title: Can early diagnosis and management of costochondritis reduce acute chest pain admissions?
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Rheumatology, Harrogate District Hospital, Harrogate, North Yorkshire, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Freeston
authors.forename: Zunaid
authors.initials: Z
authors.lastname: Karim
authors.forename: Karen
authors.initials: K
authors.lastname: Lindsay
authors.forename: Andrew
authors.initials: A
authors.lastname: Gough
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012219:Rheumatology / Q000191:economics / Q000379:methods*; D012460:Sulfasalazine / Q000627:therapeutic use; D013991:Tietze's Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D012460:Sulfasalazine