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Posterior spondylitis of costovertebral joints in a patient with psoriatic arthritis.

A 41-year-old white man presented with neck and upper back pain of 1-year duration. The pain was excruciating, continuous, and radiating from the upper back to the occipital region. He was diagnosed with psoriasis at 20 years old. He was treated with methotrexate for 1 year and etanercept for 6 months but discontinued these medications because of inefficacy. He developed joint pain, and psoriatic arthritis was diagnosed 5 years ago. On physical examination, there were multiple tender and swollen joints and generalized psoriatic lesions including nail dystrophy. His neck examination showed markedly limited range of motion in all directions. A magnetic resonance imaging (MRI) showed heterogeneous signals at several levels throughout the posterior vertebral endplates of the thoracic spine. These regions of abnormal signal were noted to be of low signal intensity on T1-weighted imaging (Fig. 1A) and increased signal intensity on T2 and Short TI inversion recovery (Fig. 1B). These findings indicated bone marrow edema in costovertebral joints. On a computed tomographyscan, these signals corresponded to regions