Anisau, Aliaksandr

De Clerck, Thomas

Vanhoenacker, Filip

English

Ghent University Academic Bibliography

Case 14777 Rice Bodies associated with Rheumatoid ArthritisThomas De Clercq , Aliaksandr Anisau , Filip Vanhoenacker1 2 234 University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium1 Department of Radiology, AZ Sint-Maarten, Duffel-Mechelen, Belgium2 University Hospital Antwerp, Department of Radiology, University Hospital Antwerp;3Wilrijkstraat, 10 2650 Antwerp, Belgium University of Ghent, Faculty of Medicine and Health Sciences, De Pintelaan 185, 9000 Ghent4;Email:filip.vanhoenacker@telenet.be University Hospital Antwerp  Musculoskeletal System Section: 2017, Jul. 24 Published: 57 year(s), femalePatient:Clinical HistoryA 57-year-old female with a history of longstanding seronegative, ANF-positive rheumatoidarthritis presents to the department of orthopedic surgery with shoulder pain.Imaging FindingsPlain radiography of the right shoulder revealed degenerative changes at the acromioclavicular jointand sclerotic delineated erosions at the humeral head [Fig. 1]. Conventional Arthrography of theright shoulder showed irregular delineation of the joint capsule with multiple intra-articular fillingdefects and a partial articular infraspinatus tear [Fig. 2]. Subsequent MR Arthrography confirmederosions at the anatomical neck, the partial articular tear of the infraspinatus tendon and theintra-articular foci of intermediate signal on both pulse sequences, in keeping with rice bodies [Fig.3]. Plain radiographies of the hands and feet performed at a previous date showed sequelae oflongstanding rheumatoid arthritis [Fig. 4].DiscussionThe term rice body was originally coined in 1895 due to its resemblance to polished grains of rice[1]. Rice bodies are considered a non-specific response to synovial inflammation, most commonlyfound in rheumatoid arthritis (RA) [2]. Other causes of rice body formation are tuberculous arthritis,septic arthritis and spondyloarthropathy [3, 4]. Its pathogeneses is not fully understood. Most authors believe that rice bodies result frommicro-infarcts in hypertrophic synovium, leading to detachment of synovial free fragments into thejoint cavity. Histologically rice bodies consist of acidophilic amorphous core surrounded by fibrinand collagen [3, 4]. They appear to be unrelated to disease activity, severity or duration [1, 2, 5, 6].Plain radiography (CR) is usually nonspecific and adds little in the diagnosis. Although CR mayshow marginal erosions as a consequence of longstanding underlying joint disease in RA, directvisualization of rice bodies - however - is impossible. Conventional arthrography may revealmultiple intra-articular filling defects. Ultrasound shows multiple hyperechoic, intra-articular loosebodies, associated with signs of arthritis including hypervascular synovial inflammation, bursitisand erosions [4]. The imaging modality of choice is MRI or MR arthrography. On MRI, rice bodiesappear as multiple intra-articular foci iso- or hypointense to skeletal muscle on T1-weighted images(WI) and hypointense on T2-WI [2-5]. The differential diagnosis on imaging includes synovial chondromatosis, pigmented villonodularsynovitis (PVNS) and lipoma arborescens. Synovial chondromatosis may be primary or secondarydue to underlying joint disease. The signal intensity of the intra-articular loose bodies is variableaccording to the stage of the disease. Loose bodies may contain hyaline cartilage in the initial stage,that may later calcify or ossify. PVNS is characterized by hypointense synovial structures on bothpulse sequences and shows blooming artifacts on gradient echo imaging, due to the presence ofhemosiderin. In joints with a tight capsule bone erosions are often associated. Lipoma arborescensconsist of a subsynovial lipomatous soft tissue proliferation which is isointense to fat on T1- andT2-WI [7].Removal of rice bodies may correlate with clinical improvement in affected joints [1, 2]. Someauthors recommend aspiration or arthroscopic lavage or surgical synovectomy as potential treatmentoptions [1, 3, 4]. In conclusion, rice bodies are a relatively uncommon imaging finding in patients with longstandingarticular disease. Meticulous analysis of the imaging findings, knowledge of underlying jointdisease, such as RA, and correlation with previous imaging allows a correct diagnosis.Final DiagnosisRice body formation in rheumatoid arthritis.Differential Diagnosis List• Synovial chondromatosis., • Pigmented villonodular synovitis., • Lipoma arborescens.FiguresFigure 1 Fig. 1 Anteroposterior plain radiography of the right shoulderPlain radiography of the shoulder shows degenerative changes at the acromioclavicular jointwith osteophyte formation (arrow ). Note the presence of partially sclerotic delineatedradiolucent lesions superolateral aspect of the humeral head (arrowheads). © Vanhoenacker F, Department of Radiology, AZ St. Maarten, Duffel-Mechelen, Belgium Area of Interest: Musculoskeletal joint;  Imaging Technique: Conventional radiography;  Procedure: History;  Special Focus: Arthritides; Figure 2 Fig. 2 Shoulder arthrogramThe anteroposterior view shows irregular delineation of the joint capsule (white arrowheads).© Vanhoenacker F, Department of Radiology, AZ St. Maarten, Duffel-Mechelen, Belgium Area of Interest: Musculoskeletal joint;  Imaging Technique: Conventional radiography;  Procedure: Arthrography;  Special Focus: Arthritides; The scapular Y-view shows multiple intra-articular filling defects (black arrowheads). Notealso contrast leakage at the articular side of the infraspinatus in keeping with a partial tendontear (long arrow). © Vanhoenacker F, Department of Radiology, AZ St. Maarten, Duffel-Mechelen, Belgium Area of Interest: Musculoskeletal joint;  Imaging Technique: Conventional radiography;  Procedure: Arthrography;  Special Focus: Arthritides; Figure 3 Fig. 3 Magnetic resonance of the right shoulderOblique sagittal T1-WI slice shows multiple intra-articular hypointense foci in keeping withrice bodies (arrowheads). © Vanhoenacker F, Department of Radiology, AZ St. Maarten, Duffel-Mechelen, Belgium Area of Interest: Musculoskeletal joint;  Imaging Technique: MR;  Procedure: Arthrography;  Special Focus: Arthritides; Oblique sagittal T1-WI more laterally shows huge erosions at the superolateral aspect of thehumeral head (arrows). © Vanhoenacker F, Department of Radiology, AZ St. Maarten, Duffel-Mechelen, Belgium Area of Interest: Musculoskeletal bone;  Imaging Technique: MR;  Procedure: Arthrography;  Special Focus: Arthritides; Oblique sagittal T1-WI with fat suppression shows multiple intra-articular hypointense foci(arrowheads). © Vanhoenacker F, Department of Radiology, AZ St. Maarten, Duffel-Mechelen, Belgium Area of Interest: Musculoskeletal joint;  Imaging Technique: MR;  Procedure: Arthrography;  Special Focus: Arthritides; Coronal T2-WI with fat suppression shows intra-articular hypointense foci in keeping withrice bodies (arrowheads). © Vanhoenacker F, Department of Radiology, AZ St. Maarten, Duffel-Mechelen, Belgium Area of Interest: Musculoskeletal joint;  Imaging Technique: MR;  Procedure: Arthrography;  Special Focus: Arthritides; Axial T1-WI with fat suppression shows the multiple erosions at the anterior and posteriorside of the humeral head (arrows). © Vanhoenacker F, Department of Radiology, AZ St. Maarten, Duffel-Mechelen, Belgium Area of Interest: Musculoskeletal bone;  Imaging Technique: MR;  Procedure: Arthrography;  Special Focus: Arthritides; Figure 4 Fig. 4 Plain radiography of hands and feetAnteroposterior view of the feet shows multiple sclerotic delineated erosions and cartilageloss at the metatarsophalangeal joints and fusion of the second proximal interphalangeal jointof the left foot due to previous surgery . © Vanhoenacker F, Department of Radiology, AZ St. Maarten, Duffel-Mechelen, Belgium Area of Interest: Musculoskeletal joint;  Imaging Technique: Conventional radiography;  Procedure: History;  Special Focus: Arthritides; Anteroposterior view of the hands shows sequelae of long standing rheumatoid arthritis withcartilage loss and joint destruction, particularly at the left metacarpophalangeal joint II andthe right metacarpophalangeal joint I and multiple interphalangeal locations. © Vanhoenacker F, Department of Radiology, AZ St. Maarten, Duffel-Mechelen, Belgium Area of Interest: Musculoskeletal joint;  Imaging Technique: Conventional radiography;  Procedure: History;  Special Focus: Arthritides; References[1] Popert AJ, Scott DL, Wainwright AC, Walton KW, Williamson N, Chapman JH (1982)Frequency of occurrence, mode of development, and significance of rice bodies in rheumatoidjoints Ann Rheum Dis 41:109-117[2] Narvaez JA, Narvaez J, Roca Y, Aguilera C (2002) MR imaging assessment of clinicalproblems in rheumatoid arthritis Eur Radiol 2:1819-1828[3] Forse CL, Mucha BL, Zabala Santos ML, Ongcapin EH (2012) Rice body formation withoutrheumatic disease or tuberculosis infection: a case report and literature review Clin Rheumatol31:1753-1756[4] Edison MN, Caram A, Flores M, Scherer K (2016) Rice Body Formation Within aPeri-Articular Shoulder Mass Cureus 8(8): e718. DOI 10.7759/cureus.718[5] Griffith JF, Peh WCG, Evans NS, Smallman LA, Wong RWS, Thomas AMC (1996) MultipleRice Body Formation in Chronic Subacromial/Subdeltoid Bursitis: MR Appearances Clin Radiol51:511-514[6] Tan CHA, Rai SB, Chanddy J (2004) MRI appearances of multiple rice body formation inchronic subacromial and subdeltoid bursitis, in association with synovial chondromatosis ClinRadiol 59: 753-757[7] Tsifountoudis I, Kapoutsis D, Tzavellas AN, Kalaitzoglou I, Tsikes A, Gkouvas G (2017)Lipoma Arborescens of the Knee: Report of Three Cases and Review of the Literature Case RepMed 2017 Article ID: 3569512CitationThomas De Clercq , Aliaksandr Anisau , Filip Vanhoenacker1 2 234 University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium1 Department of Radiology, AZ Sint-Maarten, Duffel-Mechelen, Belgium2 University Hospital Antwerp, Department of Radiology, University Hospital Antwerp;3Wilrijkstraat, 10 2650 Antwerp, Belgium University of Ghent, Faculty of Medicine and Health Sciences, De Pintelaan 185, 9000 Ghent4;Email:filip.vanhoenacker@telenet.be (2017, Jul. 24)  Rice Bodies associated with Rheumatoid Arthritis {Online}URL: http://www.eurorad.org/case.php?id=14777

Rice bodies associated with rheumatoid arthritis

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Rice bodies associated with rheumatoid arthritis

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