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We describe a patient with ankylosing spondylitis who had severe pain in the thoracic spine area owing to a destructive arthropathy of a costovertebral joint. A computed tomographic scan revealed severe osteolysis of the head of the right eleventh rib, with hypertrophic sclerotic arthropathy of the joint as the source of the patient's pain. Costovertebral arthropathy should be considered in ankylosing spondylitis patients with severe thoracic pain.
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