Rheumatoid Arthritis (RA) is a chronic autoimmune condition primarily affecting the joints, causing inflammation, pain, and swelling. As a systemic disease, RA can affect various other parts of the body, including those within the chest. Thus, RA can cause chest pain, with varying mechanisms. Any new or unexplained chest pain should always prompt a medical evaluation.
Direct Causes of Chest Pain from Rheumatoid Arthritis
Rheumatoid arthritis can directly cause chest pain by inflaming structures within the chest. Pericarditis, inflammation of the two-layered sac surrounding the heart, is one direct cause. While pericardial involvement may be seen on imaging, symptomatic pericarditis is less common, affecting less than 10% of patients. This condition manifests as sharp, stabbing chest pain that may worsen when lying down or taking a deep breath.
Pleurisy, or rheumatoid pleuritis, involves inflammation of the pleura, the membranes lining the lungs and chest cavity. This condition leads to sharp chest pain that intensifies with deep breathing or coughing, often accompanied by shortness of breath. While pleural involvement is common, symptomatic pleurisy is rare, affecting only a small percentage of patients. It is considered a relatively rare complication.
Costochondritis, inflammation of the cartilage connecting the ribs to the breastbone, is another direct cause of chest pain associated with RA. This condition causes localized pain and tenderness in the chest wall, often described as sharp or pressure-like, worsened by movement, coughing, or deep breaths. Rheumatoid nodules, firm lumps that can form under the skin, may also develop in the lungs or chest wall, potentially causing pain or discomfort if they inflame or rupture.
Related Conditions That Cause Chest Pain
Rheumatoid arthritis can contribute to chest pain indirectly through its systemic effects. Chronic inflammation, a hallmark of RA, increases the risk of cardiovascular disease, including atherosclerosis. Patients with RA have a higher risk of developing heart disease compared to the general population, a risk comparable to that of diabetes. This increased risk can lead to symptoms like angina, or even heart attack symptoms.
Interstitial lung disease (ILD) is a serious lung complication of RA, characterized by inflammation and scarring of the lung tissue. This condition can cause persistent shortness of breath, a dry cough, and chest discomfort. ILD impacts the health and lifespan of RA patients. It is a significant concern.
Certain medications used to treat RA can also lead to chest pain as a side effect. For instance, nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastrointestinal issues like heartburn or stomach ulcers, which can feel like chest pain. Some disease-modifying antirheumatic drugs (DMARDs) or biologic therapies can rarely affect the heart or lungs, potentially leading to chest discomfort.
Other Reasons for Chest Pain
Chest pain has many potential causes beyond rheumatoid arthritis. Cardiac issues, such as a heart attack or unstable angina, are serious concerns that can present with chest pain, often described as pressure, tightness, or squeezing. Other cardiac conditions like myocarditis can also cause discomfort.
Gastrointestinal problems are a common source of chest pain. Conditions like gastroesophageal reflux disease (GERD), where stomach acid flows back, can cause a burning sensation in the chest. Esophageal spasms or gallstones can also lead to chest discomfort that can mimic heart-related pain.
Musculoskeletal issues frequently cause chest wall pain. Examples include muscle strains from strenuous activity or direct trauma, or rib fractures. Pulmonary issues, such as pneumonia or a pulmonary embolism, can also manifest as chest pain, often accompanied by shortness of breath or cough. Anxiety or panic attacks can also cause chest tightness and discomfort, mimicking more serious conditions. A medical professional should evaluate any chest pain.
When to Seek Medical Attention
Immediate medical attention is necessary for any new, severe, or unexplained chest pain, especially if it presents with other concerning symptoms. These warning signs include shortness of breath, profuse sweating, dizziness, lightheadedness, or pain that radiates to the arm, jaw, or back. A sensation of pressure or tightness in the chest also warrants urgent evaluation, as these can be indicators of a cardiac event.
Individuals with rheumatoid arthritis who experience persistent or recurring chest pain, even if less severe, should consult their rheumatologist or general practitioner. This allows investigation of the underlying cause, whether RA-related, a complication, or unrelated. Prompt diagnosis and management help address the pain and prevent complications.