Anterior Chest Wall Non-traumatic Arthropathies: A Crucial but Often Overlooked Site

Abstract

Objective: The purpose of this study was to describe the distribution of Anterior Chest Wall (ACW) arthropathies in a tertiary care center and identify clinical, biological and imaging findings to differentiate osteoarthritis (OA) from non-osteoarthritis (N-OA) etiologies. Methods: Search from medical records from January 2009 to April 2022, including patients with manubriosternal and/or sternoclavicular and/or sternocostal joint changes confirmed by ultrasonography, computed tomography or magnetic resonance imaging. The final study group was divided into OA and N-OA subgroups. Results: A total of 108 patients (34 males and 74 females, mean age: 47.3±13 years) were included. Twenty patients had findings of OA, while 88 were diagnosed with N-OA pathologies. SpA was the most common etiology in the N-OA group (n=75). The other N-OA etiologies were less common: rheumatoid arthritis (n=4), Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome (n=3), infectious arthritis (n=3) and microcrystalline arthropathies (n=3). Regarding the distinctive features, ACW pain was the inaugural manifestation in 50% of patients in OA group and 18.2% of patients in N-OA group (p=0.003); high inflammatory biomarkers were more common in N-OA group (p=0.033). Imaging findings significantly associated with OA included subchondral bone cysts (p<0.001) and intra-articular vacuum phenomenon (p<0.001), while the presence of erosions was significantly associated with N-OA arthropathies (p=0.019). OA was independently predicted by the presence of subchondral bone cysts (p=0.026). Conclusion: ACW pain is a common but often underestimated complaint. Knowledge of the different non-traumatic pathologies and differentiation between OA and N-OA etiologies is fundamental for appropriate therapeutic management.