Felty’s syndrome – report of three cases

Felty’s syndrome (FS) is a rare complication of rheumatoid arthritis (RA). FS comprises a triad of signs: RA, neutropenia and (obligatory) splenomegaly. Severe articular and extra-articular manifestations of RA are distinctive for FS. Proposed mechanisms of neutropenia in FS include: maturation arrest of granulocyte precursors, inhibition of G-CSF by cytokines, antibodies directed against granulocytes and increased granulocyte margination. The main problems connected with neutropenia are recurrent bacterial infections involving mostly the respiratory tract and skin. Hyperviscosity syndrome is very rare in FS. In differential diagnosis of neutropenia in RA drug toxicity, viral infections and haematological diseases (first of all T-cell large granular lymphocyte leukaemia – T-LGL) should be excluded. Treatment of FS is based on disease-modifying drugs (DMARD). Sometimes granulocyte colony-stimulating factors (G-CSF and GM-CSF) or splenectomy are applied. We describe three cases of patients with FS treated in our department.