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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2002 May;61(5):387–390. doi: 10.1136/ard.61.5.387

Calcium apatite crystals in synovial fluid rice bodies

J Li-Yu 1, G Clayburne 1, M Sieck 1, S Walker 1, B Athreya 1, R DeHoratius 1, H Schumacher 1
PMCID: PMC1754079  PMID: 11959760

Abstract

Background: Rice bodies can occur in the joints in many rheumatic conditions, but they are most common in rheumatoid arthritis. They are generally believed to occur rarely in patients with osteoarthritis, but one study reported rice bodies with apatite crystals.

Objective: To report on a series of joint fluids with rice bodies containing apatite clumps and examine their clinical pictures.

Methods: All synovial fluid analysis reports for 10 years were reviewed for rice bodies and eight patients were reported on. A series of patients with a variety of diseases with synovial fluid rice bodies found to contain calcific material is described. All were examined by compensated polarised light and alizarin red stain, and four were examined by electron microscopy.

Results: The eight patients all had alizarin red S chunks embedded throughout the rice body. Transmission electron microscopy disclosed the presence of a matrix of collagen, fibrin, and amorphous materials containing typical apatite crystals. Clinical diagnoses, radiographic findings, and leucocyte counts varied, but six of the eight patients had had previous repeated corticosteroid injections into the joints.

Conclusion: Aggregates of apatites may be more common than previously recognised in rice bodies as they are not routinely sought. Whether they are a result of joint damage or depot steroid injections and whether that might contribute to further joint injury now needs to be investigated.

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Figure 1 .

Figure 1

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Alizarin red S staining clumps of probable apatite among the fibrils of a rice body in patient No 8 (400x).

Figure 2 .

Figure 2

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Apatite crystals (A) in granular materials being enfolded into a mononuclear cell vacuole within a rice body of patient No 1. Electron micrograph 40 000x.

Figure 3 .

Figure 3

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Electron micrograph of tiny dark apatite crystals in granular materials (A) but not among collagen fibres (C) of patient No 1 rice body. Note a suspected small CPPD crystal apparently forming along a collagen fibre (arrow) (40 000x).

Figure 4 .

Figure 4

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Electron micrograph showing profuse fibrin (F), clumps of collagen (C), and sparse cells (arrows) characteristic of the rice bodies. No apatite is seen in this area. Patient No 4 (6000x).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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