Rice bodies are a rare finding in medicine and remain to be a challenge to provide adequate treatment. As occurrence varies over multiple rheumatic as well as infectious diseases, multiple hypotheses have been made about their origin. While rice bodies are most frequently reported in the shoulder and knee joints, flexor tendon synovitis with accompanying rice bodies is more rare. We report a case of extensive flexor tenosynovitis with rice bodies in the wrist in a 90-year old patient with seronegative rheumatoid arthritis. The patient reported a 5 month history of painful swelling of the right wrist. Ultrasound showed pronounced swelling of the synovial tissue of the flexor digitorum tendons as well as the flexor pollicis longus tendon. Laboratory test were negative for rheumatology tests with normal CRP and sedimentation rates. T2 weighted MRI demonstrated an extensive synovitis reaching from the distal forearm into the hand with inclusions, better known as rice bodies. Synovectomy including carpal tunnel release was performed with dissection of the mass revealing an extensive synovitis with a multitude of rice bodies. Histopathology showed lymphohistiocytic infiltrates consistent with rheumatoid nodules, no atypical cells were discovered. After surgery the patient regained full function of the wrist within two weeks without any remaining pain or mass in the affected limb.