Felty syndrome (FS) is a rare manifestation in rheumatoid arthritis (RA) characterized by neutropenia and splenomegaly. 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 anti-rheumatic drugs (DMARDs) refractory FS and quiescent RA who was successfully treated with rituximab.
Antirheumatic Agents ; Arthritis ; Arthritis, Rheumatoid* ; Felty Syndrome* ; Humans ; Neutropenia ; Splenomegaly ; Rituximab

Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in the synovial membrane, periarticular structures, skeletal muscle and perineural sheath. Eventually, the joints are destroyed, ankylosed and deformed. Therefore, the aim of treatment is to keep the inflammatory process at a minimum, thereby preserving joint motion, maintaining the health of muscle supplying motor power about the joint, and preventing secondary joint stiffness and deformity. Surgical treatment in rheumatoid arthritis has progressed and there have been advances in the relief of pain and increase in the range of motion. For the period of 15 years from January 1973 to December 1987, 55 cases of rheumatoid arthritis who received surgical treatment were reviewed and the results of clinical observation were as follows : 1. Among 977 patients of rheumatoid arthritis, 76 sites in 55 patients were operated on. 2. Sites of operation were the knee in 33 cases, hip in 20 cases, wrist and finger in 12 cases, ankle in 5 cases, elbow in 5 cases, and cervial spine in 1 case. 3. Operative methods were 40 cases of joint replacement, 27 cases of synovectomy, 4 cases of fusion, and 2 cases of tenotomy and capsulectomy. 4. Postoperative results were good in 19 patients, satisfactory in 16 patients, unsatisfactory in 5 patients, and poor in 2 patients. 5. The clinical stage at the time of joint replacement was not related to the end results of the operations. 6. Causes of unsatisfactory and poor results were preoperative flexion contracture and Felty's syndrome.
Adult ; Ankle ; Arthritis, Rheumatoid ; Congenital Abnormalities ; Contracture ; Elbow ; Felty Syndrome ; Fingers ; Hip ; Humans ; Joints ; Knee ; Middle Aged ; Muscle, Skeletal ; Range of Motion, Articular ; Spine ; Synovial Membrane ; Tenotomy ; Wrist

Felty's syndrome is an uncommon condition characterized by the combination of rheumatoid arthritis (RA), splenomegaly, and neutropenia. Disease-modifying anti-rheumatic drugs and biologic agents have been used to treat early RA to achieve remission. Anti-tumor necrosis factor (TNF)-alpha agents are effective for controlling the disease; however, some studies have suggested the possibility of adverse effects such as increased frequency of infection or malignancy. Bowen's disease, known as squamous cell carcinoma in situ, is a skin cancer that can be caused by sun exposure, arsenic ingestion, human papilloma virus, skin damage, and prolonged immunosuppression. We report the case of a 64-year-old female diagnosed with Bowen's disease during treatment with an anti-TNF agent for Felty's syndrome with a review of the literature.
Antibodies, Monoclonal, Humanized ; Antirheumatic Agents ; Arsenic ; Arthritis, Rheumatoid ; Bowen's Disease ; Carcinoma, Squamous Cell ; Eating ; Felty Syndrome ; Female ; Humans ; Immunosuppression ; Middle Aged ; Necrosis ; Neutropenia ; Papilloma ; Skin ; Skin Neoplasms ; Solar System ; Splenomegaly ; Viruses ; Adalimumab