Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Anterior Chest Wall Pain in Spondyloarthritis Is a Frequent Manifestation, Appearing Early in the Disease Course, Which May Respond to NSAIDs.

Elhai1,  Muriel, Paternotte1,  Simon, Roure1,  Fanny, Koumakis1,  Eugénie, Payet1,  Judith, Burki1,  Vincent, Fabreguet1,  Isabelle

Cochin Hospital and Paris Descartes University, Paris, France
Hospital Cochin, Paris, France

Background:

Chest pain is a common but little studied feature of spondyloarthritis (SpA).

Objective:

To assess the prevalence of anterior chest wall pain (ACWP) among a cohort of patients with SpA in a tertiary care center and to describe clinical characteristics of ACWP.

Method:

Study design: retrolective single center observational study in 2010 (COSPA). Patients: definite SpA (Amor's criteria). Each patient underwent direct interview by a physician. Data collection: prevalence of ACWP, according to SpA subtype (axial versus peripheral, enthesitic or extra-articular) and if present, the date of appearance, the localization and nature of the pain, and effectiveness of the different treatments. Analysis: descriptive analysis.

Results:

To date, 151 consecutive SpA patients were assessed: median age 43 (inter-quartile range 35–55) years, median disease duration 15 (8–25) years, 97 (64%) were men. In all, 56 patients (37%) suffered from SpA-associated ACWP. ACWP appeared before the diagnosis of SpA in 38% (17/45) cases; it was the first symptom of SpA in 5% (3/56) cases, and it appeared during the first 5 years of disease duration in 69% (31/45) cases. ACWP was localized in the sternoclavicular joint (26%), the manubrio-sternal joint (48%), the upper sternocostal joints (67%) and/or the lower sternocostal joints (55%). ACWP was usually acute, with painful flares (76%), with (N=16) or without (N=24) chronic pain. Coronary tests were performed for this pain in 2 cases. Respiratory movements and movements of the arm increased the pain in respectively 78% (40/51) and 55% (26/47) of cases; pain during the night was less frequent (40%, 21/53). Nonsteroidal anti-inflammatory drugs prescribed for this indication were effective in 53 % of cases (17/32), whereas anti-tumor necrosis factor agents were reported as effective in 73 % of cases (19/26).

Conclusion:

This study is the largest clinical description of ACWP in SpA. ACWP is a frequent manifestation in SpA (37%); it occurs early in the disease which may be a challenge for diagnosis. ACWP in SpA is usually acute; it does not frequently lead to night pain. NSAIDs may be a useful first line treatment.

To cite this abstract, please use the following information:
Elhai, Muriel, Paternotte, Simon, Roure, Fanny, Koumakis, Eugénie, Payet, Judith, Burki, Vincent, et al; Anterior Chest Wall Pain in Spondyloarthritis Is a Frequent Manifestation, Appearing Early in the Disease Course, Which May Respond to NSAIDs. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1924
DOI: 10.1002/art.29689

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