Extract

1The Rheumatology Department, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA 5011, 2University of Adelaide, North Terrace, Adelaide, SA 5000 and 3The Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia

Sir, A 73-yr-old man presented with several weeks of severe mid-thoracic back pain and dysphagia, which occurred only on assuming a supine position. The pain was likened to ‘being thumped by a truckload of watermelons’, and was associated with a sensation of struggling to swallow. Both symptoms were prominent in the recumbent position and settled promptly with change of posture.

His past medical history included seropositive rheumatoid arthritis diagnosed at age 50 and currently well controlled, left elbow prosthesis, inactive peptic ulcer disease, mild gastro-oesophageal reflux symptoms relieved with antacids, hypertension, hypercholesterolaemia, ischaemic heart disease and cerebral vascular disease. He was taking hydroxychloroquine and sulphasalazine, was a non-smoker and did not drink alcohol nor use non-steroidal anti-inflammatories. Examination revealed a symmetrical deforming polyarthropathy with no active synovitis, and reduced movements of the cervical spine. Examination was otherwise unremarkable.

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