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Felty Syndrome — RACP Adult Medicine MCQ

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ModerateRheumatologyFelty SyndromeRACP Adult Medicine

A 55-year-old woman with long-standing seropositive RA has neutropenia (ANC 0.5 × 10⁹/L), splenomegaly, and recurrent infections. She has leg ulcers. Platelet count and Hb are normal. She is on methotrexate 15 mg weekly. Bone marrow shows myeloid hyperplasia with maturation arrest. What is the most likely diagnosis?

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Correct answer: C — Felty syndrome

Long-standing seropositive RA + neutropenia + splenomegaly = Felty syndrome. Classic triad: RA + splenomegaly + neutropenia. It occurs in severe erosive seropositive RA (usually RF+++ with high titre). Associated with HLA-DR4. Complications: recurrent infections (from neutropenia), leg ulcers, and hepatomegaly. Large granular lymphocyte (LGL) leukaemia may co-exist or mimic Felty syndrome. Treatment: methotrexate (improves neutropenia), G-CSF for severe neutropenia, rituximab for refractory cases. Splenectomy is rarely needed.

Reference: eTG Rheumatology – 2024 – Felty Syndrome; BSR 2024