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
Chest pain is a common but little studied feature of spondyloarthritis (SpA).
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.
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.
To date, 151 consecutive SpA patients were assessed: median age 43 (inter-quartile range 3555) years, median disease duration 15 (825) 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).
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