Treatment of Felty syndrome: modern approaches

S.S. Spitsina^{1, 2}, I.A. Zborovskaya¹, A.S. Trofimenko¹, E.E. Mozgovaya¹, S.A. Bedina¹, M.A. Mamus¹

¹Research Institute of Clinical and Experimental Rheumatology named after A.B. Zborovsky, Volgograd

²Volgograd State Medical University, Volgograd

Felty syndrome is a rare (less than 1%) type of seropositive rheumatoid arthritis, in which neutropenia and splenomegaly occur. Clinical manifestations of Felty syndrome also include severe destructive joint damage, rheumatoid nodules, lymphadenopathy, hepatopathy, vasculitis, lower-extremity ulcers, skin pigmentation, etc. The causes of neutropenia are considered to be both a decrease in the granulopoiesis intensity and an increase in the peripheral destruction of granulocytes. Recurrent bacterial infections commonly develop due to severe neutropenia. This can cause an increase in the patients’ mortality, which requires special diagnostic caution due to the similarity of Felty syndrome manifestations with adverse events in the treatment of rheumatoid arthritis. Based on the up-to-date data, the treatment tactics of Felty syndrome has a number of features. Neutropenia ca n be effectively corrected with the help of some disease-modifying anti-rheumatic drugs, primarily methotrexate. Among genetically engineered biological drugs, encouraging results were achieved with the use of rituximab; for cases of severe neutropenia with recurrent infection, there is an experience in using granulocyte colony-stimulating factor. Splenectomy should be considered as a last measure in patients with Felty syndrome who do not respond to conservative treatment methods.

Keywords: rheumatoid arthritis, Felty syndrome, basic anti-inflammatory therapy, methotrexate, genetically engineered biological therapy, tumor necrosis factor α inhibitors, rituximab, granulocyte colony-stimulating factor, splenectomy.

For citation: Spitsina S.S., Zborovskaya I.A., Trofimenko A.S. et al. Treatment of Felty syndrome: modern approaches. RMJ. 2021;7:56–60.