Felty syndrome

The Felty syndrome is a rheumatic disease. The inflammatory rheumatic disease is a special form of the so-called rheumatoid arthritis. Felty syndrome was described for the first time in 1924.

What is Felty Syndrome

Felty syndrome affects women far more often than men. The incidence peak in women is between 45 and 50 and between 65 and 70 years of age. Felty's syndrome is diagnosed as a special form of polyarthritis by rheumatism experts.

Before patients were diagnosed with Felty Syndrome, they had previously had rheumatoid arthritis. Not every patient affected will develop the clinical signs of Felty's syndrome over time. There is an average of more than 12 years between the first onset of polyarthritis and the diagnosis of Felty syndrome.

In order to diagnose Felty syndrome, the clinical manifestation of a so-called triad is essential. In Felty's syndrome, those affected regularly suffer from severe rheumatic pain and restricted mobility. The destruction and deformation of the joints or joint ends can take on considerable proportions.

causes

As with most rheumatic diseases, the causes of invasive inflammatory joint changes in Felty's syndrome are still largely in the dark. Since Felty's syndrome, in contrast to rheumatoid arthritis, is a rare variant of rheumatism, according to the German Rheumatism League there is a lack of public funding, which is urgently needed to research the cause.

Felty syndrome occurs in less than 1 percent of cases of so-called uncomplicated rheumatoid arthritis. If blood vessels are also affected by the rheumatic-inflammatory change, doctors speak of vasculitis. Felty syndrome affects around 7 percent of patients with vasculitis.

With increasing age, patients with rheumatoid arthritis are more likely to develop Felty's syndrome. Recent research results allow the conclusion that Felty's syndrome could be an autoimmune disease, i.e. the organism produces antibodies against the body's own cartilage and bone structures, which in turn leads to an inflammatory reaction.

Symptoms, ailments & signs

Felty syndrome is associated with very unpleasant complaints, all of which have a very negative effect on the quality of life of the person concerned. As a rule, the patients suffer from arthritis and also from swelling of the lymph nodes. This results in significant restrictions in the everyday life of the person affected, so that they depend on the help of other people.

Everyday things can no longer be carried out easily. Felty syndrome also increases the patient's susceptibility to infections, so that they get sick more often and suffer from various infections and inflammations. This very often leads to pneumonia, which leads to breathing difficulties and, if left untreated, to death of the patient. The immune system of the person concerned is generally significantly weakened and the person concerned becomes tired and exhausted.

Pneumonia can also have various complications if diagnosed and treated late. Felty syndrome can also lead to damage to the spleen, which is usually irreversible and can no longer be treated. In this case, the affected person's spleen is completely removed. The syndrome can also lead to mental impairments or depression.

Diagnosis & course

The diagnosis of Felty Syndrome is usually not made in the family doctor's practice, but by the rheumatologist. It is not uncommon for the patients to already have a long doctor odyssey behind them at this point. According to the guidelines of the German Society for Rheumatology, the diagnosis of Felty Syndrome may only be made if a triad of symptoms can be clinically determined.

These are symmetrical, erosive polyarthritis, neutropenia and splenomegaly. The inflammatory joint changes must therefore not only occur on one side, but in approximately the same form in corresponding parts of the body. The term neutropenia describes the decrease in a certain fraction of white blood cells, leukocytes.

Splenomegaly is a simultaneous enlargement of the spleen. Overall, this immunological event speaks for a far-reaching and misdirected involvement of the immune system. In addition to the clinical picture, laboratory values ​​must therefore be available in order to make a diagnosis, which, in addition to neutropenia, also show a strong increase in so-called rheumatoid factors.

Complications

In most cases, women are affected by Felty's syndrome; in men, the disease is far less common and leads to fewer complications and symptoms. This mainly affects adults. In the case of Felty syndrome, busy patients experience severe restrictions on movement.

Ordinary activities and sports can no longer be performed without pain or effort. This also has a negative effect on the immune system. Most patients complain of a high susceptibility to infections. This can manifest itself primarily as an inflammation in the lungs. With pneumonia, complications can arise from late or improper treatment.

However, these can also occur if the patient falls ill with other infections or diseases due to the weakened immune system. Most people have swollen lymph nodes. Complications can also arise during treatment as it is not always successful.

It mainly depends on the cause of the Felty syndrome and can result in the patient's spleen having to be removed completely. The affected person is prescribed infusions and medication, which must be taken over a longer period of time. The other symptoms depend heavily on the patient's previous course of the disease.

When should you go to the doctor?

Felty syndrome is usually only treated symptomatically. For this reason, the doctor should always be consulted if the person concerned suffers from acute symptoms. Often, not all symptoms can be completely limited, so that patients are dependent on lengthy treatment.

A doctor should be seen if the person has swelling of the lymph nodes that has persisted for a long time. Different nodes can be affected by the swelling. A strong susceptibility to various infections or inflammations can also indicate Felty's syndrome and should be investigated.

Those affected often have difficulty breathing or pneumonia. Restrictions in movement or in general in everyday life can also indicate the syndrome and should be examined if they also occur over a longer period of time and for no particular reason. Felty syndrome is usually examined and treated by a general practitioner or an orthopedic surgeon. Furthermore, those affected can also be dependent on surgical interventions. The further course depends heavily on the severity of the syndrome, so that no general prediction is possible.

Doctors & therapists in your area

Treatment & Therapy

Felty's syndrome is a special form of rheumatoid arthritis and is characterized by a progressive and chronically recurrent course. Without soothing therapy, most of the female patients can develop an enormous amount of suffering over time.

The therapy will be based on the course of the disease, which always depends on the clinical picture, current laboratory findings or imaging to show deformations or destruction of the affected joints. A differential diagnosis should also be carried out prior to treatment in order to rule out systemic lupus erythematosus or pseudo-felty syndrome. For this purpose, biopsy of inflammatory fluid from skin ulcers may be necessary to confirm vasculitis diagnostically.

Particularly in the acute stage, treatment is carried out with high-dose corticosteroids, either orally or with the active ingredient methotrexate as an infusion therapy. Due to the already low leukocyte count, close blood counts are necessary during the entire therapy cycle. In addition, the injection of preparations with gold salts has proven itself as a therapeutic approach. The side effects of the treatment lead in quite a few cases to the premature termination of a therapy cycle.

If the leukocytes drop too sharply, there may also be a pronounced tendency towards infection or open leg ulcers that do not heal well. In this particularly severe form of Felty's syndrome, after a critical evaluation, surgical and complete removal of the spleen, a splenectomy, may be indicated.

Outlook & forecast

Felty syndrome is a serious complication of rheumatoid arthritis. When this disease occurs, the prospect of a cure is usually no longer given.Those affected can be treated sympathetically, but the physical complaints that have already arisen cannot be remedied by drug and physiotherapeutic therapy.

The older the patient, the worse the prognosis. In young people, for example, there is a chance that arthritis will improve despite Felty's syndrome if the prescribed medication and other accompanying measures show the desired effect.

In older people, the administration of appropriate preparations can only relieve pain. In the course of the disease, other concomitant diseases such as swelling of the lymph nodes and granulocytopenia appear, which additionally worsen the prognosis. Felty syndrome therefore does not offer a positive prognosis.

The suffering significantly reduces the quality of life and the well-being of the patient. This often leads to psychological complaints, which in turn are associated with complications. Felty syndrome does not reduce life expectancy. However, the syndrome increases the risk of accidents and falls at home and at work.

prevention

As a special form of rheumatoid arthritis, direct prevention of Felty's syndrome is unfortunately not possible. Felty syndrome is a serious rheumatism complication and is considered incurable. Rheumatics should adapt their way of life to their illness. The renouncement of stimulant poisons and a change in diet may not heal, but have the potential to reduce the inflammatory reactions.

The diet should be plant-based and acid-forming products such as meat or sweets should only be consumed in moderation. As a preventive measure, everything should be done to maintain the mobility of the affected joints.

Aftercare

As a rule, the options for follow-up care for Felty syndrome are severely limited, so that those affected are primarily dependent on the treatment of the symptoms. A complete cure may not always occur, so that the life expectancy of the person affected may also be limited or significantly reduced by the Felty Syndrome.

In most cases, however, an early diagnosis has a positive effect on the course of this syndrome. Treatment is often carried out through surgical interventions that are intended to restore the joints. There are no particular complications. However, the person affected should always take it easy after these procedures and not unnecessarily strain their body.

Exhausting activities or sporting activities should also be avoided, whereby stress should also be avoided. Physiotherapy measures should also be initiated after the treatment of Felty's syndrome, whereby many exercises from this therapy can also be performed in your own home.

Since in Felty syndrome it is usually necessary to take medication, attention should be paid to correct and regular intake. The care and support of those affected by outsiders also has a positive effect on the course of the Felty Syndrome and can prevent psychological upsets.

You can do that yourself

In the case of Felty syndrome, the sick person should avoid physical overexertion or excessive stress. In everyday life, the joints and bones should be avoided. In addition, the muscles must be warmed up and adequately protected. The body should not be exposed to drafts and obesity should be avoided. Warming baths or going to the sauna help to alleviate the symptoms.

Regular sporting activities are also important to support the immune system. It is important to ensure that sports are practiced that trigger an even and gentle activation of muscles, tendons and nerves.

A healthy and balanced diet helps to fight off pathogens. Physical fitness supports the organism in its daily fight against viruses and bacteria. You should also refrain from consuming nicotine, alcohol or drugs.

In addition to strengthening physical strength, the sick person should maintain a positive attitude. Optimism and confidence are important in order to be able to deal with the disease and its complaints in the best possible way. Relaxation techniques help reduce stress and promote inner balance. They can be used independently and according to individual wishes. The exchange with other people and common leisure activities are also important in order to improve wellbeing.