TLDR: Yes. Rheumatoid arthritis can cause chest pain through inflamed rib cartilage (costochondritis), inflamed lung lining (pleurisy), or an inflamed heart sac (pericarditis), though everyday chest wall strain remains the most common cause overall. RA also raises heart disease risk by roughly 50%, so pressure, spreading pain, or breathlessness calls for 911 first.

What is rheumatoid arthritis chest pain?

Rheumatoid arthritis chest pain refers to any chest pain that traces back to RA, whether it comes from inflamed rib joints, an inflamed lining around the lungs or heart, or the heart disease that RA makes more likely. It names a group of problems, not a single diagnosis.

Most people know RA as the disease that swells knuckles and stiffens wrists. That picture leaves a lot out. RA is an autoimmune condition: the immune system attacks the synovium, the thin lining inside joints, and the inflammation it stirs up travels through the whole body. Roughly 1.3 to 1.5 million adults in the US live with it, and women outnumber men about two or three to one.

So when someone with RA feels a stab under the breastbone, the honest answer to "is this my arthritis?" is maybe. It could be RA. It could be a strained muscle from hauling groceries with sore hands. It could be the heart, and that possibility has to come off the table first.

The sections below walk through each cause in plain terms. For a broader primer on the disease itself, our Rheumatoid Arthritis Wiki covers the basics.

Can rheumatoid arthritis cause chest pain?

Yes. RA can inflame the joints where your ribs meet your breastbone, the lining around your lungs, and the sac around your heart, and it speeds up artery disease. Everyday chest wall strain still causes more chest pain overall, but a doctor should rule out heart and lung causes before you assume that.

That answer can feel unsatisfying, because it doesn't settle anything on its own. The useful part comes next: each cause leaves a fingerprint. Pain that jumps when you press one spot beside your breastbone points one way. Pain that catches on every deep breath points another. A heavy, squeezing pressure that creeps into your jaw or left arm points somewhere you should never wait out at home.

RA-specific chest problems turn up more often in people with seropositive disease (a positive rheumatoid factor or anti-CCP antibody test), in smokers, and in people with long-standing or poorly controlled RA. Men, oddly enough, face higher odds of lung-lining involvement even though RA itself favors women.

Why does RA affect more than your joints?

RA reaches beyond the joints because the inflammation behind it circulates in your bloodstream, not just in your knuckles. Doctors call the non-joint effects "extra-articular" disease, and the chest happens to hold several tissues RA likes to target.

Your lungs sit inside a lining called the pleura, and your heart sits inside a sac called the pericardium. Both behave a lot like joint lining: thin, slick membranes that make a little lubricating fluid so surfaces can glide. When the immune system turns on joint lining, these membranes can get caught in the same crossfire.

Blood vessels take a hit too. The chemical messengers that drive RA, such as TNF and IL-6, irritate artery walls and help cholesterol plaque form and break open, which explains much of the extra heart risk.

A note on the odds: Costochondritis, pleurisy, lung nodules, and inflammation of the heart sac all have real links to RA, but each one shows up far less often than ordinary muscle strain. Knowing the full list helps you ask better questions at your next appointment. Heart disease gets an exception to the "don't panic" rule: in RA it happens often enough to deserve its own section and regular checkups.

Why does my breastbone hurt when I press on it?

A breastbone that hurts when you press on it usually points to costochondritis, an inflammation of the cartilage that joins the upper ribs to the sternum. Tenderness you can reproduce with a fingertip is its signature.

The pain typically sits along one edge of the breastbone, most often at the second through fifth ribs, and usually involves more than one rib. People describe it as sharp, aching, or pressure-like. Deep breaths, twisting, reaching across the body, and coughing all tend to set it off. Some feel it spread into the back or upper belly, and that spread explains why it scares people: costochondritis can mimic a heart attack closely enough to send someone to the ER.

RA matters here for an anatomical reason. The joints between the breastbone and ribs two through seven are true synovial joints, the same type RA attacks in the hands. RA can also inflame the sternoclavicular joints, where the collarbones meet the breastbone, and the manubriosternal joint near the top of the sternum.

A close cousin, Tietze syndrome, causes similar pain but adds visible swelling, usually over a single joint at the second or third rib.

One caution worth repeating: a tender spot on the chest wall does not clear your heart by itself. Emergency doctors still run an ECG when the story fits, because chest wall soreness and a heart problem can show up together.

Most costochondritis settles within a few weeks. Some cases hang on for months.

Is sharp pain when you breathe a sign of RA pleurisy?

Sharp, stabbing chest pain that spikes when you breathe in, cough, or sneeze is the classic sign of pleurisy, an inflammation of the two-layer membrane (the pleura) that wraps each lung. In RA, it often comes with fluid collecting between those layers, called a pleural effusion.

Healthy pleural layers slide past each other on a thin film of fluid. Inflamed, they rub. That friction explains the pattern: pain on one side, tied tightly to breathing, easing a little when you hold your breath or lie on the sore side. Some people feel it in the shoulder. As fluid builds up, the stabbing can actually fade while shortness of breath takes over, because the fluid separates the rubbing surfaces but crowds the lung.

Autopsy studies find pleural involvement in a large share of people with RA, yet only a small minority, often quoted near 5%, ever notice symptoms. It shows up more in men, in people over 50, and in people with rheumatoid nodules or a high rheumatoid factor. Occasionally the effusion appears before any joint symptoms do.

Pleurisy has plenty of non-RA causes as well, including viral infections, pneumonia, and blood clots in the lung. RA drugs that calm the immune system also make infections easier to catch, so fever plus painful breathing calls for a same-day conversation with your doctor.

Can rheumatoid nodules in the lungs cause chest pain?

Rheumatoid nodules in the lungs rarely cause chest pain on their own; most sit quietly and turn up by accident on a chest X-ray or CT scan. Pain usually means a nodule near the lung surface has irritated nearby tissue or, in rare cases, broken open.

Nodules are firm lumps of inflammatory tissue. Roughly 20% to 30% of people with RA develop them somewhere, most often under the skin at pressure points like the elbows, fingers, or heels. Lung nodules occur less often and favor men, smokers, and people with a high rheumatoid factor. Methotrexate occasionally triggers a burst of small new nodules, a pattern doctors call accelerated nodulosis, though that mostly affects the hands.

The rare emergency: a nodule just under the lung surface can hollow out and rupture, letting air leak into the chest cavity. This collapsed lung (pneumothorax) causes sudden, sharp, one-sided chest pain with sudden breathlessness, and it needs an ER, not a wait-and-see.

Another RA lung problem rarely hurts but still deserves a mention. RA-associated interstitial lung disease, a slow scarring of lung tissue, causes clinical problems in around 1 in 10 people with RA. It usually announces itself through a dry cough and breathlessness that creep up over months. If you notice either, bring it up at your next rheumatology visit instead of waiting for pain.

How does rheumatoid arthritis affect the heart?

Rheumatoid arthritis affects the heart in two main ways: it can inflame the sac around the heart (pericarditis), and it speeds up the artery disease behind heart attacks. Large analyses put the rise in cardiovascular risk at roughly 50% compared with people who don't have RA, and heart disease remains the leading cause of death among people with RA.

Pericarditis: inflammation of the heart sac

The pericardium wraps the heart much as the pleura wraps the lungs. Inflamed, it produces sharp pain in the center or left side of the chest that often worsens when you lie flat or breathe deeply and eases when you sit up and lean forward. The pain may reach the neck or the ridge of the shoulder. Heart ultrasound studies have found extra fluid around the heart in close to a third of people with RA, yet only a small minority ever feel it. Symptoms tend to appear in people with active, seropositive disease and nodules.

Coronary artery disease: the bigger long-term risk

Chronic inflammation damages artery walls, helps plaque build faster, and makes that plaque more likely to rupture. RA also clusters with other risk factors. Painful joints cut physical activity, long-term steroids raise blood pressure and blood sugar, and many people with RA smoke or used to. The result: more angina and more heart attacks than age and cholesterol alone would predict.

Here's a finding many people never hear. Population studies have found that people with RA more often have heart attacks without classic chest pain, sometimes called silent heart attacks. Unusual fatigue, getting winded on stairs you used to climb easily, nausea, or a cold sweat may be the only clues, and women more often get these subtler signs.

Heart failure, irregular rhythms, and inflammation of the heart muscle itself also occur more often with RA, though less commonly. Palpitations, new ankle swelling, or breathlessness when lying down warrant a prompt appointment.

Could my chest pain just be a pulled muscle?

Yes, and statistically it often is. Studies of primary care clinics consistently rank chest wall pain, from strained muscles, irritated cartilage, and similar problems, as the most common diagnosis among people who come in with chest pain, well ahead of heart disease.

People with RA strain chest muscles in predictable ways. Sore hands and wrists push you to lift with your arms and chest instead of your grip, so you hug the laundry basket rather than carry it by the handles. You shove a stuck door with your shoulder. A bad cold brings two days of hard coughing. Any of these can tweak the small muscles between the ribs or the large pectoral muscles across the front of the chest.

Muscle strain usually hurts in a spot you can point to with one finger. It gets worse with specific movements like twisting or reaching overhead, feels tender when pressed, and rarely comes with sweating, nausea, or breathlessness. Relative rest, heat or cold, and time usually settle it within a few days to a couple of weeks.

Long-standing RA and years of steroid use both thin the bones, and that changes the math. In thinned bone, a coughing fit or a minor bump can crack a rib. Rib fractures cause sharp, very localized pain that catches with every breath or cough. If a "strain" feels unusually sharp after very little effort, ask your doctor about an X-ray.

Can RA medications cause chest pain?

Some RA medications can cause chest pain, usually indirectly, by irritating the esophagus, raising heart or clot risk, or rarely inflaming the lungs. None of these effects is common, but each one belongs on your radar before you blame your joints.

• NSAIDs (ibuprofen, naproxen, diclofenac and others) can cause heartburn and, if a pill lodges in the esophagus, a burning pain behind the breastbone. In 2015 the FDA strengthened its warning that non-aspirin NSAIDs raise heart attack and stroke risk, a risk that can start within the first weeks of use and climbs with higher doses.
• Bisphosphonates such as alendronate, which many people on long-term steroids take to protect their bones, can badly irritate the esophagus. The label instructions to take it with a full glass of water and stay upright for at least 30 minutes exist for exactly this reason.
• Corticosteroids like prednisone raise blood pressure, blood sugar, and cholesterol with long-term use, adding to heart risk, and they thin bones (see rib fractures above).
• Methotrexate can, uncommonly, cause methotrexate pneumonitis, a lung inflammation that usually brings dry cough, fever, and breathlessness, sometimes with chest discomfort. It most often appears within the first year of use.
• JAK inhibitors (tofacitinib, baricitinib, upadacitinib) have carried an FDA boxed warning since 2021 for a higher risk of serious heart events and blood clots, including clots in the lungs. A lung clot causes sudden sharp chest pain with breathlessness and needs emergency care.
• Biologics and other immune-suppressing drugs raise infection risk, and pneumonia can cause sharp chest pain with fever and a wet cough.

Don't stop any of these on your own. Call the prescriber, describe the pain, and let them sort out whether the drug plays a role. Our guide to over-the-counter medicine for arthritis covers the NSAID trade-offs in more depth.

RA chest pain vs. heart attack: how can you tell the difference?

You often can't tell the difference at home with confidence, which is why pressure-type pain, pain that spreads, or pain with breathlessness or sweating calls for 911. The table below lays out the patterns doctors look for. Use it to describe your symptoms clearly, never to rule out your heart.

Look at how much the "telltale sign" column overlaps. Pleurisy and pericarditis both worsen with breathing. Costochondritis can radiate like cardiac pain. Even experienced emergency physicians lean on an ECG and blood tests rather than the story alone.

When to see a doctor for chest pain with rheumatoid arthritis

See a doctor about any new chest pain if you have RA, and call 911 right away if the pain feels like pressure or squeezing, spreads, or comes with breathlessness, sweating, nausea, or lightheadedness. RA raises heart risk enough that "it's probably my arthritis" should never be your first assumption.

Call 911 (don't drive yourself) if you have:

• Chest pressure, squeezing, fullness, or heaviness that lasts more than a few minutes, or fades and returns
• Pain spreading to one or both arms, the jaw, neck, back, or upper belly
• Chest pain with shortness of breath, a cold sweat, nausea, or lightheadedness
• Sudden sharp chest pain with sudden breathlessness, especially after a long trip, recent surgery, or with one swollen, painful calf
• Coughing up blood
• Fainting or nearly fainting

Call your doctor the same day or within a day or two if you have:

• Sharp pain with breathing, especially alongside a fever or chills
• Chest pain that worsens lying flat and eases when you lean forward
• A dry cough or breathlessness that has crept up over weeks
• New ankle swelling, palpitations, or a racing heart at rest
• Chest pain that started after a new or changed RA medication
• Chest wall pain that hasn't improved after one to two weeks, or that wakes you at night

Tell whoever sees you, ER staff included, that you have RA and list every medication you take. A clinician who doesn't see much RA may not think of pleurisy or pericarditis right away.

What tests do doctors use to find the cause of chest pain in RA?

Doctors start by ruling out the dangerous causes: an electrocardiogram (ECG) and a blood test for troponin, a heart-muscle protein, can flag a heart attack within minutes to hours. From there, the workup follows whatever the history and exam suggest.

• Physical exam: pressing on the chest wall, and listening for a "rub," the scratchy sound inflamed pleura or pericardium can make.
• Chest X-ray: shows fluid around the lungs, pneumonia, a collapsed lung, rib fractures, and larger nodules.
• Echocardiogram: an ultrasound of the heart that shows fluid in the pericardium and how well the heart pumps.
• CT scan: picks up smaller nodules and early lung scarring; a CT with contrast dye (CT pulmonary angiogram) checks for clots in the lungs.
• Blood work: CRP and ESR measure overall inflammation, a complete blood count helps spot infection, and a D-dimer test helps screen for clots.
• Pleural fluid sampling (thoracentesis): a needle draws off fluid for lab testing. RA-related fluid typically shows very low glucose, which helps separate it from infection and other causes.
• Stress testing or coronary CT angiography: for chest pain that comes on with exertion, to look for narrowed arteries.

Expect your rheumatologist to share the work with a cardiologist or lung specialist. That's routine, not a sign that something has gone badly wrong.

How doctors manage RA-related chest pain

Doctors manage RA-related chest pain by calming the specific inflammation behind it and by bringing the underlying RA under tighter control, since active disease drives pleurisy, pericarditis, and heart risk alike. The details depend on the cause.

• Medication: NSAIDs often relieve costochondritis, pleurisy, and pericarditis. For pericarditis in general, cardiologists commonly add colchicine, and RA-related cases sometimes need a short course of corticosteroids. Over the longer term, disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, along with biologics, go after the root inflammation. Observational studies link well-controlled RA to fewer heart events, one more reason to stick with your DMARD plan. If you receive a biologic by IV, our piece on rheumatoid arthritis infusion therapy explains what to expect. When testing finds heart disease, doctors add heart medicines such as statins or blood pressure drugs.
• Physical therapy: Physiotherapists often recommend gentle chest stretches, posture work, and breathing exercises for costochondritis, plus deep-breathing practice after pleurisy to help the lungs fully re-expand. Our article on physical therapy for rheumatoid arthritis covers the broader program.
• Procedures: A large pleural effusion may need draining with a needle. Fluid pressing on the heart may need pericardiocentesis, a similar procedure for the heart sac. Surgery, such as removing a troublesome nodule or stripping away thickened pleura, stays rare.
• Regular monitoring: European rheumatology guidelines (EULAR) recommend a cardiovascular risk assessment for people with RA at least once every five years and again after major changes in RA medication. They also suggest bumping standard risk scores up by a factor of 1.5 for RA. In practice, that means routine checks of blood pressure, cholesterol, and blood sugar, plus an echocardiogram or stress test when symptoms call for one.
• Lifestyle changes: Quitting smoking pays off twice, since smoking worsens RA and damages arteries. General health guidelines call for about 150 minutes of moderate activity a week, and low-impact options like walking, swimming, and cycling usually suit RA joints best. A Mediterranean-style diet, heavy on vegetables, fish, olive oil, and whole grains, supports heart health and may modestly ease RA symptoms.

What can you do at home to ease chest wall pain today?

Once a doctor has ruled out heart and lung causes, chest wall pain from costochondritis or muscle strain usually responds to relative rest, heat or cold, gentle stretching, and smarter lifting. None of it costs a thing.

• Pick heat or cold by timing. For a fresh strain, a wrapped cold pack for 10 to 15 minutes, a few times a day over the first 48 hours, eases pain and swelling. For lingering ache and stiffness, low heat for 15 to 20 minutes relaxes tight muscles. Keep a cloth between the pack and your skin, and never fall asleep on a heating pad; steroid-thinned skin burns more easily than you'd expect.
• Rest the movement, not your whole body. Skip whatever reproduces the pain, like heavy lifting, pushing, or overhead reaching, for a few days. Keep walking. Bed rest stiffens RA joints and does nothing for a chest wall strain.
• Stretch gently. Many people with costochondritis find a doorway stretch helps: forearms on the door frame at shoulder height, one foot stepped forward until you feel a mild pull across the chest, held 20 to 30 seconds, three times. A mild pull is the goal. Sharp pain means stop.
• Keep breathing deep. Pain makes people breathe shallowly, which can let small patches of lung collapse. A few slow belly breaths every hour keeps the lungs open. If coughing hurts, hug a pillow firmly against your chest while you cough.
• Carry smarter. Split loads between two bags, hold them close to your body, and use a rolling cart for anything heavy. When your hands can't grip well, a backpack beats hugging a load against your chest.
• Fix your desk. Raise your screen to eye level and pull your chair in so you don't hunch. A rounded upper back loads the front of the chest wall all day long.
• Use over-the-counter pain relief carefully. Acetaminophen or an NSAID can help in the short term, but check with your doctor first if you already take a prescription NSAID, methotrexate, steroids, or a blood thinner.
• Keep a symptom log. Note when the pain starts, what you were doing, whether breathing or pressing changes it, and what helped. That record shortens appointments and sharpens the diagnosis.

Stop what you're doing and call 911 if the pain changes character, spreads, or arrives with breathlessness, sweating, or lightheadedness. Home care only makes sense once the dangerous causes are off the table.

Everything in this article is general information, not a diagnosis. As the note at the bottom of this page says, check with a healthcare professional before trying something new, particularly if you're pregnant, nursing, or managing other medical conditions.

Do arthritis supports and hot and cold packs help with RA chest pain?

Arthritis supports and hot and cold packs do not touch the inflammation behind pleurisy, pericarditis, or heart disease, and no product cures RA. A hot and cold pack can ease chest wall strain or costochondritis once a doctor has cleared you, and compression gloves can help with the hand symptoms that usually travel with RA.

We'd rather say that plainly than have you buy something for the wrong problem. Two Dr. Arthritis products earn a place in this conversation.

Reusable hot and cold compress pack

Best use: chest wall strain or costochondritis that a doctor has already checked. The Dr. Arthritis Reusable Hot and Cold Compress Pack works like a classic refillable ice bag. Fill it with ice and water for cold therapy during the first couple of days, or with warm (never boiling) water for heat once the injury moves into the stiff, achy phase. Unlike a rigid ice pack, the bag molds around the curve of the ribs, and it comes in 6", 9", and 11" sizes. Trade-offs: a full bag gets heavy, so on a tender breastbone a half-filled bag sits more comfortably; small ice-maker cubes fit better through the opening than large ones; and it does nothing for pleurisy or pericarditis pain, which starts inside the chest.

Compression gloves for RA hands

Best use: morning stiffness, mild swelling, and an achy grip. Gloves like the Dr. Arthritis Premium Compression Gloves apply gentle, even pressure and keep the hands warm, which many people find takes the edge off stiffness, especially overnight or first thing in the morning. They have no direct effect on chest pain. Less hand pain does mean fewer awkward chest-and-arm workarounds when you lift and carry, the very habit behind many chest wall strains. Trade-offs: clinical trials of arthritis gloves show mixed results, so count them as a comfort aid, not a disease therapy. Sizing matters, since a glove that's too tight can restrict circulation and one that's too loose does little. The open-finger design keeps your fingertips free for buttons and phones but leaves them exposed to the cold.

Both come with the Dr. Arthritis Handbook and are available from the official Dr. Arthritis store or on Amazon.

More from Dr. Arthritis on rheumatoid arthritis

• The Dr. Arthritis Rheumatoid Arthritis Wiki: All Your Questions Answered
• Unlocking Relief: The Power of Rheumatoid Arthritis Infusion Therapy
• My Mom Has Rheumatoid Arthritis, Will I Get It? Understanding the Genetic Links and Risks
• Can You Get Disability for Rheumatoid Arthritis? A Comprehensive Guide
• Physical Therapy for Rheumatoid Arthritis Relief
• Over the Counter Medicine for Arthritis: A Guide to Effective Non-Prescription Relief