinion. I don't know if it's pleurisy or not, but something is going on with your side. Have you had a white blood cell count to check for infection? If you are continuing to have this problem and it is bothering you, something needs to be fixed, relieved or at least diagnosed.

Don't be a passive patient and accept everything the doctor concludes. Get informed and go back to him and expect results. You are paying him to help you through this disease. Good luck, I hope you get to feeling better.

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I know nothing about pleurisy, but I do get chest pain like you describe. It happens occasionally, coincides with flares of the spondylitis (I can experience PsA in other joints without the spine's weird), and usually responds fairly well to ibuprofen and rest. The pain gets less stabby. BUT! That kind of chest pain needs to be evaluated so you can be sure it isn't something more serious.

By the way, we have tons of psoriasis in my family, but I am the only person who has the arthritis from it. Lucky us, right? ;)

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I have had pleurisy attacks over the years. They are much different than what you describe.With my pleurisy symptoms all ribs front &
and back hurt where it is extremely difficult to breathe due to the excruciating pain. Pleurisy is a infection or sorts where the lining of the ribs pull away from the bone. Therefore any movement or breathing is extreemly painful. Antibiotic treatment is the only way to cure the infection. It makes the pain go away after the first dose of antibiotics.
The pain description u describe only effecting the left side of the frontal rib section could be Shingles. Shingles is in the nerve tissue in the back area. If you ever had chicken pox then the virus lies dormant for years in the back area. A small rash of just one really really insanely itchy spot on one side of the body., is all it takes. And the pain only effects one side of the body. Immunization injections are the way to go before a shingles out break & effective after as well.
For additional info. check out shingles.
Especialy the stabby part in your description is what gives way to perhaps the symptoms could be Shingles. In my experience with P.A. I am not experiencing stabbing pain.
Crippling pain in joints. Two hip joint replacements over the past 10 years. Shoulders are sore & looking into micro surgery for a new technique to repair damaged shoulders using minimally invasive surgery procedures. P.A. in hands and feet the worst areas effected. Maybe you should think about seeing another dr. To have to endure that pain only with Ibuprofen really makes me a bit angry. Drs are supposed to help relieve pain, not ignore it.
Especially since this goes on for weeks. There again I think of Shingles due to the duration of your symptoms. If it is Shingles antiviral drugs are prescribed. And will lesson the duration. If it is pleurisy you should be on antibiotics, to clear the infection.
Of course I am not a dr maybe perhaps more tests & investigations could be done for you.
It's always something!
Hope u feel better soon.
Gods light & love be with u.

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Hi Geoma,

It sounds as though you may be experiencing costochondritis. This can be a symptom of PsA. Here's Mayo Clinic's description of it:

Costochondritis is the most common cause of chest pain originating in the chest wall.

Symptoms include:

* Pain and tenderness in the locations where your ribs attach to your breastbone (costosternal joints)
* Often sharp pain, though also dull and gnawing pain
* Location often on left side of breastbone, but possible on either side of chest

Other costochondritis symptoms may include:

* Pain when taking deep breaths
* Pain when coughing
* Difficulty breathing

When to see a doctor
Make an appointment to see your doctor if self-care measures aren't helping your pain or if your pain is worsening.

Costochondritis pain is often mistaken for heart attack pain. The pain of a heart attack is often more widespread, while costochondritis pain is focused on a small area. Heart attack pain usually feels as if it's coming from under your breastbone, while costochondritis pain seems to come from the breastbone itself. Heart attack pain may worsen with physical activity or stress, while the pain of costochondritis remains constant.

Don't waste time, though, trying to distinguish between the two if you're experiencing unexplained and persistent chest pain. Chest pain is an emergency — seek medical attention right away.

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Hi all

Thanks so much for your replies.

GIn-ice. The white bloodcell count is within normal and there is no other sign of infection. I will be taking your advice about not being passive.

Hoop-mama. you sound like a kindred spirit. The two times this has happened to me have coincided with flares/periods where everything is worse and I feel lousy. Last time I got it all investigated and they found nothing. The pain subsided eventually, although this time the flare was worse (very bad in the spine with lots of pinched nerves) the initial stabbing pain was much worse and the aching dull pain has gone on for longer.

Chotti. I had not thought of shingles. I don't think it is (primarily because this comes with the PA flares) but I'll suggest it to the new doc. I'll be taking you all up on changing doc this week and I'll try to get a rheumy referral (they weren't that helpful the first time round though). I'm sorry to hear of your troubles. It sounds like you have a more severe variant than I have. My heart goes out to you. I'm in Sweden and the docs here are all about giving the minimal effective treatment; hence the ibuprofen.

HRBarbie. I definitely have very tender ribs on the left side. Its very unlikely to be the heart because they have checked that several times and exercise has absolutely no effect on the pain.

* Pain and tenderness in the locations where your ribs attach to your breastbone (costosternal joints)

Not much of the pain is from here, THe tenderness to the touch is up near the shoulder/collar bone and especially on the ribs down under the armpit.

* Often sharp pain, though also dull and gnawing pain.

As I say, occasionally it is very sharp and very sensitive to taking deep breaths, but mostly its dull ache and tenderness to the touch.

* Location often on left side of breastbone, but possible on either side of chest.

Almost exclusively left side

* Pain when taking deep breaths

Not normally but sometimes this pain is excrutiating (see below).

* Pain when coughing

Can happen, especially the first time I cough after a while of not coughing, but not normally.

* Difficulty breathing

Only twice so far thank god and only for 10-20 seconds until I have pushed through the pain and expanded my chest fully, but oh lord the pain when I do this.....

I'm open to it being costochondritis (didn't know of this condition before so thanks for telling me about it); indeed if I had to pick I'd rather it was this than the alternatives. There is certainly some inflation in the chest wall, but there is also some inflammation in/around the lung because I'm very occasionally hacking up a little phlegm and it feels a little, little better when I do. Perhaps the inflammation around the lung is coming from the chest wall or perhaps its the other way around.

Either way I shall be getting this looked at this week by a new GP and we'll see where we go from there.

Thank you all so much for your help.

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I'm pretty sure it is PsA! I actually had a doctor feel for a tender spot in the place where your ribs meet. It wasn't only tender it was a swollen knot that reduced breathing ability and I believe was putting pressure on my heart as well. I also had spinal involvement. I can tell you some things that help some are: goat milk, caprylic acid, thyme, ibuprophen, turmeric, alfalfa, gingko biloba, potassium iodide and I also had some harmonal imbalance and was loosing overall strength so I also took tribulus terrestris. The book " Perscription for Nutritional Healing" is a big help!!!

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I have PsA also and yes my spine is affected and no I agree it is not funny. I too have the sharp pains in my chest and collar bone. The doctors have told me that it is due to PsA. I have had pleurisy and the feelings are not the same. Sometimes it feels like a sharp knife has been stabbed in my chest and twisted around. Mine how ever does not last for weeks or months. Mine only last for a few days a week at the most. It does get very tender other than that it is gone. PsA and PA are the pits to deal with because you can't tell if it is a major problem going on or just the PsA showing it's ugly side. Get a second opinion as a just in case never put all your faith in one person.

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I too have experienced a similar chest pain that sent me to the E.R. for a good chunk of the night. All of the tests performed indicated that it was not my heart. The doc shot some ibruprofen into my I.V. line and the pain went away. I am guessing that my PA was just looking for a new creative way to express itself.

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