A Case of Idiopathic Massive Rice Bodies in the Knee Joint without Rheumatoid Arthritis or Tuberculosis and a Literature Review

Whan Yong Chung; Ji-Sun Song; Hwa Eun Oh; Hee Jin Park

doi:10.4078/jrd.2016.23.5.316

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Chung, Song, Oh, and Park: A Case of Idiopathic Massive Rice Bodies in the Knee Joint without Rheumatoid Arthritis or Tuberculosis and a Literature Review

Case Report

J Rheum Dis 2016;23(5):316-320.

Published online: 31 October 2016

DOI: https://doi.org/10.4078/jrd.2016.23.5.316

A Case of Idiopathic Massive Rice Bodies in the Knee Joint without Rheumatoid Arthritis or Tuberculosis and a Literature Review

Whan Yong Chung¹, Ji-Sun Song², Hwa Eun Oh³, Hee Jin Park⁴

¹Department of Orthopedics, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea

²Department of Pathology, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea

³Department of Pathology, Korea University Ansan Hospital, Ansan, Korea

⁴Department of Rheumatology, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea

Corresponding to: Hee Jin Park, Department of Rheumatology, Catholic Kwandong University International St. Mary's Hospital, 25 Simgok-ro 100beon-gil, Seo-gu, Incheon 22711, Korea. E-mail: yolliko@ish.ac.kr

Received 19 November 201523 December 2015 Accepted 24 December 2015

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rice bodies are materials with an amorphous nucleus and a fibrin layer found floating in the synovial space and bursa. These bodies have often been detected in patients with rheumatoid arthritis, tuberculous arthritis, and bursitis. Although the etiology and pathogenesis of rice bodies are not yet fully understood, it has been hypothesized that they might be caused by chronic inflammation originating from the synovium. However, we report on a case of idiopathic massive rice bodies in the knee joint without evidence of inflammatory articular disease or infection including rheumatoid arthritis, seronegative spondyloarthritides, tuberculosis, or bacterial or fungal infection.

Keywords: Rice body, Knee, Rheumatoid arthritis, Tuberculosis

REFERENCES

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Figure 1.

Magnetic resonance images of the right knee. (A) T1-weighted image (T1WI) and (B∼ D) T2-weighted images (T2WI) showed a large amount of joint effusion with numerous low-signal foci against a background of fluid signal intensity on T2WI. Anterior and posterior cruciate ligaments and collateral ligaments were intact.

Figure 2.

Gross morphology of rice bodies in the washing synovial fluid and arthroscopic findings. (A) Many white amorphous materials were found in the washing synovial fluid collected through arthroscopic irrigation. Arthroscopic findings were consistent with rice bodies in the suprapatellar space (B) and revealed a normal synovium (C).

Figure 3.

Pathology of rice body and synovium. (A) Microscopic examination (H&E, x40) revealed multiple nodular fi-brocartilaginous tissues consistent with rice bodies. (B) The synovium of the knee joint (H&E, x100) showed a histologically clean synovial surface.

Table 1.

Clinical characteristics and prognosis after treatment of idiopathic rice bodies

Age (yr)/ gender	Site of rice body	Duration of symptom	Laboratory data	Culture	Pathology	Treatment	Follow-up duration	Prognosis	Reference
38/F	Right ankle	2 yr	RF/ANA negative	PPD skin test (−)	Tenosynovitis	Tenosynovectomy	y 5 yr	No recurr	4
51/M	Left wrist	2 yr	RF/ANA/HLA B27 negative		Tenosynovitis	Radical synovectomy	1 yr	No recurr	11
31/M	Left knee	3 mo	ESR/CRP normal RF/ANA negative	Bacterial culture (−) AFB (−)	Synovitis	Synovectomy	2 yr	No recurr	12
4/F	Both shoulder and knee	Unknown	ESR (18 mm/hr)/ CRP normal RF/ANA negative			Surgery without synovectomy	1 yr	No recurr	13
11/M	Left knee	4 mo	ESR/CRP normal RF negative		Chronic synovitis	Subtotal synovectomy	2.5 yr	No recurr	14
54/F	Both shoulder	14 mo	ESR/CRP normal RF/ANA negative		Inflammatory bursitis	Synovectomy	3 mo	No recurr	9

F: female, M: male, ANA: anti-nuclear antibodies, AFB: acid-fast bacilli, CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, HLA: human histocompatibility leukocyte antigen, PPD: purified protein derivative, RF: rheumatoid factor, recurr: recurrence

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