Can ankylosing spondylitis cause rib cage pain or chest pain? If you frequently experience chest pain with spondylitis, you’re not alone. Chest pain is a common symptom of spondylitis, and costochondritis is frequently the cause.

Spondylitis — also known as axial spondyloarthritis (axSpA) — can affect the body in many different ways. If you’re experiencing chest pain with spondylitis, be sure to talk to your doctor. It may be due to spondylitis-related inflammation. However, it may be caused by a life-threatening health condition such as heart disease or lung problems that require immediate care.

Here’s what you need to know about chest pain in spondylitis, including what it feels like, what causes it, and how it can be managed.

What Is Costochondritis?

Costochondritis is inflammation of the cartilage that connects the ribs and sternum (breastbone). This area is known as the costochondral joints. Inflammation in this cartilage can be associated with spondylitis, which is common in people with inflammatory diseases such as spondyloarthritis. Costochondritis is also known as costosternal chondrodynia, chest wall pain syndrome, or costosternal syndrome. It typically affects the upper ribs on the left side.

If you have costochondritis, your chest may feel tender, and sometimes sharp pains can travel to nearby areas like your stomach or back. Coughing, sneezing, or taking deep breaths can worsen costochondritis pain, so you may notice it more after exercise.

Chest pain in ankylosing spondylitis can also be caused by enthesitis, or inflammation in the area where ligaments connect to bones.

Because the pain may be more on the left side of the chest, it can feel like angina (chest pain caused by reduced blood flow to the heart), heart attack, or another type of heart problem. It can also mimic pain associated with lung inflammation. If you have chest pain, it’s essential to talk to your doctor as soon as possible or seek emergency care in case you have a serious condition.

What Does Ankylosing Spondylitis Chest Pain Feel Like?

Costochondritis is the most frequently cited cause of chest pain among MySpondylitisTeam members. One member reported “terrible chest pain” and difficulty breathing deeply. Another shared, “I’ve had a pretty bad case of costochondritis for the last few days. It’s tough to cough, sneeze, and breathe deeply. It’s starting to affect my sleep.”

MySpondylitisTeam members have also described their chest pain as a “crushing,” “stabbing,” or “searing” feeling in their chests that can be mistaken for a heart attack. Other members have reported on this symptom in comments like the following:

• “Mine feels like a heavy weight on my chest, and deep breathing causes coughing.”
• “It feels like a wire brush scrubbing the inside of my chest.”
• “I felt like I was being stabbed with a dull screwdriver.”
• “Tightness and pressure in my chest wall. My breathing has become short and shallow.”
• “I’ve had chest pains for years that feel like a hot knife through my chest when I breathe.”

Other Causes of Chest Pain

Below are some other potential causes of chest pain besides spondylitis.

Cardiovascular Disease

Between 2 percent and 10 percent of people with ankylosing spondylitis experience cardiac issues (heart problems). These may include:

• Inflammation of the large artery that carries blood from the heart to the body
• A weak and enlarged heart
• Irregular heartbeats that are either too fast or too slow
• Chest pain caused by restricted blood flow to the heart due to hardened arteries

Lung Inflammation

Chest pain can also be caused by lung problems, such as buildup of fluid in the lungs. People with ankylosing spondylitis may also experience chest tightness and heavy breathing due to pulmonary fibrosis (lung scarring) or inflammation in the ribs, which prevents the rib cage from expanding as much as it normally does during breathing.

Thoracic Spondylosis

Aging, ongoing physical strain, poor posture, injury, and genetics can all cause thoracic spondylosis, a common condition that causes the spine below the neck and above the lower back to degenerate.

Thoracic spondylosis is not related to spondylitis. Thoracic spondylosis is caused by wear and tear on the spine, while spondylitis is caused by inflammation in the immune system. However, thoracic spondylosis may cause pain that resembles spondylitis, including mid back pain or chest pain.

Other Conditions May Cause Chest Pain

Musculoskeletal chest pain — pain in the bones, muscles, ligaments, and other connective tissues in the chest — can also occur with fibromyalgia and other autoimmune conditions such as rheumatoid arthritis. Having one autoimmune disease, such as spondylitis, is a risk factor for developing other autoimmune conditions.

When To Seek Immediate Medical Attention

Chest pain should always be taken seriously since it may indicate a life-threatening situation. If you have chest pain, call your doctor or go to the emergency room immediately to rule out a more serious condition such as a heart attack. A physical exam and other diagnostic tests (such as an electrocardiogram or chest X-ray) can help determine the cause and severity of your chest pain.

Signs that you may be having a heart attack include:

• Chest pain
• Cold sweats
• Shortness of breath
• Flushing
• Lightheadedness
• Nausea and vomiting
• Pain or numbness that spreads to the back, jaw, left arm, or neck

Distinguishing between dangerous chest pain and chest pain from costochondritis in spondylitis can be difficult. When in doubt, don’t hesitate to contact your health care provider for guidance and peace of mind.

Managing Chest Pain With Spondylitis

Maintaining your spondylitis treatment plan and managing flare-ups may help relieve chest pain due to spondylitis.

Many MySpondylitisTeam members have developed their own strategies for dealing with costochondritis pain that often comes with spondylitis. It’s a good idea to talk with your rheumatologist and get medical advice about how best to manage your chest pain.

Heat and Cold Therapy

Hot or cold compresses can help ease the pain of costochondritis. Heat helps alleviate pain and tension by loosening the muscles around the joints and increasing flexibility and circulation. Cold, on the other hand, helps reduce inflammation and dull pain. You may want to try alternating between the two to find which option provides the most relief.

Heat therapy can be done using hot water bottles and heating pads. MySpondylitisTeam members have also recommended taking hot baths and showers to relieve pain. You can ice areas of chest pain using a cold pack or a bag of ice or frozen peas wrapped in a dishcloth.

Medication for Spondylitis Chest Pain

To alleviate chest pain, both prescription and over-the-counter (OTC) medications may help. Common OTC options include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil), and naproxen (Aleve), which are often considered first-line therapy for axial spondyloarthritis. In more severe cases or when complications arise, prescription corticosteroids may be used.

Talk to your doctor about trying either prescription or OTC medications to better manage costochondritis.

Breathing Exercises

Deep breathing exercises are typically the first line of defense for keeping the ribs flexible and the breathing muscles in good condition. The exercises are also important for long-term pain management. However, breathing exercises can be difficult for members with decreased chest expansion.

“My ribs are fused, and I only have 0.8-centimeter chest expansion,” shared one member. Another, who said their chest is “fully frozen and doesn’t get much movement,” relies on “belly breaths” for exercise.

One member offered the following advice: “Stretch, try breathing exercises to relax, and rest, and then try, try again.” Another recommended: “Try to find a relaxing place in the house and do some deep breathing exercises.”

Physical Activity

A spondylitis exercise program is often recommended to improve and prevent further changes in posture and flexibility and to reduce pain. Exercise under the guidance of a physical therapist may also be helpful. Swimming is a great and helpful way of maintaining physical activity, strengthening back muscles and improving posture.

“Any exercise I can do always improves my pain and stiffness,” one member wrote. “I would say we must keep as active as we possibly can, no matter how slow we may be.”

Others have used exercise bikes and tai chi training. Yoga helped one member get moving. “I have to modify some of the moves,” they said. “I also take restorative yoga, and it’s a perfect fit!”

You can ask your doctor for a referral for physical therapy to help you with exercise and physical activity that is appropriate for your particular condition.

Rest

Costochondritis can sometimes be due to physical stress, such as overexertion during exercise. Don’t forget to take time to rest, and avoid certain activities if you notice they tend to bring on chest pain.

Massage

Gently massaging the neck and shoulder area may help alleviate pain and tension associated with chest pain, some members have shared.

Surgical Intervention

If your chest pain is caused by heart disease, you may be referred to a cardiologist or cardiac surgeon for further evaluation and treatment options. Some common causes of chest pain in heart disease may require surgery.

Find Your Team

MySpondylitisTeam is the social network and online support group for people with spondylitis and their loved ones. Here, more than 98,000 members come together to ask questions, give advice, and share their experiences of living with spondylitis.

Do you experience chest pain due to your spondylitis? What are your go-to tips for managing pain due to costochondritis? Share your tips in the comments below or by posting to your Activities feed.