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Felty's syndrome (FS) (rheumatoid arthritis with neutropenia and splenomegaly) has a poor prognosis, largely because of the high risk of severe infection. Granulocyte colony-stimulating factor (G-CSF) is an emerging treatment for chronic neutropenia. We prospectively monitored its use in eight patients with recurrent infections or who required joint surgery. Significant side-effects were documented in five, including nausea, malaise, generalized joint pains, and in one patient, a vasculitic skin rash. In two patients treatment had to be stopped, and in these cases G-CSF had been started at full vial dosage (300 micrograms/ml filgrastim or 263 micrograms/ml lenograstim) alternate days or daily. G-CSF treatment was continued in three patients by restarting at reduced dose, and changing the proprietary formulation. G-CSF raised the neutrophil count, reduced severe infection, and allowed surgery to be performed. A combined clinical and laboratory index suggested that long-term treatment (up to 3.5 years) did not exacerbate the arthritis. Once on established treatment, it may be possible to use smaller weekly doses of G-CSF to maintain the same clinical benefit. One of the three patients whose FS was associated with a large granular T-cell lymphocytosis showed a reduction in this subset of lymphocytes during G-CSF treatment.

Original publication

DOI

10.1093/qjmed/91.1.49

Type

Journal article

Journal

QJM

Publication Date

01/1998

Volume

91

Pages

49 - 56

Keywords

Adjuvants, Immunologic, Aged, CD8-Positive T-Lymphocytes, Drug Administration Schedule, Felty Syndrome, Female, Filgrastim, Granulocyte Colony-Stimulating Factor, Humans, Lenograstim, Leukocyte Count, Male, Middle Aged, Platelet Count, Prospective Studies, Recombinant Proteins