A recent case report published in the “Journal of Clinical Orthopaedics and Trauma” has shone light on an unusual manifestation of rheumatoid arthritis (RA). A 44-year-old female from Biratnagar, Nepal, presented with subacromial-subdeltoid bursitis of her right shoulder, with an uncommon feature of numerous rice body formations. This peculiar case has sparked discussions in the medical community due to the rarity and intriguing nature of rice body formations within bursitis related to RA.

DOI: 10.1016/j.jcot.2018.09.014

Introduction

Rheumatoid arthritis is an inflammatory condition typically affecting the joints, but it can have systemic implications. Bursitis, an inflammation of the bursa, is one such common affliction where rice bodies, resembling grains of polished white rice, can occasionally accumulate. The pathogenesis of rice body formation remains poorly understood, although correlations with clinical conditions like rheumatoid arthritis, tuberculous arthritis, seronegative inflammatory arthritis, juvenile rheumatoid arthritis, and osteoarthritis have been noted.

Case Report Synopsis

The subject of the case report, a 44-year-old female, underwent subacromial and subdeltoid bursectomy, which resulted in the removal of the abnormally formed rice bodies and an immediate improvement in her symptoms. The related study emphasizes the importance of recognizing and understanding rice body formation in subacromial-subdeltoid bursitis as a potential presentation of RA.

The unique feature of this case is the rice body formation, which has been referenced in historical medical literature but remains a relatively rare occurrence.

Rice Body Formation in Rheumatoid Arthritis

Rice body formation in a clinical context is associated with chronic inflammation. Although the exact mechanism is still a subject of research, there is a significant link between this condition and rheumatoid arthritis. RA is an autoimmune condition known for its erosive impact on joint integrity and can lead to severe disability. In the presence of such inflammation, the formation of rice bodies is thought to be the body’s response to chronic irritation and inflammation within the bursae or synovial sheaths.

Literature Review

A review of related literature shows that rice body formation within bursitis has been documented across various inflammatory and infectious conditions.

Subramaniam et al. (2012) reported a case of subacromial bursitis with giant rice bodies as an initial presentation of rheumatoid arthritis, highlighting the diagnostic challenge such presentations can pose.

Riese (1895) was among the early observers of rice bodies in synovial sacs affected by tuberculosis, while Griffith et al. (1996) provided magnetic resonance imaging (MRI) characterization of multiple rice body formation in chronic subacromial/subdeltoid bursitis.

The numerous cases reported indicate that while rare, the presence of rice bodies is a distinct clinical entity that often correlates with chronic inflammatory conditions.

Diagnostic Challenges

The diagnosis of rice body formation within bursitis is complex, largely due to its rarity and the nonspecific nature of symptoms. It is reliant on a combination of clinical assessment, imaging techniques, and histopathological examination.

Bhattarai et al. provided a radiological perspective, noting that advanced imaging techniques such as MRI are particularly useful in differentiating rice body formations from other types of intra-articular bodies like synovial chondromatosis.

Aletaha et al. (2010) put forth that the classification criteria for rheumatoid arthritis should be inclusive of various presentations to assist in the early identification and treatment of the disease, emphasizing that understanding the presentations such as rice bodies can aid in diagnosis.

Treatment and Prognosis

The mainstay of management for subacromial-subdeltoid bursitis with rice bodies includes surgical intervention to remove the rice bodies and address the underlying inflammation.

The patient in the case report experienced significant symptomatic relief following the bursectomy and removal of rice bodies, demonstrating the effectiveness of this approach.

Literature suggests that prognosis following treatment is generally positive with a low recurrence rate when accompanied by appropriate medical management of the underlying RA.

Conclusion

This case from Nepal contributes to the medical understanding of rheumatoid subacromial-subdeltoid bursitis with rice body formation. It underscores the complexity of RA’s manifestations and the need for a high index of suspicion in diagnosing such unique clinical presentations.

This rare case has raised awareness of the diversity of rheumatoid arthritis symptoms and has reiterated the relevance of comprehensive diagnostic and treatment approaches in managing RA effectively.

References

1. Mishra, B.N., Poudel, R.R., Jha, A., Mainali, N., & Bhattarai, M. (2020). Rheumatoid subacromial-subdeltoid bursitis with rice bodies: A case report. Journal of Clinical Orthopaedics and Trauma, 11(6), 514-517. doi: 10.1016/j.jcot.2018.09.014

2. Subramaniam, R., Tan, J.W.L., Chau, C.Y.P., Lee, K.T. (2012). Subacromial bursitis with giant rice bodies as initial presentation of rheumatoid arthritis. Journal of Clinical Rheumatology, 18(7), 352–5. doi: 10.1097/RHU.0b013e31826bfc8e

3. Griffith, J.F., Peh, W.C.G., Evans, N.S., Smallman, L.A., Wong, R.W.S., Thomas, A.M.C. (1996). Multiple rice body formation in chronic subacromial/subdeltoid bursitis: MR appearances. Clinical Radiology, 51(7), 511–514. doi: 10.1016/s0009-9260(96)80252-9

4. Aletaha, D., Neogi, T., Silman, A.J. (2010). Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis and Rheumatism, 62(9), 2569–2581. doi: 10.1002/art.27584

5. Bhattarai, M., Mainali, N., Rijal, S., & Ghimire, R.K. (2018). Rice Bodies, Synovial Chondromatosis, or a Combination of Both: A Remarkable Case Report. Case Reports in Radiology, 2018, 1-4. doi: 10.1155/2018/4729568

Keywords

1. Rheumatoid arthritis rice bodies
2. Subacromial-subdeltoid bursitis
3. Rice body formation
4. Rheumatoid arthritis case report
5. Chronic inflammatory bursitis

By incorporating the latest findings and understandings from a diverse range of clinical and research perspectives, healthcare professionals are better equipped to identify and treat this uncommon yet significant manifestation of a pervasive inflammatory condition.