Metachronous sequential involvement of rice-body bursitis in the shoulder and knee: a case report of rare polyarticular presentation in a patient with rheumatoid arthritis
Year: 2026
Type: article
Study design: Case Report
Abstract: Rice-body bursitis is an uncommon complication of rheumatoid arthritis (RA). Metachronous involvement of multiple joints has rarely been described. We report a 52-year-old woman with a 16-year history of RA who presented in 2019 with refractory swelling of the right shoulder. Ultrasound and MRI revealed "honeycomb-like" effusion and T2-hypointense particles within the subacromial-subdeltoid bursa, leading to a probable imaging-based diagnosis of rice-body bursitis. She achieved complete remission approximately 6 months after adalimumab was started, during which leflunomide was continued; adalimumab was then discontinued by the patient. In April 2026, left knee swelling recurred, ESR was 37 mm/h and CRP was 1.842 mg/dl, while other joint symptoms were minimal. MRI showed numerous floating particles and T2-low-signal bodies, and arthroscopic exploration confirmed rice-body bursitis of the knee. After arthroscopic debridement, the knee symptoms resolved completely within one week. The two episodes occurred 7 years apart and involved different joints, indicating that rice-body bursitis in RA can present as a metachronous sequential condition. Inflammatory marker levels did not parallel the severity of local joint involvement in this patient. This case underscores that rice-body bursitis should be considered in RA patients with refractory monoarthritis. Arthroscopic clearance combined with systemic antirheumatic therapy was followed by resolution of knee symptoms within one week in this patient. Because the two episodes involved different joints, disease phases, and concurrent treatments, no comparison between treatment strategies can be made.
Source: Frontiers in Medicine
Authors: HanYing Mei, SenGuo Ji, Xuming Zhang, Xiaoping Shen
Institution: Jiujiang First People's Hospital
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223101267