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Felty Syndrome: Enlarged Spleen and Frequent Infections in Rheumatoid Arthritis

Posted on November 15, 2021
See how 180 members reacted on this article
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Anastasia Climan

Frequent infections are an unfortunate part of life for some people with rheumatoid arthritis (RA). One member of myRAteam wrote, “In the past year, I had three urinary infections, a respiratory infection, ear infection, and a sinus infection.” Another stated, “This year, I have had bronchitis, two sinus infections, and my very first UTI (urinary tract infection).”

A weakened immune system is common in people with RA, and certain RA medications can suppress the immune system and make you more vulnerable to recurrent infections from bacteria and viruses. However, a rare condition called Felty syndrome is sometimes to blame.

Learning to recognize the signs of Felty syndrome will help you avoid frequent sick days and trips to the doctor. Here’s what you should know about Felty syndrome and ways to keep your immune system healthy with RA.

What Is Felty Syndrome?

Felty syndrome is named after the American physician, Augustus Felty, who was the first recorded person to identify the condition at Johns Hopkins Hospital in 1924. The National Organization for Rare Disorders defines Felty syndrome as “splenomegaly with rheumatoid arthritis.” In addition to an enlarged spleen, those with Felty syndrome also have neutropenia (a low white blood cell count).

Experts estimate that between 1 percent to 3 percent of people with RA experience Felty syndrome. It usually shows up about 16.1 years after the initial RA diagnosis, affecting primarily white females in middle age. The exact cause of Felty syndrome is unknown, but multiple genetic risk factors have been identified. Fortunately, the more widespread use of effective rheumatoid arthritis treatments has led to a decline in Felty syndrome.

Symptoms of Felty Syndrome

People with Felty syndrome have many of the classic signs of feeling “under the weather.” They’re more likely to experience skin and respiratory infections. Symptoms may include:

  • Fatigue
  • Fever
  • Joint pain and stiffness
  • Red, irritated eyes
  • Weakness in the arms and legs
  • Weight loss

Your doctor may be able to feel an enlarged spleen during a physical exam or use imaging tests, such as an ultrasound, computed tomography, or X-rays for diagnosis. The spleen is located on the left side of the body, just below the rib cage. An enlarged spleen can press on your stomach and affect your eating habits. Many people don’t notice the symptoms of spleen enlargement, but these can include early satiety (feeling full) after eating a small amount, or a loss of appetite. Pain in the upper left abdomen that may extend to the left shoulder is another symptom.

Spleen enlargement can happen in response to a passing cold or as part of an ongoing problem, like Felty syndrome. Because the spleen’s job is to filter damaged blood cells and help produce neutrophils, the signs of an enlarged spleen can be seen in blood test results.

Felty syndrome may also cause discoloration and ulcers or sores on the lower leg, as well as an enlarged liver (hepatomegaly) and lymph nodes. Blood vessels may become inflamed, and reduced levels of red blood cells (anemia) and platelets (thrombocytopenia) can impair the blood’s ability to clot. People with rheumatic diseases and other autoimmune diseases should keep a close eye on any unexpected changes to their health or the way they look and they feel.

Treatment of Felty Syndrome

Felty syndrome doesn’t always require specific treatment. Start by getting a better handle on your RA to help improve your other symptoms. For example, medications like methotrexate, Rituxan (rituximab), or granulocyte-colony stimulating factor can help boost your neutrophil count.

If you’re not feeling well, your rheumatologist will advise you to take appropriate measures to feel better with heating pads, extra rest, and over-the-counter medicines. You should not stop taking your RA medication or make other changes to your care plan without speaking to your doctor.

In some cases, surgical removal of the spleen (splenectomy) is recommended. Removing the spleen tends to reduce blood abnormalities and chronic bacterial infections in the short term, but more research on the long-term effects is needed. People with RA and Felty syndrome who have severe infections like pneumonia, septicemia, or leg ulcers that won’t heal are most likely to be given a splenectomy.

Preventing Infections

People with any form of autoimmune disease should use extra caution to avoid getting sick, especially during cold and flu season. Staying away from large crowds, washing your hands, avoiding people who have cold symptoms, eating healthy, getting regular exercise, and making sleep a priority are all essential steps to protect your body against pathogens. Talk to your doctor to make sure you’re up to date on any recommended vaccinations and health screenings.

When to Talk to Your Doctor

When you have RA, it’s important to inform your doctor if you experience any new or worsening symptoms. It can be easy to mistake Felty syndrome with an RA flare-up, but getting a blood test and a physical exam can provide more information about your health. If you notice the symptoms of an enlarged spleen, let your rheumatologist know right away. Enlarged spleens are at higher risk of rupture in response to trauma like a car accident, which can lead to life-threatening abdominal bleeding.

Getting adequate treatment for RA can reduce the likelihood of complications like Felty syndrome. If you’re feeling run down or getting sick more than usual, listen to your body and find the support you need to get back on track.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis, more than 169,000 members come together to ask questions, give advice, and share their stories with those who understand life with RA.

Have you experienced an enlarged spleen and frequent infections with RA? Share your story in the comments below, or start a conversation by posting on your Activities page.

A myRAteam Member said:

Thanks for sharing. Answered my question about rib pain!

posted about 21 hours ago

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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Anastasia Climan is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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