Chest Pain in Patients with Rheumatic Disease

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Chest Pain in Patients with Rheumatic Disease

Chest pain is defined as any discomfort in the chest. Patients with chest

pain and a rheumatic disease can best be evaluated by a thorough history and

by identifying a physical finding of the chest, heart, or lungs. Questions

that should be asked include:

Was the onset of pain sudden or gradual?

Was it associated with trauma or overexertion?

Are there any other symptoms, such as fever, chills, nausea, or

palpitations?

The patient should also be asked to describe the pain and point out its

exact location.

Patients who describe chest pain in a localized area and do not have

respiratory symptoms, but do complain of pain with exertion or movement may

suffer from musculoskeletal conditions. Examination of the chest may show

bruising, swelling, or signs of trauma. Chest pain can originate from the

chest wall or be caused from pain in other organs. After a complete history

and physical, a chest x-ray is indicated and if cardiac problems are

suspected and an electrocardiogram can be helpful.

In many cases, chest pain caused by trauma is obvious by feeling the area or

by seeing bruising or swelling. If feeling the area during examination

reproduces the pain, a chest wall syndrome may be the cause. Fibromyalgia

may also present with muscular pain that is localized to the chest. Other

conditions that could cause such chest pain include arthritis, nerve

compression, nerve impingement caused by osteoarthritis, disc herniation,

and angina.

A fractured rib from trauma or from bone conditions such as osteoporosis is

evidenced by sudden onset and confirmed through x-ray. Bone scans and MRI

are often used in diagnosing such problems. Rib fractures can sometimes

cause difficulty breathing, especially if air or fluid fills the lung space.

Both lung diseases and cardiac diseases can cause difficulty breathing.

Shrinking lung syndrome is a rare complication of lupus. Difficulty

breathing is usually worse when lying flat. This is treatable with steroid

therapy. In some cases lupus can cause difficulty breathing without known

cause.

Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) can also

cause swelling in the lung tissue, which can lead to such problems. Asthma

and pneumonia can also cause chest pain and should be considered if symptoms

correlate with these conditions. If chest pain is experienced, medical

attention should be sought immediately to rule out life-threatening

complications.