Psoriatic arthritis (PsA) causes inflammation in the joints and tends to present in people with psoriasis. A less common symptom of PsA is chest pain, which may occur as a result of inflammation in the cartilage that links the breastbone to the ribs.

However, people with PsA are also more likely to develop cardiovascular disease than people without the condition. For this reason, it is important that people with PsA speak with a doctor if they are experiencing chest pain.

In this article, we look at the link between PsA and chest pain, discuss other signs that PsA is affecting the chest, and explain what treatments and management strategies may help.

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Yes, PsA can cause chest pain. This pain is typically due to either costochondritis or cardiovascular disease.

Costochondritis

PsA causes inflammation in multiple areas, which may include the cartilage between the breastbone and the ribs. Inflammation of this part of the body is known as costochondritis.

Costochondritis can cause sharp pain, pressure, or a dull ache in the chest. In some cases, the pain may be so severe that a person may mistake it for a heart attack. However, costochondritis itself does not cause any damage.

Cardiovascular disease

Another potential cause of chest pain in people with PsA is cardiovascular disease.

Having PsA puts a person at higher risk of developing cardiovascular disease. Research suggests that this could be due to several factors, including:

  • chronic inflammation
  • damage to the cells that line blood vessels
  • high blood levels of uric acid, which is also involved in the development of gout
  • mental health conditions, which are more common among people with PsA
  • accelerated development of atherosclerosis, a condition that causes the arteries to become narrow and hard

Additionally, people with PsA have a higher likelihood of having other conditions that are risk factors for cardiovascular disease, such as:

Cardiovascular disease requires medical treatment, so if someone with PsA is experiencing chest pain, they should not just assume that it is costochondritis. A doctor can perform tests to rule out more serious causes.

Chest pain is just one of the signs indicating that a person may have PsA that is affecting their chest. Other possible symptoms include:

  • pain when breathing, coughing, or laughing
  • tender ribs
  • shortness of breath

If cardiovascular disease is the cause of chest pain, a person may also experience:

  • chest pressure, discomfort, or tightness
  • shortness of breath
  • pain in the neck, jaw, or throat
  • pain in the upper back or abdomen
  • a cold, numb, or weak feeling in the arms or legs
  • nausea
  • heartburn
  • dizziness
  • sweating

Anyone with any of these symptoms should speak with their doctor as soon as possible.

There is no test to determine whether a person has PsA. To diagnose PsA, a doctor will take note of a person’s family medical history to find out whether they have any close relatives living with psoriasis or PsA. They will also ask the person about their symptoms and conduct a physical examination.

Possible symptoms include:

  • scaly patches of inflammation on the scalp, elbows, and knees
  • fatigue
  • swelling and stiffness in one or more joints
  • tenderness where tendons join to the bone — for example, the heel
  • sausage-like swelling of at least one finger and toe
  • inflammation around the middle layer of the eye
  • inflammatory bowel disease

To confirm a diagnosis, a doctor may also request imaging tests or blood samples.

If someone with PsA has chest pain, they may also run tests to rule out serious conditions, such as cardiovascular or lung disease.

People can often manage the symptoms of mild PsA with over-the-counter (OTC) anti-inflammatory and pain medications. These should also ease pain resulting from costochondritis.

However, if the symptoms are more severe, doctors may prescribe stronger medications. These could include:

It is important to discuss the medication options for PsA with a doctor, as some can raise the risk of cardiovascular disease, whereas others can reduce it. Treating PsA by reducing inflammation overall may also lower the risk, although research into this is still ongoing.

Alongside taking medication, people with PsA may be able to lower inflammation by adjusting their diet and lifestyle. These changes may reduce the symptoms and also lower the risk of developing other conditions.

Following an anti-inflammatory diet

Plant-based diets are anti-inflammatory, as is the Mediterranean diet. These diets also lower the risk of cardiovascular disease. People can follow a Mediterranean dietary pattern by:

  • eating a diet high in fresh fruits, vegetables, legumes, and whole grains
  • swapping red or processed meat for lean protein and oily fish, which contains omega-3
  • reducing sugar consumption
  • avoiding foods high in saturated fat and salt

Maintaining a moderate weight

Changes to the diet can help a person reach or maintain a moderate weight. People with PsA can also try low impact exercises, such as:

  • walking
  • cycling
  • swimming
  • yoga
  • tai chi

However, before starting any exercise, a person should speak with their doctor.

Addressing mental health

Living with a chronic condition, particularly chronic pain, is difficult. However, stress, anxiety, and depression also have an effect on physical health, so it is important to seek support for any mental health symptoms.

Treating mental health conditions can sometimes make it easier for people to avoid behaviors — such as smoking, drinking alcohol, and overeating — that increase the risk of heart disease. If a person is finding it difficult to stop these habits, they may benefit from support from a doctor or therapist.

For further help and advice, some people may find it beneficial to join a PsA support group.

A person should speak with a doctor when they are experiencing any form of chest pain, regardless of whether they have a PsA diagnosis already. They should also speak with a doctor if they have PsA symptoms, such as painful joints or scaly patches of skin.

It is important to call 911 or the number of the nearest emergency department straight away if the following symptoms occur:

  • severe chest pain
  • a feeling of tightness, squeezing, or pressure in the chest
  • difficulty breathing
  • pain in the arms, jaw, neck, upper back, or stomach
  • lightheadedness
  • nausea or vomiting
  • excessive sweating

PsA is an inflammatory form of arthritis. A person may experience chest pain if the cartilage connecting the ribs to the breastbone becomes inflamed. However, in some cases, it may be a symptom of another condition.

People with PsA have an increased risk of cardiovascular disease and the conditions associated with it, including high blood pressure, high cholesterol, and atherosclerosis. For this reason, it is important to speak with a doctor if chest pain develops. Controlling PsA through medications may reduce the risk of complications.