Causes and risk factors
The exact cause of Felty syndrome is not known. Studies show that Felty syndrome can occur in cases of longstanding rheumatoid arthritis. It can occur as one of the complications of RA. Studies suggest that it is an autoimmune disorder. It is seen to be associated with HLA-DR4 genotype.
Clinical presentation:
As Felty syndrome is a triad of rheumatoid arthritis, enlargement of spleen, and decreased white blood cells, the patient can come up with a variety of complaints. The most common joints affected are the knees, wrists, and small joints of fingers. Pain in joint, swelling, and stiffness are the prominent features. Pain may vary from person to person. It can be mild or severe. Difficulty in movement like walking, standing, sitting is experienced by the patient. Formation of nodes on small joints are seen. Muscle weakness, malaise, and tenderness are also present. Gradually over a period of time nonresponsive or untreated patients develop deformities. Extra-articular manifestations of rheumatoid arthritis also occur. The common ones seen are pleurocarditis, vasculitis, and peripheral neuropathy. The spleen in enlarged. Eventually it can lead to splenic rupture, leading to gastrointestinal bleeding. Involvement of the eye can lead to episcleritis. Felty syndrome can also lead to serious bacterial infections particularly of the skin and the pulmonary system. Enlargement of the liver and affections of lymph nodes can also be seen. Sjogren’s syndrome, pleuritis, and portal hypertension can occur. Felty syndrome can lead to a serious life-threatening condition.
Investigations:
As multiple systems are affected at the same time, there is no specific diagnostic test for Felty syndrome. The symptoms of the patient are taken into consideration and physical examination is carried out. Ophthalmic examination is recommended. Certain investigations like routine blood test and serum antibodies are done. Rheumatoid factor test is advised. Ultrasonography, liver function test, and CT scan of the abdomen can also be done. Bone marrow is done to rule out other causes – complaints of joints and bones. Other investigations can also be suggested as per the symptom presentation.
Treatment:
The treatment plan aims at first managing the joint complaints. Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, DMARDS (disease-modifying antirheumatic drugs) and pain relieving drugs are prescribed. In severe cases, corticosteroid injections and topical pain relieving gels and lubricants are advised. Immunosuppressive agents and hematopoietic growth factors are administered. Antibiotic medications are started to treat the infections and the enlarged spleen. In some cases, surgical intervention is needed. In such cases, splenectomy is done. In a serious life-threatening condition, hospitalization is needed.
Other Modes of treatment:
Certain other modes of treatment can also be helpful in coping up with the symptoms. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints. Certain yoga exercises can also be helpful in strengthening the muscles.
Facts and Figures:
The incidence of Felty syndrome is seen in less than 1% patients suffering from rheumatoid arthritis.
