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Abstract
Felty syndrome (FS) is a rare manifestation in rheumatoid arthritis (RA) characterized by neutropenia and spleno-megaly. Treatment for FS is not well established because there has been no randomized controlled study. A few recent reports found rituximab effective in patients with refractory FS. According to those reports, most patients with RA and FS had active arthritis. Here we report a case of a patient with glucocorticoid dependent and disease-modifying antirheumatic drugs (DMARDs) refractory FS and qui-escent RA who was successfully treated with rituximab.
References
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Figure 1.
A mild hepatosplenomegaly was shown in abdominal CT scan taken at the diagnosis of Felty syndrome.
Figure 2.
Bone marrow aspiration and biopsy revealed no abnormalities except partial maturation arrest of myeloid lineage at the diagnosis of Felty syndrome. (A) Bone marrow aspirate (magnification ×400) and (B) biopsy (Hematoxylin and eosin stain, magnification ×400).
Figure 3.
Laboratory findings and medications during the course of treatment. Methotrexate, azathioprine, IVIg and recombinant human G-CSF failed to maintain WBC and ANC. A total of five intravenous infusions of Rituximab (500 mg) were given (total: 2,500 mg). After the last 5th infusion of rituximab (RTX), prednisolone was successfully tapered to 2.5 mg/day. Arrows indicate rituximab infusion. Empty arrows indicate other treatment except rituximab (AZP, G-CSF and IVIg). Abbreviation: MTX, Methotrexate; AZP, azathioprine; IVIg, intravenous immunog-lobulin; RTX, rituximab; G-CSF, granulocyte colony stimulating factor; ANC, absolute neutrophil count.
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