Longterm outcome of treatment of Felty's syndrome with intramuscular gold: case reports and recommendations for management.
OBJECTIVE: To evaluate the incidence, complications, and course of Felty's syndrome (FS) in patients treated with intramuscular (IM) gold. METHODS: Retrospective chart review of all FS cases (1979 to 2003) was conducted in the Mary Pack Arthritis Centre (MPAC) gold clinic. FS was diagnosed if patients had rheumatoid arthritis (RA; American College of Rheumatology criteria) and persistent leukopenia [white blood cell (WBC) count < 4] in the absence of other known causes of leukopenia. Splenomegaly was not part of the inclusion criteria. RESULTS: Thirteen patients with FS were identified in the gold clinic population. The mean age at diagnosis of FS was 58.7 years and the mean duration of RA at time of diagnosis was 6.9 years. The weekly dose of gold ranged from 10 mg to 50 mg depending on tolerability. Gold therapy resulted in normalization of the WBC count in 9 of 13 patients. The mean time to normalization of the WBC was 40 weeks. Only one patient with FS had experienced recurrent infectious complications from FS, and this did not recur after gold treatment was initiated. No patient had vasculitis. CONCLUSION: In our gold clinic population FS is a mild disease and is rarely associated with infectious complications. Gold is an effective treatment of FS.