Felty syndrome

Last revised by Yuranga Weerakkody on 24 Mar 2023

Felty syndrome is a rare autoimmune disorder that is associated with a triad of rheumatoid arthritis, splenomegaly, and neutropenia.

It is thought to occur in ~ 1% of patients with rheumatoid arthritis 2. It is more common in women, and it is most commonly diagnosed in people above the age of 50.

Felty syndrome comprises of the triad of:

Additionally, patients may have bicytopaenia or pancytopaenia, recurrent bacterial infections, and non-cirrhotic portal hypertension.

  • rheumatoid factor (RF): >95% of patients are positive 5

  • antinuclear antibody (ANA): 47-100% are positive 5

  • HLA-DR4*0401 antigen: 78% of patients have the antigen 5

  • large granular lymphocyte (LGL) expansion: ~ 30% of patients may have it 5

X-rays may show signs of joint destruction, osteoporosis, joint space narrowing, erosions, and deformities.

Ultrasound of the joints may show synovial thickening and fluid accumulation within the joints, which are features typical of rheumatoid arthritis.

CT of the chest may demonstrate bronchiectasis, pleural effusions, and pulmonary nodules.

Treatment is through immunosuppression such as methotrexate and rituximab 6. If frequent severe bacterial infections are encounted, G-CSF may be administered 6.

It is named after Augustus Roi Felty (1895 -1964), an American physician 1.

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