Rheumatoid arthritis complication — SCE Rheumatology MCQ

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ModerateInflammatory ArthritisRheumatoid arthritis complicationSCE Rheumatology

A 59-year-old man with long-standing nodular rheumatoid arthritis presents with fever and a painful leg ulcer. Examination shows splenomegaly and active synovitis. Blood tests show neutrophils 0.7 × 10⁹/L, platelets 140 × 10⁹/L and positive RF. Blood cultures are pending. What is the most likely diagnosis?

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Correct answer: E — Felty syndrome

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · B = shown as D

Felty syndrome is best because the triad of established seropositive RA, splenomegaly and neutropenia is characteristic of Felty syndrome. A is less suitable because adult-onset Still disease usually causes quotidian fever, rash and very high ferritin rather than nodular RA; B is less suitable because large granular lymphocytic leukaemia can mimic this and should be considered, but the classic exam diagnosis here is Felty syndrome; C is less suitable because SLE can cause cytopenias but the rheumatoid phenotype dominates; D is less suitable because reactive arthritis would not explain chronic nodular RA with splenomegaly. Clinical pearl: Felty syndrome increases infection risk and may present with ulcers or sepsis.

Reference: Oxford Textbook of Rheumatology; BSR RA guidance