Massive Subacromial Bursitis with Rice Bodies in Rheumatoid Arthritis

Shim, Seung Cheol; Jun, Jae Bum; Chang, Dae Kook; Lee, Je Kyung; Yoo, Tae Seok; Koh, Hee Kwan; Kim, Tae Hwan; Jung, Sung Soo; Lee, In Hong; Bae, Sang Cheol; Lee, Kwang Hyun; Hyun, Dae

Abstract

Rice bodies are numerous small fibrinous, cartilaginous-like materials which were first described in tuberculous joints. Rice bodies are common findings in joints afflicted with rheumatoid arthritis or other seronegative arthropathy. But less commonly, those can be seen in periarticular bursae or at the sites of tendon or ligament insertion. Rice bodies, thought to be a nonspecific response to synovial inflammation, probably evolve from ischemia in a proliferative synovium. Some of these bodies contain a core of collagen with a mantle of fibrin, others contain only fibrin. Subacromial bursa are sometimes involved in the patients with rheumatoid arthritis and can reach impressive dimensions before becoming clinically detectable because significant constrain is lacking. Subacromial arthrography or magnetic resonance imaging accurately delineated the existence of cartilaginous loose bodies before surgical exision. We experienced a man with rheumatoid arthritis who had massive subacromial bursitis with rice bodies. His shoulder had been swollen since 5 years ago. He felt no pain and had only mild limitation of motion. Subacromial arthrography or magnetic resonance imaging of right shoulder showed multiple rice bodies in enlarged subacromial bursa. Operation finding showed a large encapsulated mass in the subacromial bursa, and hundreds of fibrinous rice bodies were revealed, which were resected. We report this patient with a review of literatures.