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Living with Psoriatic Arthritis (PsA)

Costochondroitis, virus, or what?

HELP!
I’ve had extreme pain in my upper torso—front to back. The pain can be hard and steady with added sharp shooting pains in my ribs, or it can settle down to be less distressing. I called the nurse first thing Monday morning and she told me to go to the ER because “you are having signs of a heart attack”. So, I went to the ER. My BP was elevated but EKG was ok. Triptonin level normal, D-dimer slightly elevated. Because of the D-dimer being above normal, they did a CT of my chest, which showed no blood clots in my lungs. They sent me home with a diagnosis of “pleurisy and a flu-like virus”. I have no fever or other typical flu symptoms.

I started thinking maybe this is really bad heartburn, so I took Pepcid yesterday. So far that hasn’t helped. This is day 4 and I’m worried there’s something serious going on in my body! I’ve never had anything like this…

I’ve read about costochondroitis and I do have pain in my breastbone and front of my chest. It hurts more when I cough, sneeze, hiccup, etc, But, there’s terrible pain in my back and my sides, too. I can’t tell for sure if it’s muscular skeletal or what???

Has anybody had a viral or bacterial infection that attacked their body this way??? I’m holding off taking my Enbrel this week just to be safe. I’ve been with a lot of sick family recently, and wondering if I caught something that isn’t manifesting itself with the usual symptoms.

I’d appreciate anybody’s thoughts before I call my doctor again.

That sounds miserable. Going to see your doctor and go through all the tests was the righting to do, especially with your history of heart problems.

Costochondritis is not limited to the sternum. If your do a search here you’ll see that people have described pain similar to what you’re describing. Many people seem to get some relief from heat in the front, cold in the back, then flip it next time.

Are you able to take anti-inflammatories? You can try and add that in for now, but you want to take it on a schedule not when you think you need it.

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That sounds like what I had … increasing pain in chest, in my case upper chest & neck too. The rest of my torso felt bruised, front & back.

Okay so that went with other stuff which may or may not have been connected - wheezing, hoarse voice, breathing difficulties. And as you know I was dx-ed with COPD - but just this morning the dx has been changed to asthma.

None of this is helpful … all I can say is that my experience was odd - I did start to feel feverish and lousy all over too but no temperature. I’m better now. So I hope your pain takes the same path … keep vigilant, but here’s hoping it is short-lived.

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Hi Stoney and Sybil. Thank you for your thoughts and suggestions. This, whatever it is, is very uncomfortable. IDK what to think. I hardly slept at all last night but still had to work today. I only work 5 hours so it’s not too bad. The pain was terrible during the night. It added a spot and got into one of my lower ribs on my left side. I used a heating pad and ice pack and it helped somewhat. This morning I stood in the shower and used the pulsating spray and alternated stretching and arching my back to loosen it up. Today at work I had a yucky lump in my throat that lasted about three hours. It felt like something was caught in there. I’m hoping this is just some kind of weird virus.
Sybil you give me hope! You recovered, so I will too. It’s just one of the weirdest and scariest illnesses I’ve ever had. If it is costochondroitis, I have tons of sympathy for those of you who get it frequently.
Stoney, I’m not supposed to take anti-inflammatories, but I do take ibuprofen once-in-awhile. I took two Tylenol arthritis last night and they didn’t help a bit!

I thought I remembered that you could not take anti-inflammatories. I would see if your rheumatologist could fit you in. You would definitely want to make sure that the doctor had access to all of your recent visits to Medical Care.

If you’ve already ruled out the big bad stuff, you need to go to the Rheumatology route, in my opinion.

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@Grandma_J what you’re describing sounds an awful lot like my costochrondritis. Pain everywhere but the sternum, in my collarbones and weird pains down the sides of ribs from my armpit down, breast pain or pain under my breasts either side, it bounces around a lot including my back. Worse lying in bed than sitting up. Hurts like hell, can reduce me to tears. And obviously worse when coughing, sneezing or laughing. It’s frightening and horrid.

I haven’t thankfully had it much if at all for a while.

So let’s look at this logically. Your heart is fine and you’ve no bloodclots on your lungs. You feel lousy but have no real fever or flu stuff going on. Did the ER check your CRP and ESR levels for signs of any other infection or indeed just a spiking of inflammation? Why don’t you visit your ‘GP’ and see? Sadly if it is costochrondritis, it can take an age to calm down again. Biggest hugs. x

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I no longer expect anything that may be linked to chronic disease to go away completely. ‘Stuff’ comes and goes, it’s a learning curve involving acknowledging the symptoms, trying to remember them, storing the knowledge away & moving on. And then at the same time we need to stay vigilant in case something does turn out to be more serious. Easy-peasy! (Yeah, right).

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Sounds like Pleurisy to me too. Not uncommon for us… Warm moist "hot packs and NSAIDS. Rotate front to back

TJ

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I’ve had some weird combo of pleurisy and pericarditis for the better part of two years. Don’t take steroids! It can create my situation, where it becomes recurrent.

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Bingo, Stoney! But that’s true for all of our encounters with medical help.

Insider preview: we are going to be rolling out a tool for doing exactly this, and more very soon. You will be able to compile (and control) all your important medical records, treatments and medications, as well as PsA information for medical personnel (did you know that not all docs have a good understanding of our disease?) and the contacts of all of your medical providers in one place: on your phone. Think of the possibilities.

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That sounds awesome. It will have a section for prior surgeries as well? I have to tell you I have a hard time keeping track of those.

It will support x-rays, doctor’s reports and whatever. It’s amazing. In an “new doc” situation you will be able to give them the most important things from your medical file, electronically, and they’ve got the lowdown on you. Sure beats recounting all your “stuff” when you are lying there feeling awful.

Yup, totally amazing.

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Ugh. Ouch. Yuck. #!!*!”%# <- whatever nasty word you want to insert there!

So not fun. But pain usually isn’t.

So it’s probably costochondroitis and/or pleurisy with a pinch (or handful) of indigestion for good measure? That’s what it felt like.

And, I think, as someone said, it takes awhile for it to go away. At least yesterday and today it only struck intermittently in my upper back. The most annoying thing today was the soreness surrounding my esophagus—its painful to burp, hiccup, cough, sneeze, etc., but definitely not at its worst. Plus I had a lump in my throat at the base of my neck that feels like something’s caught in there.

I appreciate everyone’s input. I will be seeing my rheumy in about 2 weeks, so hopefully he’ll be able to give me his educated guess. He’ll probably want me to switch to a different biologic. I hope not.

Fyi, I haven’t been switched to a different biologic. I did have a crazy amount more testing done, to ensure that it wasn’t drug-induced lupus, because pericarditis is more closely associated with that.

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I don’t see why that would be the case …

You and I need to be careful, some mysterious quantum force gives us similar symptoms even though we’ve never met. I think you get the worst of it though.

I was wondering if I have an oesophageal issue on top of other stuff … so is the asthma nurse … there’s GERD and there’s another thing - a long word. Like GERD but without acid reflux.

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That IS strange, except we both have the same icky inflammatory disease and I think we’re all more susceptible to these unusual flares of whatever.

Several weeks ago for a few weeks I kept getting sharp shooting pains through my head all day every day. I googled “sharp shooting pains in the head” :thinking: and it turned out they’re called icepick headaches. For the past few weeks they’ve almost completely disappeared except for an occasional one. I had asked my primary care doctor about this and we talked about me having an MRI and MRA of my head and neck, because of some other symptoms I’ve had, just to rule out anything bad. IDK what to do—the appointments are so time consuming and inconvenient, and when one feels better it’s why bother???

@Sybil, I hope you don’t get the icepick headaches, too! And, I hope I don’t get your knee problems! We don’t need to share EVERY ache and pain!

That inflammatory disease of which you speak CAN be the trigger for a condition called Pseudotumor cerebri also known as idiopathic intracranial hypertension. The MRI/MRA is very appropriate. Just because its not a “real” tumor doesn’t mean it isn’t serious and can’t return with a real vengeance at the worst possible time. So yeah you need to bother.

If you want to read the textbook explanation you can start at https://www.dartmouth.edu/~dons/part_2/chapter_18.html

Its most common in women of a certain age and even slightly overweight. Its ICD10 code FWI is G93. 2 not totally unrelated to L40. 52 which is the new ICD 10 code for PsA adopted October 1, 2019.

TJ

No, but I will soon.

You are right though … I think the combo of inflammatory disease & getting older may result in apparently random, disconcerting symptoms, some of which may be fleeting. I’m hoping yours are fleeting!

I see my GP more than ever. I tend to think I’ll be summarily dismissed but that doesn’t happen, they take everything seriously these days. I reckon they understand that it’s hard to know what will pass on what won’t given the burden of underlying disease.