Severe Sub-Acromial Bursitis with Rice Bodies in a Patient with Rheumatoid Arthritis: A Case Report and Review of Literature.

Joshi Ps

doi:10.5704/moj.1807.010

Abstract

Multiple rice body formation is a rare presentation of chronic sub-acromial bursitis secondary to extensive underlying rheumatoid arthritis, sero-negative inflammatory arthritis or tuberculous joints. Although there is usually an accompanying inflammatory arthropathy, it can occur in the absence of any underlying systemic disorder. We report a case of five years old neglected rice body deposition in shoulder in a 54-years old lady diagnosed to be having rheumatoid arthritis. After initial investigations, arthroscopic removal of rice bodies with bursa excision relieved the symptoms. The underlying rheumatic condition continued its course, generally sparing the involved shoulder joint. We suggest thorough examination for systemic rheumatologic disease in patients diagnosed with such lesions.

Highlights

Multiple rice bodies in joints or bursae may be the presenting sign of an extensive underlying rheumatoid or seronegative arthropathy
We present a rare case of rice body deposition, neglected over a period of five years, in the sub-acromial space in a 54-year old lady with rheumatoid arthritis
Rice body formation is usually associated with rheumatoid arthritis, seronegative inflammatory arthritis and tuberculous joints

Summary

Introduction

Multiple rice bodies in joints or bursae may be the presenting sign of an extensive underlying rheumatoid or seronegative arthropathy. Involvement of sub-acromial bursa, a rare occurrence in itself, in particular can reach impressive dimensions before becoming clinically evident because of spacious sub-deltoid space. Irritation of surrounding structures such as rotator cuff, acromioclavicular joint and deltoid muscle leads to diffuse painful restriction of shoulder movements. A sub-acromial bursa containing large numbers of rice bodies without extension into the glenohumeral joint may be the presenting sign of a severe rheumatoid condition.

Results

Conclusion