Refractory Felty Syndrome — SCE Rheumatology MCQ

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HardRheumatoid ArthritisRefractory Felty SyndromeSCE Rheumatology

A patient with RA has Felty syndrome with severe neutropenia (neutrophils 0.2 x10^9/L) and recurrent infections. Initial Methotrexate therapy has not improved the neutropenia. What treatment should be considered?

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Correct answer: D — Rituximab or G-CSF for refractory Felty syndrome

For Felty syndrome refractory to initial DMARD therapy (usually Methotrexate) options include Rituximab (which targets the underlying autoimmune mechanism) and G-CSF (Filgrastim) for acute severe neutropenia with active infection. Splenectomy was historically used but is now reserved for refractory cases due to surgical risks and post-splenectomy infection risk. Large granular lymphocyte (LGL) syndrome should be excluded by flow cytometry as it can mimic Felty syndrome and may require different treatment (Methotrexate Cyclophosphamide or Ciclosporin).

Reference: Balint GP et al 2003 Felty syndrome; Rashba EJ et al 1996 Felty treatment