Neutropenia and Felty Syndrome in the Twenty-First Century: Redefining Ancient Concepts in Rheumatoid Arthritis Patients

Objectives: To describe the frequency of neutropenia and Felty syndrome in patients with rheumatoid arthritis (RA) attended in routine clinical practice. Methods: We selected by randomization a sample of 270 RA patients attended from January 2014 to November 2022. Demographic, clinical, and neutrope...

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Autores: Rodas Flores, Jorge Luis, Hernández-Cruz, Blanca, Sánchez Margalet, Víctor, Fernández-Reboul Fernández, Ana, Fernández Panadero, Esther, Moral García, Gracia, Pérez Venegas, José Javier
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/174811
Acceso en línea:https://hdl.handle.net/11441/174811
https://doi.org/10.3390/jcm13247677
Access Level:acceso abierto
Palabra clave:Rheumatoid arthritis
Neutropenia
DMARDs
Felty syndrome
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spelling Neutropenia and Felty Syndrome in the Twenty-First Century: Redefining Ancient Concepts in Rheumatoid Arthritis PatientsRodas Flores, Jorge LuisHernández-Cruz, BlancaSánchez Margalet, VíctorFernández-Reboul Fernández, AnaFernández Panadero, EstherMoral García, GraciaPérez Venegas, José JavierRheumatoid arthritisNeutropeniaDMARDsFelty syndromeObjectives: To describe the frequency of neutropenia and Felty syndrome in patients with rheumatoid arthritis (RA) attended in routine clinical practice. Methods: We selected by randomization a sample of 270 RA patients attended from January 2014 to November 2022. Demographic, clinical, and neutropenia-related variables were collected from the electronic medical records. Neutropenia was defined as having an absolute neutrophil count (ANC) of less than 1500/mm3 once, and acute if it persisted for <3 months. Felty syndrome was defined as RA-related neutropenia, rheumatoid factor (RF) and/or anti citrullinated protein antibody (ACPA) positivity. Results: We found 50 patients who had at least one neutropenia episode, with an incidence of 18.5% (14.0–25.6%). Most were women, with age (mean, p25–p75) at the time of neutropenia of 61.5 (57.4–69.3) years, 85% RF+and 76% ACPA+. The demographic and RA characteristics of patients with and without neutropenia were very similar, except for sex: most patients with neutropenia were women. The 50 patients had 99 episodes of neutropenia; 59% were acute. The lower ANC was 1240 (1000–1395) mm3, and most of the episodes were mild (74%). In 32% of cases, there was other cytopenia. The RA activity measured by DAS28 in patients with neutropenia was low, at 2.18 (1.75–2.97). A total of 82 of 99 neutropenia episodes were related to DMARDs, 60% to Anti-IL6 drugs in monotherapy, 13% to RA activity, 3% to infectious diseases and 1% to hematologic malignancy. There were five (1.8%) cases with Felty syndrome, but only one woman with the classic combination of RA, positivity of autoantibodies (RF and ACPA), neutropenia and splenomegaly. Conclusions: In the 21st century, neutropenia in RA patients is most commonly related to biologics, mostly IL6 inhibitors and methotrexate. Episodes are mild, acute, with low RA activity, and associated with severe infections in few cases. Felty syndrome is rare.MDPIBioquímica Médica y Biología Molecular e InmunologíaCTS151: Bioquímica Medica2024info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/174811https://doi.org/10.3390/jcm13247677reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésJournal of clinical medicine, 13 (24), 7677.https://www.mdpi.com/2077-0383/13/24/7677info:eu-repo/semantics/openAccessoai:idus.us.es:11441/1748112026-06-17T12:51:07Z
dc.title.none.fl_str_mv Neutropenia and Felty Syndrome in the Twenty-First Century: Redefining Ancient Concepts in Rheumatoid Arthritis Patients
title Neutropenia and Felty Syndrome in the Twenty-First Century: Redefining Ancient Concepts in Rheumatoid Arthritis Patients
spellingShingle Neutropenia and Felty Syndrome in the Twenty-First Century: Redefining Ancient Concepts in Rheumatoid Arthritis Patients
Rodas Flores, Jorge Luis
Rheumatoid arthritis
Neutropenia
DMARDs
Felty syndrome
title_short Neutropenia and Felty Syndrome in the Twenty-First Century: Redefining Ancient Concepts in Rheumatoid Arthritis Patients
title_full Neutropenia and Felty Syndrome in the Twenty-First Century: Redefining Ancient Concepts in Rheumatoid Arthritis Patients
title_fullStr Neutropenia and Felty Syndrome in the Twenty-First Century: Redefining Ancient Concepts in Rheumatoid Arthritis Patients
title_full_unstemmed Neutropenia and Felty Syndrome in the Twenty-First Century: Redefining Ancient Concepts in Rheumatoid Arthritis Patients
title_sort Neutropenia and Felty Syndrome in the Twenty-First Century: Redefining Ancient Concepts in Rheumatoid Arthritis Patients
dc.creator.none.fl_str_mv Rodas Flores, Jorge Luis
Hernández-Cruz, Blanca
Sánchez Margalet, Víctor
Fernández-Reboul Fernández, Ana
Fernández Panadero, Esther
Moral García, Gracia
Pérez Venegas, José Javier
author Rodas Flores, Jorge Luis
author_facet Rodas Flores, Jorge Luis
Hernández-Cruz, Blanca
Sánchez Margalet, Víctor
Fernández-Reboul Fernández, Ana
Fernández Panadero, Esther
Moral García, Gracia
Pérez Venegas, José Javier
author_role author
author2 Hernández-Cruz, Blanca
Sánchez Margalet, Víctor
Fernández-Reboul Fernández, Ana
Fernández Panadero, Esther
Moral García, Gracia
Pérez Venegas, José Javier
author2_role author
author
author
author
author
author
dc.contributor.none.fl_str_mv Bioquímica Médica y Biología Molecular e Inmunología
CTS151: Bioquímica Medica
dc.subject.none.fl_str_mv Rheumatoid arthritis
Neutropenia
DMARDs
Felty syndrome
topic Rheumatoid arthritis
Neutropenia
DMARDs
Felty syndrome
description Objectives: To describe the frequency of neutropenia and Felty syndrome in patients with rheumatoid arthritis (RA) attended in routine clinical practice. Methods: We selected by randomization a sample of 270 RA patients attended from January 2014 to November 2022. Demographic, clinical, and neutropenia-related variables were collected from the electronic medical records. Neutropenia was defined as having an absolute neutrophil count (ANC) of less than 1500/mm3 once, and acute if it persisted for <3 months. Felty syndrome was defined as RA-related neutropenia, rheumatoid factor (RF) and/or anti citrullinated protein antibody (ACPA) positivity. Results: We found 50 patients who had at least one neutropenia episode, with an incidence of 18.5% (14.0–25.6%). Most were women, with age (mean, p25–p75) at the time of neutropenia of 61.5 (57.4–69.3) years, 85% RF+and 76% ACPA+. The demographic and RA characteristics of patients with and without neutropenia were very similar, except for sex: most patients with neutropenia were women. The 50 patients had 99 episodes of neutropenia; 59% were acute. The lower ANC was 1240 (1000–1395) mm3, and most of the episodes were mild (74%). In 32% of cases, there was other cytopenia. The RA activity measured by DAS28 in patients with neutropenia was low, at 2.18 (1.75–2.97). A total of 82 of 99 neutropenia episodes were related to DMARDs, 60% to Anti-IL6 drugs in monotherapy, 13% to RA activity, 3% to infectious diseases and 1% to hematologic malignancy. There were five (1.8%) cases with Felty syndrome, but only one woman with the classic combination of RA, positivity of autoantibodies (RF and ACPA), neutropenia and splenomegaly. Conclusions: In the 21st century, neutropenia in RA patients is most commonly related to biologics, mostly IL6 inhibitors and methotrexate. Episodes are mild, acute, with low RA activity, and associated with severe infections in few cases. Felty syndrome is rare.
publishDate 2024
dc.date.none.fl_str_mv 2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/174811
https://doi.org/10.3390/jcm13247677
url https://hdl.handle.net/11441/174811
https://doi.org/10.3390/jcm13247677
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Journal of clinical medicine, 13 (24), 7677.
https://www.mdpi.com/2077-0383/13/24/7677
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
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