Rheumatology: Felty syndrome: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Rheumatology: Felty syndrome

Sample item

A 58-year-old woman with long-standing seropositive rheumatoid arthritis with deformed hands, who takes only NSAIDs, has recurrent skin and chest infections. Examination shows splenomegaly, and her neutrophil count is 0.9 x 10^9/L with normal haemoglobin and platelets. What is the most likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Felty syndrome

Felty syndrome is the triad of rheumatoid arthritis, splenomegaly and neutropenia, occurring in severe, seropositive, long-standing disease, often with HLA-DR4. Neutropenia arises from immune destruction, splenic sequestration and marrow suppression, causing recurrent infections. Disease-modifying therapy, particularly methotrexate, is the mainstay, with splenectomy for refractory cases.

Option by option

  • A. Caplan syndrome

    Caplan syndrome is rheumatoid arthritis with pneumoconiosis and lung nodules, with no splenomegaly or neutropenia.

  • B. Sjogren syndrome with lymphoma

    Sjogren syndrome with lymphoma is possible, but nothing here points to sicca symptoms or a mass, and the triad fits better with Felty.

  • C. Felty syndrome (correct)

    Correct. Rheumatoid arthritis with splenomegaly and neutropenia defines Felty syndrome.

  • D. Systemic lupus erythematosus

    Lupus causes cytopenias but is not characterised by deforming seropositive arthritis with splenomegaly in this pattern.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Felty syndrome. Felty syndrome is the triad of rheumatoid arthritis, splenomegaly and neutropenia, occurring in severe, seropositive, long-standing disease, often with HLA-DR4.

Why is "Caplan syndrome" not the answer?

Caplan syndrome is rheumatoid arthritis with pneumoconiosis and lung nodules, with no splenomegaly or neutropenia.

Why is "Sjogren syndrome with lymphoma" not the answer?

Sjogren syndrome with lymphoma is possible, but nothing here points to sicca symptoms or a mass, and the triad fits better with Felty.

Why is "Systemic lupus erythematosus" not the answer?

Lupus causes cytopenias but is not characterised by deforming seropositive arthritis with splenomegaly in this pattern.

What concept does this question test?

It tests Rheumatology: Felty syndrome in General Medicine. Neutropenia arises from immune destruction, splenic sequestration and marrow suppression, causing recurrent infections. Disease-modifying therapy, particularly methotrexate, is the mainstay, with splenectomy for refractory cases.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: Felty syndrome?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.