Version May 2024
| Disorder | Clinical characteristics |
| Fibromyalgia | Widespread pain with tenderness to palpation of the soft tissue in multiple anatomic regions, including the chest wall; fatigue, sleep disturbance, cognitive dysfunction; may have symptoms of depression and anxiety. |
| Rheumatoid arthritis | Up to one-fifth with sternoclavicular joint involvement; typically without costochondral involvement; usually symmetric, inflammatory polyarthritis, affecting hands, wrists, feet, and other peripheral joints; extraarticular manifestations may occur. |
| Ankylosing spondylitis | Thoracic spine and chest wall pain from costovertebral, costotransverse, and thoracic apophyseal joint inflammation is common; usually low back pain and stiffness, buttock pain, and sacroiliitis; some have peripheral arthritis, enthesitis, dactylitis, and uveitis. |
| Psoriatic arthritis | Uncommon to rare anterior chest wall symptoms despite imaging evidence of manubriosternal and sternoclavicular joint disease in 10 to 25%; spondyloarthritis and inflammatory polyarthritis, nail diseases, enthesitis, and dactylitis may occur. |
| Sternocostoclavicular hyperostosis (SAPHO syndrome) | Arthritis of the anterior chest wall in the majority of patients, with sterile osteomyelitis; hyperostosis; palmoplantar pustulosis, acne, peripheral, and/or axial arthritis. |
| Systemic lupus erythematosus | Tenderness in muscles and joints of the chest wall that can mimic pleuritic pain; patients have multisystem autoimmune disease with arthritis, cutaneous manifestations, pleurisy, pericarditis, neurologic changes, and/or cytopenias; antinuclear antibodies. |
| Infectious arthritis | Most often affects the sternoclavicular joint, when present, but joints of chest wall and ribs are infrequent sites of bacterial arthritis. |
| Relapsing polychondritis | Up to 25% have inflammation of costochondral and manubriosternal regions, rarely with destructive changes; cartilage inflammation involves ears, nasal cartilage, respiratory tract; synovitis, ocular inflammation, inner ear dysfunction may occur. |
| Other systemic conditions | |
| Osteoporosis, osteomalacia | Low bone mass increases the risk of fracture, including fracture of the ribs; risk factors for osteoporosis include advanced age, glucocorticoids, chronic kidney injury, and others; osteomalacia may be associated with bone pain, muscle weakness, elevated alkaline phosphatase, and parathyroid hormone with decreased calcium and vitamin D. |
| Tumors (benign, malignant, metastatic and primary) | Primary neoplasms (eg, sarcoma or multiple myeloma) or secondary neoplasms (eg, lung or breast cancer) may very infrequently involve the ribs or soft tissues of the chest wall. |
| Sickle cell disease | Rib infarct, with resultant local pain, is a rare cause of acute chest pain syndrome in patients with sickle cell crisis. |
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