Rice bodies

This figure illustrates the left knee fluid aspiration of a 68-year-old patient with long standing rheumatoid arthritis (RA) who was also diagnosed with osteoarthritis at the age of 51. His physical examination revealed advanced genu varus deformity of knees with massive joint effusion, but try with a usual 22-gauge needle for aspiration gained no fluid. Second attempt with a Pleural needle biopsy was successful, and more than 60 cc of synovial fluid, full of floating particles typical of «rice bodies», was aspirated. His laboratory investigations showed persistently elevated ESR, positive CRP, negative rheumatoid factor (RF) and low titer of anti-CCP (anti-cyclic citrullinated peptide antibody; ACPA). Histopathologic examination demonstrated non-specific acute on chronic inflammation typical of inflammatory arthritis with fibrin exudates and no granuloma. The most important differential diagnoses of these findings are RA and tuberculosis.