context: Tietze syndrome is a rare musculoskeletal disease that can be painful but is almost never serious. It happens when the cartilage around the joints connecting your upper ribs to your breastbone swells up. Usually the second or third ribs are most affected. No one knows exactly what causes Tietze syndrome. Some experts believe that it is caused by many tiny traumas to the chest wall. You might also get the condition if you've had a lot of respiratory infections, bad coughing fits, or strain from exercise or other physical activity. Sometimes Tietze syndrome happens as a result of having other things, such as psoriatic arthritis. You're most likely to get Tietze syndrome if you're an older child or young adult under the age of 40. Tietze syndrome is different from Tietz syndrome, a condition marked by loss of hearing, fair skin, and light hair. Tietz syndrome is congenital, or present from birth, and is also rare. The most common symptoms of Tietze syndrome are chest pain and swelling. These can appear suddenly and disappear just as suddenly, or they may develop gradually then come and go for years. It's also possible for the pain to disappear even while the swelling continues. The pain of Tietze syndrome sometimes extends to the neck, arms, and shoulders. The pain can be mild or severe, dull or sharp. Some say it feels like being stabbed with a knife. Coughing, sneezing, exercise or other physical activity, breathing deeply, laughing, wearing a seatbelt, hugging someone, or even just lying down might make the pain worse. You might mistake the pain from Tietze syndrome for a heart attack but there are differences: Tietze syndrome usually only affects a small area of the chest while a heart attack covers the whole chest. If you're having a heart attack, you may also be short of breath, nauseous, and sweating. Tietze syndrome can be hard to diagnose because the symptoms are like those of other problems besides a heart attack. They can seem like angina, which is chest pain when your heart muscles don't get enough oxygen. They are also very similar to certain lung problems, rheumatoid arthritis, and costochondritis, also called chest wall pain. Because there is no special test for Tietze syndrome, doctors usually want to know about your symptoms. Your doctor will probably do a physical exam which could involve pressing on your chest. He may also order tests to rule out other things. These tests might include X-rays, an ultrasound, magnetic resonance imaging ( MRI), a biopsy, or an electrocardiogram to see the electrical activity in your heart. The symptoms of Tietze syndrome usually aren't serious and often will go away with no treatment. Sometimes just hearing from your doctor that it's Tietze syndrome and not a heart attack can reassure you enough to deal with the pain until it goes away on its own. Other treatments can help ease the pain and swelling. These include nonsteroidal anti-inflammatory drugs ( NSAIDs) like ibuprofen, naproxen, and aspirin. Talk to your pharmacist or doctor before taking any medicine, even over-the-counter medicine. This is because it may interact with medication you're already taking, or make other health conditions worse. If your pain is really bad, your doctor might recommend corticosteroid injections right into your joint area to reduce pain and swelling. You can only do this a couple of times without risking damage to your joint. Other things that may help are lots of rest, no heavy physical activity for a while, and applying heat or ice to the painful area. You can find out more about Tietze syndrome and about joint diseases and childhood disorders from these organizations: The Genetic and Rare Diseases ( GARD) Information Center, part of the National Institutes of Health The National Institute of Arthritis and Musculoskeletal and Skin Diseases The National Organization for Rare Disorders The Arthritis Foundation The American Academy of Pediatrics