Early-onset rice body synovitis of the knee in children under three years: a case series and review of the literature

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OBJECTIVE: Rice body synovitis reports have been rarely reported in children under three years of age. We aimed to explore the clinical characteristics and treatment experience of rice body-like synovitis in children's knees. METHODS: We retrospectively analyzed the clinical and imaging data of 4 cases (5 knees) of rice body-like synovitis in children treated at our hospital from January 2014 to December 2021. Among the patients, 1 was male and 3 were female, with an average age of 22.5 months. The average length of symptoms before admission was 1.86 months. Clinical presentations included swelling and limping, with no fever or rash. RESULTS: Three patients with unilateral onset and one patient with bilateral onset underwent unilateral arthroscopic excision of synovial lesions. All 4 patients had pathological findings consistent with chronic inflammation, leading to a postoperative diagnosis of juvenile idiopathic arthritis (JIA). Postoperatively, all patients received standardized pharmacological treatment and were followed for 24 to 48 months in collaboration with the rheumatology department. None of the 4 knees undergoing surgery experienced recurrence, and the symptoms of the knee treated conservatively resolved spontaneously. In the last follow-up session, MRI and ultrasound showed only mild synovial thickening, with effusion and loose bodies disappearing. CONCLUSION: Rice body-like synovitis may be a specific manifestation of JIA. It can be observed in younger children, presenting with insidious symptoms. Arthroscopic debridement combined with post-operative standard medical treatment can offer satisfactory therapeutic outcomes.

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