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
- 1Department of Rheumatology and Immunology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang NO.1 People’s Hospital Jiujiang, Jiangxi, China
- 2Department of Neurology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang NO.1 People’s Hospital Jiujiang, Jiangxi, China
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.
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BibTeX
@article{mei2026metachronous,
title = {{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}},
author = {HanYing Mei and SenGuo Ji and Xuming Zhang and Xiaoping Shen},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1977597},
url = {https://doi.org/10.3389/fmed.2026.1977597},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - HanYing Mei
AU - SenGuo Ji
AU - Xuming Zhang
AU - Xiaoping Shen
PY - 2026
DA - 2026/10/21
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1977597
UR - https://doi.org/10.3389/fmed.2026.1977597
AB - 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.
SN - 2296-858X
ER -