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Proc K, Madej M, Wiland P, Sebastian A. Biological treatment in Felty's syndrome with profound neutropenia. Reumatologia 2023; 61:213-218. [PMID: 37522143 PMCID: PMC10373170 DOI: 10.5114/reum/167472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/06/2023] [Indexed: 08/01/2023] Open
Abstract
A triad of symptoms characterises Felty's syndrome: seropositive rheumatoid arthritis (RA), splenomegaly and neutropenia. The treatment of Felty's syndrome is based on using classic synthetic and biological disease-modifying anti-rheumatic drugs (DMARDs). In this article, we present a case of a patient with Felty's syndrome who was treated with biologic treatment. A systematic search of the literature on the electronic medical database was conducted. The drugs from the DMARD group, despite reducing the activity of the disease, may cause significant clinical complications. It is important to know about the diagnosis, differentiation and treatment of neutropenia and the prevention of febrile neutropenia. The article discusses the current therapeutic possibilities using both classical and biologic DMARDs.
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Affiliation(s)
- Krzysztof Proc
- Department of Rheumatology and Internal Medicine, Medical University Hospital, Wroclaw, Poland
| | - Marta Madej
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
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Serrano Santiago VE, Morgan Z. The Diagnosis Felt(y) Right: A Case Report of Felty Syndrome With Limited Articular Involvement. Cureus 2022; 14:e24593. [PMID: 35602797 PMCID: PMC9113736 DOI: 10.7759/cureus.24593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/05/2022] Open
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Wu P, Sun W, Li J. Rheumatoid arthritis patients with peripheral blood cell reduction should be evaluated for latent Felty syndrome: A case report. Medicine (Baltimore) 2020; 99:e23608. [PMID: 33371095 PMCID: PMC7748335 DOI: 10.1097/md.0000000000023608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 10/11/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Felty syndrome is a rare and life-threatening type of rheumatoid arthritis (RA). PATIENT CONCERNS A patient with RA had skin rash and subcutaneous hemorrhage, with a significant decrease in blood hemoglobin (Hb), white blood cell count (WBC), and blood platelet count (BPC). DIAGNOSES The patient had a history of RA, splenomegaly, decreased Hb, WBC, BPC, and normal immunological indexes, combined with a series of bone marrow related tests and genetic tests. INTERVENTIONS She was given high-doses of glucocorticoids intravenously, followed by oral prednisone and cyclosporine maintenance therapy. OUTCOMES Her symptoms were resolved within 2 weeks after the start of immunosuppression. After 2 weeks of discharge, the Hb, WBC, BPC basically returned to normal, and prednisone gradually decreased. LESSONS Felty syndrome is a rare complication of RA. Reductions in Hb, WBC, BPC, and subcutaneous hemorrhage should be considered strongly as the possibility of Felty syndrome. Multi-disciplinary diagnosis and related tests of bone marrow and genes are helpful for diagnosis and correct treatment.
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Affiliation(s)
- Peng Wu
- The First Affiliated Hospital of GuangDong Pharmaceutical University
| | - Weifeng Sun
- Department of traditional Chinese medicine, southern theater general hospital, the Chinese People's Liberation Army, Guangzhou, China
| | - Jing Li
- Department of traditional Chinese medicine, southern theater general hospital, the Chinese People's Liberation Army, Guangzhou, China
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Kimura Y, Yoshida S. Successful abatacept treatment for Felty's syndrome in a patient with rheumatoid arthritis. Mod Rheumatol Case Rep 2020; 4:168-170. [PMID: 33086993 DOI: 10.1080/24725625.2020.1717740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report the case of a 69-year-old man with a 38-year history of rheumatoid arthritis (RA), who developed Felty's syndrome, successful treatment with abatacept (ABT). He was treated with etanercept 50 mg/w and methotrexate 8 mg/w for the past 5 years. He was suffered from febrile neutropenia 6 months ago. Etanercept and methotrexate was discontinued 3 months ago, however, neutrophil count was not changed. Abdominal ultrasound showed splenomegaly, the diagnosis of Felty's syndrome was made. Granulocyte colony-stimulating factor therapy showed no effect on neutropenia, he was treated with ABT. After ABT therapy, absolute neutrophil count was elevated 234/μL to 1840/μL.
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Affiliation(s)
- Yuko Kimura
- Department of Immuno-Rheumatology Center, Arisawa General Hospital, Hirakata, Osaka, Japan
| | - Shuzo Yoshida
- Department of Immuno-Rheumatology Center, Arisawa General Hospital, Hirakata, Osaka, Japan
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Bigot W, Viallard JF, Sellam J, Dellal A, Retbi A, Gobert D, Malard F, Mohty M, Mekinian A, Fain O. Efficacy and safety of rituximab for autoimmune neutropenia: a French case series and literature review. Rheumatology (Oxford) 2020; 59:2637-2640. [DOI: 10.1093/rheumatology/keaa045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/09/2019] [Accepted: 12/30/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- William Bigot
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department, Sorbonne Université, AP-HP, Hôpital Saint-Antoine
- Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), Paris
| | | | - Jérémie Sellam
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department, Sorbonne Université, AP-HP, Hôpital Saint-Antoine
| | | | - Aurélie Retbi
- Hôpital Saint Antoine, Sorbonne Universités, AP-HP, Paris, France
| | - Delphine Gobert
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department, Sorbonne Université, AP-HP, Hôpital Saint-Antoine
| | - Florent Malard
- Service de Rhumatologie, Hôpital Montfermeil, Monfermeil
| | - Mohamad Mohty
- Service de Rhumatologie, Hôpital Montfermeil, Monfermeil
| | - Arsène Mekinian
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department, Sorbonne Université, AP-HP, Hôpital Saint-Antoine
| | - Olivier Fain
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department, Sorbonne Université, AP-HP, Hôpital Saint-Antoine
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Li GM, Liu HM, Guan WZ, Li YF, Xu H, Sun L. Phenotypic variability in a child with Felty's syndrome: a case report. BMC Pediatr 2020; 20:153. [PMID: 32264838 PMCID: PMC7137412 DOI: 10.1186/s12887-020-02054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background Felty’s syndrome (FS) is characterized by the triad of rheumatoid arthritis (RA), splenomegaly and neutropenia. The arthritis is typically severe and virtually always associated with high-titer rheumatoid factor. The presence of persistent neutropenia is generally required to make the diagnosis. Most patients diagnosed with FS are aged 50–70 years and have had RA for more than 10 years. It is rarely seen in patients with juvenile idiopathic arthritis (JIA), with only five cases having been reported throughout the world. Case presentation The present study describes the case of a 14-year-old female with a seven-year history of polyarticular JIA, presenting with splenomegaly, hepatomegaly, cholestasis and thrombocytopenia. However, she occasionally developed neutropenia. Titers of rheumatoid factor and anti-CCP were persistently high, and the antinuclear antibody titer was 1:320, while the antibody results for anti-dsDNA and anti-Sm were negative. Serum levels of IgA, IgG, IgM and IgE were all persistently elevated, and the ratio of CD19+ lymphocytes in the subgroups of lymphocytes was persistently high. The level of complements was normal. No STAT3 and STAT5B mutations were found by next-generation sequencing. The patient did not respond to methotrexate, prednisolone, hydroxychloroquine (HCQ), sulfasalazine and etanercept but was responsive to rituximab. Conclusions JIA, thrombocytopenia and splenomegaly are the most common and important features in six children with FS, while persistent neutropenia is not seen in all these patients. No complement deficiency has been found in children with FS so far. Manifestations of FS without neutropenia may be extremely rare. There are differences between adults and children in the clinical and laboratory features of FS.
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Affiliation(s)
- Guo-Min Li
- Department of Rheumatology, Children's Hospital of Fudan University, 399 Wan-yuan Road, Shanghai, 201102, China
| | - Hai-Mei Liu
- Department of Rheumatology, Children's Hospital of Fudan University, 399 Wan-yuan Road, Shanghai, 201102, China
| | - Wan-Zhen Guan
- Department of Rheumatology, Children's Hospital of Fudan University, 399 Wan-yuan Road, Shanghai, 201102, China
| | - Yi-Fan Li
- Department of Rheumatology, Children's Hospital of Fudan University, 399 Wan-yuan Road, Shanghai, 201102, China
| | - Hong Xu
- Department of Rheumatology, Children's Hospital of Fudan University, 399 Wan-yuan Road, Shanghai, 201102, China
| | - Li Sun
- Department of Rheumatology, Children's Hospital of Fudan University, 399 Wan-yuan Road, Shanghai, 201102, China.
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Successful Treatment of a Large Cutaneous Ulcer and Improvement in the Hematologic Manifestations of Felty Syndrome With Rituximab. J Clin Rheumatol 2014; 20:440-1. [DOI: 10.1097/01.rhu.0000450285.43361.ab] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Xiao RZ, Xiong MJ, Long ZJ, Fan RF, Lin DJ. Diagnosis of Felty's syndrome, distinguished from hematological neoplasm: A case report. Oncol Lett 2013; 7:713-716. [PMID: 24527077 PMCID: PMC3919908 DOI: 10.3892/ol.2013.1779] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/13/2013] [Indexed: 01/19/2023] Open
Abstract
Felty’s syndrome (FS) is characterized by the three conditions of rheumatoid arthritis (RA), neutropenia and splenomegaly, and occurs in few cases of longstanding erosive RA. Discriminating between rare occurrences of autoimmune diseases and malignancies is crucial. The present study describes the case of a 17-year-old female with a two-year history of RA, presenting with an irregular fever, hepatosplenomegaly and enlarged lymph nodes. The antinuclear antibody titer was 1:320, while antibody results for anti-dsDNA, anti-Sm and rheumatoid factor were negative. The clinical presentation was similar to that of lymphoma. However, the fluorodeoxyglucose-positron emission tomography and biopsy examinations of the liver and cervical lymph node did not support the diagnosis of lymphoma. According to the laboratory results and clinical symptoms, the differential diagnosis indicated FS, and immunosuppressive agents were administered. Two weeks later, the patient no longer had a fever, and the transaminase levels were normal, associated with shrinkage of the liver and spleen.
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Affiliation(s)
- Ruo-Zhi Xiao
- Department of Hematology, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China ; Sun Yat-Sen Institute of Hematology, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Mu-Jun Xiong
- Department of Hematology, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China ; Sun Yat-Sen Institute of Hematology, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Zi-Jie Long
- Department of Hematology, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China ; Sun Yat-Sen Institute of Hematology, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Rui-Fang Fan
- Department of Hematology, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China ; Sun Yat-Sen Institute of Hematology, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Dong-Jun Lin
- Department of Hematology, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China ; Sun Yat-Sen Institute of Hematology, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
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Lazarou I, Petitpierre N, Auger I, Reber G, Roux-Lombard P, Boehlen F, Villard J. Felty's syndrome and hypofibrinogenemia: an unusual target for anti-cyclic citrullinated peptide antibodies? Mod Rheumatol 2013; 25:790-3. [PMID: 24252003 DOI: 10.3109/14397595.2013.844392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a risk factor for the development of Felty's syndrome and large granular lymphocyte (LGL) leukemia. Anti-cyclic citrullinated peptide (CCP) antibodies are considered highly specific for RA and are directed against various citrullinated antigens, including citrullinated fibrinogen. Anti-CCP antibodies may interfere with the detection of citrullinated proteins and their function. In this article, we describe the possible inhibition of fibrinogen by anti-CCP antibodies with clinical consequences which have never been reported in the literature to our best knowledge. CASE REPORT We present the case of a 79-year-old Caucasian woman with a longstanding history of untreated seropositive RA and who had been investigated for severe neutropenia since several months. The association of splenomegaly led to suspicion of Felty's syndrome. Flux cytometry was compatible with T-cell LGL leukemia. In addition, severe hypofibrinogenemia was detected. The later finding has not been consistently associated with the former clinical entities. Further investigations demonstrated that the anti-CCP antibodies of the patient also recognized the P41 peptide of citrullinated fibrinogen. The patient deceased of intracranial hemorrhage. CONCLUSION It is likely, yet not definite, that high anti-citrullinated fibrinogen titers may contribute to low fibrinogen levels and could have contributed to the fatal hemorrhagic event.
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Affiliation(s)
- Ilias Lazarou
- a Division of Immunology and Allergology, University Hospitals of Geneva , Switzerland
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Narváez J, Domingo-Domenech E, Gómez-Vaquero C, López-Vives L, Estrada P, Aparicio M, Martín-Esteve I, Nolla JM. Biological Agents in the Management of Felty's Syndrome: A Systematic Review. Semin Arthritis Rheum 2012; 41:658-68. [DOI: 10.1016/j.semarthrit.2011.08.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/29/2011] [Accepted: 08/31/2011] [Indexed: 11/27/2022]
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Tomi AL, Lioté F, Ea HK. One case of Felty's syndrome efficiently treated with rituximab. Joint Bone Spine 2012; 79:624-5. [PMID: 22401785 DOI: 10.1016/j.jbspin.2012.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 01/24/2012] [Indexed: 11/18/2022]
Abstract
Felty's syndrome (FS) is a rare association of rheumatoid arthritis (RA), neutropenia and splenomegaly. Mechanisms of neutropenia in FS are unclear but involve both innate and humoral immunity, impaired granulopoiesis and decreased granulocyte half-life. Several treatments have been used without clear efficiency. We report a patient with FS efficiently treated with rituximab (RTX), the monoclonal anti-CD20 antibody. A literature review of FS treated with RTX was performed.
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Affiliation(s)
- Anne-Laurence Tomi
- Hôpital Lariboisière, Rheumatology Department, pôle appareil locomoteur, centre Viggo-Petersen, 2 rue Ambroise-Paré, Paris, France
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