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Felty syndrome — SCE Rheumatology MCQ

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HardInflammatory ArthritisFelty syndromeSCE Rheumatology

A 67-year-old man has longstanding erosive seropositive rheumatoid arthritis, recurrent leg ulcers, splenomegaly and neutrophils of 0.7 × 10^9/L. What is the most appropriate biologic?

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Correct answer: BRituximab

Rituximab is the single best answer because rheumatoid arthritis with splenomegaly and neutropenia is the classic Felty syndrome pattern. The stem is testing biologic selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Palindromic rheumatism is less suitable because it fits a different clinical pattern or a different treatment threshold; Erosive osteoarthritis, Hydroxychloroquine monotherapy and Etanercept do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NICE NG100; BSR rheumatoid arthritis guideline; BNF