Treatment for Costochondritis in Adults

Pharmacological Management

The American College of Rheumatology recommends starting NSAIDs at maximum tolerated and approved dosage for adults with active costochondritis 1
Acetaminophen (paracetamol) can be used for pain relief, with regular dosing as needed, as suggested by the British Medical Journal 2, 3
Topical NSAIDs should be considered before oral NSAIDs, particularly for mild to moderate pain, according to the British Medical Journal 3
If NSAIDs are insufficient after 2-4 weeks, consider NSAID rotation or advancing to second-line treatment, as recommended by the Annals of the Rheumatic Diseases 1
Oral NSAIDs or COX-2 inhibitors should be used at the lowest effective dose for the shortest possible period of time, as advised by the British Medical Journal and the Annals of the Rheumatic Diseases 3, 4
When prescribing oral NSAIDs/COX-2 inhibitors, add a proton pump inhibitor for gastroprotection, as recommended by the British Medical Journal and the Annals of the Rheumatic Diseases 3, 4
Short courses of oral prednisolone or intra-articular glucocorticoid injections may be considered as bridging options in cases of severe pain, according to the Annals of the Rheumatic Diseases 1
Avoid long-term use of systemic glucocorticoids, as recommended by the Annals of the Rheumatic Diseases and Arthritis Care & Research 1, 5
In cases of isolated active inflammation, locally administered parenteral glucocorticoids may be considered, as suggested by Arthritis Care & Research 5

Physical therapy is strongly recommended for costochondritis treatment, according to Arthritis Care & Research 5
Local heat or cold applications can provide temporary pain relief, as suggested by the British Medical Journal 2, 3
These can be used as adjuncts to pharmacological treatment, according to the British Medical Journal and Praxis Medical Insights 3, 6
Pacing activities (avoiding "peaks" and "troughs") is recommended, as advised by the British Medical Journal 2

Start NSAIDs at maximum tolerated dose, as recommended by the Annals of the Rheumatic Diseases 1
Apply local heat or cold for symptomatic relief, as suggested by the British Medical Journal and the BMJ 2, 3
If sufficient response, continue current treatment and re-evaluate at 12 weeks, as recommended by the Annals of the Rheumatic Diseases 1
If insufficient response, consider NSAID rotation or add second-line treatment, as advised by the Annals of the Rheumatic Diseases 1
Consider local glucocorticoid injection for severe cases, according to the Annals of the Rheumatic Diseases and Arthritis Care & Research 1, 5