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Felty syndrome — SCE Rheumatology MCQ

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EasyRheumatoid arthritisFelty syndromeSCE Rheumatology

A 42-year-old woman has long-standing erosive inflammatory arthritis and recurrent infections. Examination shows there is splenomegaly and nodular hand deformity. Investigations show neutrophils are 0.7 x 10^9/L. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: A — Felty syndrome

Felty syndrome is the best answer because the pattern described is most consistent with Felty syndrome, including the distribution of symptoms and the targeted investigation results. Giant cell arteritis is a plausible distractor, but it does not account for the key discriminator in the stem. Neonatal lupus risk and Granulomatosis with polyangiitis would be more appropriate in a different clinical pattern or at another point in the pathway, while Primary Sjögren syndrome is suboptimal for this presentation. Clinical pearl: in SCE-style questions, the decisive clue is usually the pattern across joints, extra-articular features and targeted immunology rather than a single antibody result.

Reference: NICE NG100; BSR biologic/targeted DMARD safety guideline; BNF