[A woman with swollen shoulders]

Area of Science:

• Rheumatology
• Orthopedic Surgery
• Medical Imaging

Background:

• Erosive rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation and damage.
• Shoulder involvement is common in RA, potentially leading to significant pain and functional limitation.
• Rice bodies are intra-articular or bursal bodies composed of fibrinoid material and synovium, often associated with inflammatory arthropathies.

Observation:

• A 65-year-old woman with a history of erosive RA presented with bilateral shoulder swelling and left arm fatigue.
• Magnetic Resonance Imaging (MRI) of the left shoulder revealed multiple rice bodies within the subacromial-subdeltoid bursa.
• The patient's symptoms were localized and indicative of mechanical irritation or inflammation within the bursal space.

Findings:

• Surgical excision of the rice bodies from the subacromial-subdeltoid bursa was performed using a deltopectoral approach.
• Histopathological examination confirmed the nature of the extracted nodules as rice bodies, consistent with RA.
• Post-operatively, the patient experienced complete resolution of shoulder swelling and left arm weariness.

Implications:

• This case highlights rice bodies as a potential, albeit less common, cause of shoulder pain and dysfunction in patients with rheumatoid arthritis.
• Surgical intervention, such as bursectomy and nodule extraction, can be an effective treatment option for symptomatic rice bodies unresponsive to conservative management.
• Early diagnosis through imaging and prompt surgical treatment can significantly improve quality of life for RA patients experiencing such complications.