多数の米粒体を伴ったリウマチ性肩峰下滑液包炎の２例

Abstract

Two cases of rheumatoid subacromial bursitis containing a large number of rice bodies are presented.Case 1: A 51-year-old man visited our clinic with a chief complaint of swelling and motor pain in his right shoulder. Since December 1995, he had a swelling of the 2nd MP joint of his left foot. But RA-F, CRP, ESR showed no abnormality. He had been treated conservatively with NSAIDs, by an orthopedic surgeon. Since early September 1996, he noticed a swelling in the anterior aspect of his right shoulder and slight motor pain.He visited our clinic on 27. 9. 1996. He had morning stiffness for 1 hour. A diffuse swelling on the antero-lateral aspect of the right shoulder was observed, showing local heat and fluctuation but no redness. Shoulder motion was not restricted. Swelling of the MP joint of the left 2nd toe was also recognized. Laboratory examination: ESR 19mm/46mm, CRP2+, RA-F 111iu/ml, Mantoux's Reaction (±). Plain radiograph showed no abnormality of his right shoulder, but bone erosion of the 2nd proximal phalanges. Subacromial bursography showed an enlargement of the bursa and a honeycomb shadow. The clinical symptoms, laboratory data, radiographs fulfilled the criteria for a diagnosis of definite RA. Surgical excision of the subacromial bursa and synovectomy of the left 2nd MP joint were performed on 16. 1. 1997. The subacromial bursa contained 111 rice bodies. Pathologic diagnosis was chronic rheumatoid arthritis. The postoperative course was uneventful.Case 2: A 71-year-old woman, who was treated with NSAIDs, gold and steroids for RA by an orthopedic surgeon since 1964, visited our clinic on 1. 9. 1995, with a chief complaint of a swelling and pain in the anterior aspect of her left shoulder. Since August 1995 she had noticed swelling and pain in her left shoulder. The swelling increased gradually and ROM of the shoulder gradually decreased. The swelling was in the anterior aspect of the left shoulder, tenderness and local heat was recognized. Shoulder motion was slightly restricted. Plain radiographs showed no abnormality of the shoulder joint, but subacromial bursograph showed an enlargement of the bursa and a honeycomb shadow. Surgical excision of the subacromial bursa was performed on 9. 11. 1995.The postoperative course was uneventful and she had no further problems with her shoulder.