J Rheum Dis.  2014 Feb;21(1):35-39. 10.4078/jrd.2014.21.1.35.

Treatment with Rituximab in a Patient with Refractory Felty Syndrome and Low Rheumatoid Arthritis Disease Activity: A Case Report

• Chang SH
• Yang JA
• Lee SJ
• Park JW
• Shin K
• Lee EB
• Song YW
• Lee EY

• KMID: 2222987
• DOI: http://doi.org/10.4078/jrd.2014.21.1.35

Abstract

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.

Keyword

Felty syndrome; Rituximab; Rheumatoid arthritis

MeSH Terms

Antirheumatic Agents
Arthritis
Arthritis, Rheumatoid*
Felty Syndrome*
Humans
Neutropenia
Splenomegaly
Rituximab
Antirheumatic Agents

Figure

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  Figure 1. A mild hepatosplenomegaly was shown in abdominal CT scan taken at the diagnosis of Felty syndrome.

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  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).

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  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.

Reference

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