Living with Psoriatic Arthritis (PsA)

Rib pain!


Dear All
Am I alone with this??

I have terrible pain on my left side rib cage and chest cavity, had ultrasound which shows nothing!!

It is so painful I can not sit upright or lay on that side… it feels as if I have been in a boxing ring and lost the fight!!

Feel like I am going mad as the pain is real to me but the drs are stumped!!

Am I alone??


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Hi Niks and welcome!!

You’re not alone with this confusing disease, we get it 'cos we’ve got it. So share all and any concerns, there will very likely be at least some of us here who have experienced similar things and can commiserate / explain.

You may have hit us with an easy one for starters. My money is on costochondritis i.e. inflammation affecting the rib area. It is quite common with PsA. Did you know that PsA causes enthesitis? That is inflammation of the points at which tendons attach to bone and I think that is what causes costochondritis. If you search for ‘costonchondritis’ or ‘rib pain’ (click on the magnifying glass symbol, top right of page) you’ll find many discussions about exactly this.

Your doctors are stumped though. Well, maybe they’ve considered costonchondritis and decided it isn’t that. Or maybe, just maybe, they have tunnel vision about PsA and don’t associate it with anything other than swollen joints plus ‘a bit’ of fatigue. Unfortunately that can be the case.

We’re in the same country and, as it happens, the same county. I’m in a permanently bad mood about rheumatology in the UK at the moment but there are some great rheumatologists out there, it’s a matter of finding them.

I actually don’t really know what can be done about the rib cage, I get costonchondritis on and off, but not as severely as you describe. I reckon it may well respond to gentle exercise, swimming for example, if that’s possible. Tight bras should be avoided, too. I hope others have more ideas. When you start on more aggressive medication that may help, though I think enthesitis can be a little difficult to tackle.

How are you doing otherwise?



Hi Sybil

Wow what a great informative answer thank you so I much!

I really appreciated your response. What are the chances of that, you being in the same county!!

Outside of the ribs, fingers, feet, backache and feeling like I can do more ( brain is willing) but I am dragging myself around in lead quicksand… like you describe, I am always in a bad mood, in fact I would go as far as saying I am old lady!!

It’s so frustrating talking to the medical professionals as you always get the feeling that they are looking at you like you are making it up and having a good old moan!

Are the stronger meds good?

I am going to take up your advise, re. Swimming etc, I had not considered that!! I have the pain so stop usually.

How long have you been living with this?

Kind regs



Hi Niks,

Got it in one!

To answer your questions, I think the simple answer is that the stronger meds can be very good. Before PsA I would occasionally take a Nurofen, that was it - very wary of drugs! Because PsA is a progressive and destructive disease, most of us here advocate the most aggressive treatment possible i.e. the biologics such as Enbrel and Humira. I think the biologics are the only treatment proven to slow joint damage. Not everybody gets a great result from them, but many do. And although that word ‘aggressive’ sounds scary, it would seem that it is the disease that gets the aggression, not the whole body. Many of us find that the biologics cause few if any side effects.

In the UK there are treatment protocols, basically starting with anti-inflammatories and then progressing to ‘traditional DMARDs’ - the most commonly used one is Methotrexate. Then, if you’ve tried 2 traditional DMARDs and still have 3 or more swollen joints, the next step is a biologic drug. It varies a little but that’s the outline. Oral or injected steroids are often used to give temporary relief, too.

I had a wonderful rheumy whose bearing suggested that he considered himself a vastly superior being. Turned out it was just his way, he helped me so much that I came to consider him a superior being lol! There is arrogance, there is what I can only describe as indifference encouraged by sheer lack of funds, but I’ve learned not to judge doctors by their manner but by what they actually do.

I could go on forever, damn it, I will! Exercise … well, you will probably meet our wonderful tntlamb soon. An expert on all things PsA plus other stuff such as … fishing, I think, all sorts of things! I think it’s him who first compared managing PsA to a 3-legged stool: meds, exercise, nutrition. Seeing as exercise has long been recommended for just about anything, it’s easy to overlook just how effective it can be in managing this particular disease. But it really, really helps. Regular exercise would even seem to reduce fatigue. Apart from the fact that it (probably) doesn’t slow joint damage, exercise probably does more to tackle my PsA symptoms than the biologic does. And in fact it may help prevent joint damage because strong muscles and tendons support the joints and limit what PsA can do to them. It can also help with the feeling that you have suddenly turned into your grandmother.

Okay, I had better shut up. It’d be interesting to know which hospital you attend and so on, if you want to say anything negative then best to send me a personal message so we don’t get sued! Oh, and I was diagnosed in 2012 during a massive flare. However it looks like I may have had it since I was a teenager, though at what my rheumy calls ‘background level’. As I am 62, that is a long time!

You have done well to get a diagnosis, I see that there was … hum … a bit of a delay!! It’s not a great thing to happen, but so often that diagnosis heralds much better days. The tricky phase is the one you’re in at the moment: aware now of what you’re dealing with, but waiting for more effective treatment. And, incidentally, while the wait can be soooo worth it, most of the drugs are slow acting. You know, there is a good chance that you will get to grips with PsA, there really is. Very glad you’ve joined us.



Hi Niks!
I’d say Sybil’s accurate in saying it’s probably costochondritis. It’s pretty common with PsA. My right side ribs give me some weird pain—it feels to me like the ribs are rubbing together. But it comes and goes and is usually a probl only when I try to sleep on my right side. I’ve never mentioned it to my doctor (or anyone) because it’s not steady pain, but just occasional and it usually only last a few hours. I stretch to the left to help relieve it.
I was going to mention, too, for those who haven’t tried cold (icy) packs—they have worked wonders for a lot of my pain! I guess they just freeze the pain away. It’s only temporary, but temporary is better than nothing…sometimes the pain subsides completely for quite awhile after icing it. :hugs:



Yep, I’ve had this experience too, costrochrondritis as well - though the first time I got it, it pre-diagnosis and emerged as central pressure on my sternum and pain in the Centre of my chest! Boy did I hot-foot it to the GP, and luckily she was switched on!

At the time, yoga was still good for me, and it was excellent for this - particularly any chest-opening poses. Others here have said they get good relief from putting a warm pack on their chest, and a cold pack on their back.

If you like massages, it can also be a good excuse to get one - your ribs are attached at the back too, so if that’s not hurting, releasing tight muscles there can take the pressure off as well.



I seem to recall a previous thread about pain in the bra strap area - on the side of the ribs and around the back. I confess, as a gay man, I know less about bras than most people (although sometimes I look at myself in the mirror and think I should start wearing one!) but I know that I get an achy/bruised feeling on the side of my rib cage quite often. Not “terrible” but enough to get my hypochondriac brain dwelling on it. It might be worth trying to find that thread for more info.



Hi Niks,

Welcome and I’m in Kent too. And suffered the dreaded rib pain which wasn’t a heart attack. It’s so frightening the first time.

Glad you’ve joined us.

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Dear Sybil, Grandma_J, Jen75, darinfan and Poo_therapy

Sorry for a delay in my reply I am having one of my complete energy battery out and confusion chip in!! Sometimes I am concerned about my mental state with this disease!!

My energy chip leaves only for my confusion chip to move in!!

I can not thank you all for all your supportive replies!! Darinfan you really make me chuckle - thank you for making me smile!!

Sybil, your moment of wanting to go on forever, normalised how I feel about myself…infact I get sick of hearing my own rants, groans and moans, and nutty mad overtones!!

Grandma_J… icy packs on the rocks as we speak!!

Jen75, I read your reply and I felt that my concern over this was valid if only I can get someone to listen!!

I was sent for a Ultrasound and boy, OMG how bad was that! The pressure on the left hand side left me in tears…the chappie doing the scan did not understand and said it must be a bowel thing as there is no important organs on that side of my body!! I felt like I was lying and found myself justifying my pain to him, catching myself saying…‘I am not imagining this…this is real pain’…:persevere:

I saw the doctor yesterday morning as an emergency and she checked the scan…did not address what I was saying but was more interested that apparently I have a fatty liver…and that I need to take painkillers then book in to discuss this!! I am sorry…I am sure you all have your experiences and I am aware I am having a rant!!

Darinfan, I had not considered my bra…but I am going to be more mindful re. this :grinning:

I want to say to you all, how appreciate both for your time and your eye reading time, its odd, but through your welcome and support I feel less alone in this pit that is PsA.

I am eternally grateful to all of you…:relaxed:

PS If there are words missing or mistakes, I am a severe Dsypraxic for my sins…so I will not see these until I post this…bear me…



I too have experienced these kinds of pains. For me I have a very informed orthopedist who has also helped a lot. March 14th I have to go for shoulder manipulation and cortisone shots. When I visit he can tell right away if I’m having flare without saying anything to him. He’s the one who told me the Plaquenil that I’m taking now can affect the tendons which is what the manipulation is for. My rhuemy is in the process of getting me approved thru insurance to take Otezla. The Plaquenil is doing barely anything. I have had pain on and off in my ribs and chest. Depends on the day which side I can sleep on. Hope you get relief soon.



Sorry to hear about the rib and sternum pain. I have the same problem. I have had to have my doctors tell me it is just the PsA, because when it is in y sternum I get anxious about my hurt, which makes the pain worse.

I haven’t found a good solution tot he pain in the ribs. I some oxy 5mgs I take when thing s get real bad, but they don’t seem to do much for this. I found that there is a lot of pain that pain pmeds don’t do much for with PsA. I can’t take NSAIDs anymore because they make my heart act up. I would recommend them if you can tolerate them



No, I had a round of that for about four months. Right now no issue in the rib chest area relating to chronic pain. Mine passed but from what I understand it has something to do with muscles and connective tissue being inflamed. Psa i can tell you personally lower back pain always along with neck, shoulder blades sporadically. Also, knees, hips, elbows some, finger joints and wrists. The one pain are a that has not left is lower back. There appears to be no pattern other than pain from inflammation or perhaps fibro. I think Ps a myself.



Hi woodworm

I thank you for your time in replying.

I too get pains in my finger joints, lower back, neck (which is spine fused cervical and also lumber fusion too). But I get pain in and between my shoulder blades…at time like electric shock.

My feet are constantly an issue…even this weekend I have been having to elevate, and ice them as my ankles swell!!

I am very early on in my journey with the diagnosis and hope the meds will help!!



Hi Tamac

Firstly, thanks for your time in replying.

Sounds like you have been through trailing lots of painkillers and I agree, I am finding my doc issues various pills (at the mo I take 16 pills a day. But not a lot helps.

I have taken in board all the support and I am so eternally appreciative.

I feel sad that we all have to suffer this way and that there is no real known cause for why this happens??

Do you have any idea what was the root cause of your PsA?

No one has really explained to me why this happens??




Apologies for typos!!



We’ve simply been born with faulty immune systems - that’s the real root cause. Then something comes long which stirs it up for me at any rate. My psoriasis was ingnited by a strep throat and PsA was ignited by a bunion correction operation. Both times it came on suddenly. What’s happening is that your immune system is thinking your joints, tendons and whatever else are being attacked by something so it goes to war and inflammes various bits of you. All the meds such as DMARDS and biologics are targeting parts of your immume system to get it to behave normally again. Hope this explains it somewhat for you.



Ditto, well said Niks.



Thanks Woodworm. It’s far too simplistic a description but hopefully engages the mind into at least understanding it’s not any of our faults. It’s not what we eat, have done or haven’t done in the past or anything of that nature. It just is what it is. A faulty immune system, no less nor no more, which for me anyhow I believe, is wholly genetically induced. It’s also the reason to truly fear the disease far, far, far more than the meds. The meds can be changed, the disease and its ability to be so rampant can’t be changed (almost always) without the help and re-education of the meds. Sucks doesn’t it?



I can surely relate, Niks. And, unfortunately, the joint pain–feet, back, elbows, fingers, whatever…once you’re on a biologic and it’s working, that doesn’t guarantee you’ll feel perfect.
Sometimes I can barely walk because the pain is so bad. That’s when I apply Voltaren gel (I think it’s diclofenac?) and take a couple Ibuprofen, and of course, use the ice packs. I’ve never taken opiods or prescription pain meds, I don’t like pills and I only take what prescriptions I absolutely have to, which at this time is way too many because of my heart and the biologic I already take and a pill for indigestion…oh, and now we added sertraline for my anxiety, but I’m hesitating to start it.
I don’t want to disappoint those of you who haven’t started a biologic yet but are looking forward to doing so, but it is a reality that while the disease progresses and we aren’t treating it, we are becoming damaged goods. I still sing my praises about Enbrel because it did make a world of difference–more at first than it does now, but I like to think it’s still working because I don’t have the stiffness (which caused tons of pain in my whole body) or fatigue that I had before.
So, don’t get discouraged. I look around at other people and wonder how many of them have aches and pains, and I think most people my age (64) do have some. I feel bad for those of you who are very young and have to deal with this stuff!!!

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Dear All

You know I agree with this think it TOTALLY SUCKS!!

I have spend this weekend in bed, feet/ankles on ice packs (well bags of frozen veg actually :slight_smile:️) watching my ankles like swimming arm band aids!!

Feeling utterly USELESS, while poor d hubby runs around with my twin girls like a headless chicken… even more annoyed that I missing church, but the idea of walking was like offering me to walk across hot coals, it just wasn’t happening!!

My rheumy did say about the meds but was very clear to point out that this is progressive, and unfortunately the meds are to help control symptoms, they are not the answer.

I feel that if I could drop some of the meds for this and for that(as I feel my dr is firefighting my situation) and have something more targetted that may be useful. I am under no illusions that they will come with side-effects and difficulties of there own, but while I am wading through what they bring at least I will know in my heart of hearts I am putting up an internal fight!!

There is no answer, I feel somehow I have been blessed to suffer somehow…I know may not make sense but I must have done something REAL bad in my previous life so I am paying for it now.

But it is what it is I suppose, in the cold light of day, live and get on with it, but it is the acceptance of watching my body disfunction and feel the sheer pointless and vulnerability of my situation.

The thing I find so hard to consider is having to rely on others, I have been so fiercely independent it blows my mind when I am not!!

If the medication can ease some of the symptoms, even though this maybe a temporary bandaid, I will be saving a bit of my sanity!!!

What are types of side effects you have experienced?

My concern around genetics is my twins😞. That really fills me with dread…