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Subacromial Bursitis With Giant Rice Bodies as Initial Presentation of Rheumatoid Arthritis

Subramaniam, Ramesh MBBS, MRCS(Edin), MMed(Ortho), FRCSEd(Tr&Orth)*; Tan, Justina Wei Lyn MBBS, MRCP; Chau, Cora Yuk Ping MBBS, FRCPA, FHKAM; Lee, Keng Thiam MBBS, MMed, FRCSEd§

JCR: Journal of Clinical Rheumatology:
doi: 10.1097/RHU.0b013e3182677023
Case Reports

Abstract: Rice body formation is a nonspecific response to chronic synovial inflammation associated with tuberculous arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, seronegative inflammatory arthritis, and even osteoarthritis. Such bodies were termed rice bodies because of their close resemblance to grains of polished white rice. We present a case report of a middle-aged woman with right shoulder subacromial/subdeltoid bursitis with giant rice body formation as her initial presentation of rheumatoid arthritis. Her right shoulder symptoms resolved after subacromial and subdeltoid bursectomy and removal of the rice bodies. She subsequently developed inflammatory arthritis of other joints, met the criteria for rheumatoid arthritis, and has been treated medically.

Author Information

From the Departments of *Orthopaedic Surgery, †Rheumatology, Allergy & Immunology, ‡Pathology, and §Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.

The authors declare no conflict of interest.

Correspondence: Ramesh Subramaniam, MBBS, MRCS(Edin), MMed(Ortho), FRCSEd(Tr&Orth), Department of Orthopaedic Surgery, 11 Jalan, Tan Tock Seng Hospital, Singapore 308433S, Singapore. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.