Felty's Syndrome

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Felty's syndrome (FS) is a complication of rheumatoid arthritis (RA). It is defined by the presence of three conditions: rheumatoid arthritis, an enlarged spleen and an abnormally low white blood count. People with FS suffer an increased risk of infection due to their low white blood cell count. Their symptoms may include a general feeling of discomfort – or "malaise" – fatigue, loss of appetite and weight loss, a pale colour, recurrent infections and eye burning and/or discharge.

People with FS will also typically experience joint swelling, stiffness, pain and deformity, but these symptoms will likely be due to the rheumatoid arthritis. In fact, many of these symptoms could also occur as a result of RA. It is the enlarged spleen (which shows up in a physical examination) and the low white blood count (that shows up in a blood test) that signal the presence of FS.

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Treatment of FS is not always required, especially if the underlying RA is well-controlled. If people with FS experience recurring infections, active arthritis, and/or leg ulcers, they may be prescribed gold salts, methotrexate, azathioprine, penicillamine, cyclosporin and, more recently, tacrolimus. Some people require a combination of medications before the body responds. People with severe infections may benefit from weekly injections with a stimulating factor (granulocyte stimulating factor/GSF) that increases the amount of white blood cells. Surgical removal of the spleen is considered only in situations of severe, repeated infections and hospitalizations. This approach has not been evaluated by long-term research studies.

In general, people with FS should maintain their health as best as they can. It is important to get an annual flu shot and avoid crowded areas during flu outbreaks, as well as to alert friends and family to "stay away" if they have the flu or colds. Washing hands thoroughly and frequently also helps to prevent infection, as does protecting lower legs from knocks and bruising, and treating cuts and abrasions promptly according to a doctor's advice. If you have FS, it is a good idea to wear a medical alert bracelet or neck chain at all times and to keep a record of medications, blood test results and any unusual symptoms.
Arthritis medications are designed to control a disease, slow its progression, and to help manage pain. There is a wide range of options – with new ones coming on the horizon – so understanding all possible treatments is not easy. 

These medications can be very complex, so you are encouraged to ask for in-depth explanations from your health care team – including pharmacists, who are an excellent source of information. 

To explore this area of treatment, The Arthritis Society has developed a comprehensive expert guide that delivers detailed information on medications used to treat arthritis.

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The optimal treatment is what is best in each individual case – so speak with your doctor and/or pharmacist about what kind of medications are most appropriate for you.

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