Can early diagnosis and management of costochondritis reduce acute chest pain admissions?

OBJECTIVE We identified patients presenting with chest pain diagnosed as costochondritis by a consultant rheumatologist. The time taken to diagnosis was determined and the influence of diagnosis on subsequent management was assessed. We then estimated any cost benefits that early diagnosis and treatment of costochondritis might confer. Finally, we evaluated our current experience of sulfasalazine as a treatment for recurrent costochondritis. METHODS This was a retrospective observational study of 25 consecutive patients (17 female), mean age 50 years (range 26-75), with costochondritis who initially presented with acute chest pain. RESULTS The mean time to diagnosis was 9.4 (0-57) months. The total number of chest pain admissions pre-review was 39 compared with 6 post-review (p < 0.0001). The number of minor investigations was 169 pre-review compared with 17 post-review (p < 0.0001), and major investigations 30 compared with 0 (p < 0.01). All 13 patients treated with corticosteroid injections reported symptomatic improvement, and 10 of the 11 whose symptoms recurred responded to sulfasalazine. CONCLUSION Patients with costochondritis frequently present with acute chest pain, often resulting in multiple admissions and investigations. In this study admission and investigation rates were significantly reduced following rheumatological review. How much of this reduction is directly a result of rheumatological intervention is unclear, given the limitations of the study. The findings suggest early review may improve patient care and reduce expenditure; in recurrent cases of costochondritis, sulfasalazine may be of additional longterm benefit.