Felty syndrome is a rare disorder that involves rheumatoid arthritis, a swollen spleen, decreased white blood cell count, and repeated infections.

The cause of Felty syndrome is unknown. It is more common in people who have had rheumatoid arthritis for a long time. People with this syndrome are at risk of infection because they have a low white blood cell count.

• General feeling of discomfort (malaise)
• Fatigue
• Loss of appetite
• Unintentional weight loss
• Pale-looking skin
• Joint swelling, stiffness, pain, and deformity
• Recurrent infections
• Eye burning or discharge

A physical examination will show:

• Swollen spleen
• Joints that show signs of rheumatoid arthritis
• Possibly swollen liver and lymph nodes

A complete blood count ( CBC) may show decreased number of white blood cells called neutrophils.

An abdominal ultrasound may confirm a swollen spleen.

Persons with this syndrome are usually already receiving treatment for rheumatoid arthritis. They may need other medicines to suppress their immune system.

Some people benefit from removal of the spleen (splenectomy).

Rheumatoid arthritis is likely to get worse.

You may have infections that keep returning.

Call for an appointment with your health care provider if you develop symptoms of this disorder.

There is no known prevention.

Pinals RS. Felty's syndrome. In: Firestein GS, Budd RC, Harris Jr. ED, McInnes IB, Ruddy S, eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: WB Saunders; 2008: chap 68.

It is not unusual for Anemia or "low blood" to accompany rheumatoid arthritis. Anemia indicates a low number of red blood cells and that these cells are low in hemoglobin, the substance that carries oxygen through the body. A low white blood cell count (leukopenia) can occur as a result of Felty's syndrome which is a complication of rheumatoid arthritis that is also characterized by enlargement of the spleen.

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There is inflammation in your joints so if arthritis is not slowed then it can affect other organs and systems of the body including:

· Heart: A collection of fluid around the heart from inflammation is not uncommon in rheumatoid arthritis. This usually causes only mild symptoms, if any, but it can be very severe. Rheumatoid arthritis-related inflammation can affect the heart muscle, the heart valves, or the blood vessels of the heart (coronary arteries).

· Lungs: Rheumatoid arthritis' effects on the lungs may take several forms. Fluid may collect around one or both lungs and is referred to as pleuritis. Less frequently, lung tissues may become stiff or overgrown, referred to as pulmonary fibrosis. Any of these effects can have a negative effect on breathing.

· Kidneys: The kidneys are not usually affected directly by rheumatoid arthritis. Kidney problems in rheumatoid arthritis are much more likely to be caused by medications used to treat the condition.

· Blood vessels: Inflammation of the blood vessels can cause problems in any organ but are most common in the skin, where they appear as purpura or skin ulcers.

· Blood: Anemia or "low blood" is a common complication of rheumatoid arthritis. Anemia means that you have an abnormally low number of red blood cells and that these cells are low in hemoglobin, the substance that carries oxygen through the body. (Anemia has many different causes and is by no means unique to rheumatoid arthritis.) A low white blood cell count (leukopenia) can occur from Felty's syndrome, a complication of rheumatoid arthritis that is also characterized by enlargement of the spleen.

· Eyes: The eyes commonly become dry and/or inflamed in rheumatoid arthritis. This is called Sjögren syndrome. The severity of this condition depends on which parts of the eye are affected. There are many other eye complications of rheumatoid arthritis that often require the attention of an ophthalmologist.

New to the world of medical coding? ICD-9-CM codes are used throughout the healthcare industry to describe diseases, injuries, symptoms and conditions. CPT codes are used to describe medical and surgical services performed by healthcare providers. ICD-9-CM codes and CPT codes are inherently related, as the diagnosis (ICD-9-CM code) must support the procedure (CPT code). All Medicaid and Medicare claims require a valid ICD-9-CM diagnosis code and a CPT procedure code in order to be reimbursed. Turn to ICD9Data.com as your free expert source for everything related to diagnosis coding.

these are the oly references that I could find to rheumatiod

ICD-9-CM Diagnosis 714.30Chronic or unspecified polyarticular juvenile rheumatoid arthritis

• rheumatoid arthritis of children occurring in three major subtypes defined by the symptoms present during the first six months following onset: systemic onset (Still's Disease, Juvenile Onset), polyarticular onset, and pauciarticular onset; adult onset cases of Still's disease (Still's Disease, adult onset) are also known; only one subtype of juvenile rheumatoid arthritis (polyarticular onset, rheumatoid factor positive) clinically resembles adult rheumatoid arthritis and is considered its childhood equivalent.

ICD-9-CM Diagnosis 714.0Rheumatoid arthritis

• chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures; etiology is unknown, but autoimmune mechanisms have been implicated.
• A chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures. Etiology is unknown, but autoimmune mechanisms have been implicated.

RA is a disease that is often accompanied by a high Rheumatoid factor (RF), however a person can have RA with no RF at all. When this happens it is described as "seronegative rheumatoid arthritis".

RA is an autoimmune disease where the body's own immune system attacks tissue It can cause joint damage, chronic pain, loss of function and disability of joints.

This type of arthritis is a long term chronic illness that can stay with people for many years or life.

Symptoms

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of undetermined etiology involving primarily the synovial membranes and articular structures of multiple joints. The disease is often progressive and results in pain, stiffness, and swelling of joints. In late stages deformity and ankylosis develop.

The symptomsInvolving joints,d nerves and muscles of RA are as follows.

Joint pain

Joint swelling

Joint stiffness

Morning joint stiffness

Joint stiffness after inactivity

Joint tenderness

Warm joints

Ankle arthritis

Symmetrical joint pattern - both sides of the body afflicted.

Weight loss

Fatigue

Decreased appetite

Occasional fever

Bouts of mild fever

Episodic flares with remissions

Variable symptoms - different people experience different effects

Skin bumps (rheumatoid nodules) - about 25% of cases get these

Anemia

Neck pain

Dry eyes

Dry mouth

Tiredness

Afternoon fatigue

Joint involvement is typically polyarticular and symmetrical, (happens in more then one joint at a a time and often affects the same joints on opposite sides of the body.) usually sparing the distal interphalangeal (DIP) joints. Joint involvement and inflammation is evinced by the following:

Edema

Effusion

Warmth

Tenderness to palpation

Destruction of joint in advanced stages

other symptoms may manifest themselves in the skin and other organs of the body.

Subcutaneous rheumatoid nodules,

Swan-neck deformities,

Boutonniere deformities,

Ulnar deviation of fingers at MCP joints in advanced stages.

RA a is a systemic disease, that means its inflammation can affect other organs and areas of the body. RA can cause Inflammation of the glands, eyes and mouth the result being dryness of these areas, This is known as Sjogren's syndrome. Rheumatoid inflammation can also lead to pain in the chest with deep breathing. this is the result of inflammation of the lung lining, pleuritis.it can also lead to shortness of breath, or coughing. Lung tissue becoming inflamed can lead to them being scarred and coughing. rheumatoid nodules can sometimes develop in the lungs. Inflammation of the tissue (pericardium) surrounding the heart, called pericarditis, can cause a chest pain that typically changes in intensity when lying down or leaning forward. RA can also lead to anemia. Decreased white cells can be associated with an enlarged spleen (referred to as Felty's syndrome) and can increase the risk of infections. Rheumatoid nodules can occur under the skin around the elbows and fingers where there is frequent pressure. Even though these nodules usually do not cause symptoms, occasionally they can become infected. Nerves can become pinched in the wrists to cause carpal tunnel syndrome. A rare, serious complication, usually with long-standing rheumatoid disease, is blood vessel inflammation (vasculitis). Vasculitis can impair blood supply to tissues and lead to tissue death (necrosis). This is most often initially visible as tiny black areas around the nail beds or as leg ulcers.

Rheumatoid arthritis is a chronic joint disease that damages the joints of the body. It is also a systemic disease that potentially affects internal organs of the body and leads to disability. The joint damage is caused by inflammation of the joint lining tissue. Inflammation is normally a response by the body's immune system to "assaults" such as infections, wounds, and foreign objects. In rheumatoid arthritis, the inflammation is misdirected to attack the joints. Rheumatoid arthritis is often referred to as RA.

• The inflammation in the joints causes pain, stiffness, swelling, and loss of function.
• The inflammation often affects other organs and systems of the body, including the lungs, heart, and kidneys.
• If the inflammation is not slowed or stopped, it can permanently damage the affected joints and other tissues.

Rheumatoid arthritis should not be confused with other forms of arthritis, such as osteoarthritis or arthritis associated with infections. Rheumatoid arthritis is an autoimmune disease. This means that the body's immune system mistakenly attacks the tissues it is supposed to protect.

• The immune system produces specialized cells and chemicals, which are released into the bloodstream and begin to attack body tissues.
• This abnormal immune response causes inflammation and thickening of the membrane (synovium) that lines the joint. Inflammation of the synovium is called synovitis and is the hallmark of an inflammatory arthritis such as rheumatoid arthritis.
• As the synovitis expands inside and outside of the joint, it can damage the bone and cartilage of the joint and the surrounding tissues, such as ligaments, tendons, nerves, and blood vessels.

Rheumatoid arthritis most often affects the smaller joints, such as those of the hands and/or feet, wrists, elbows, knees, and/or ankles, but any joint can be affected. The symptoms often lead to significant discomfort and disability.

• Many people with rheumatoid arthritis have difficulty carrying out normal activities of daily living, such as standing, walking, dressing, washing, using the toilet, preparing food, and carrying out household chores.
• The symptoms of rheumatoid arthritis interfere with work for many people. As many as half of those with rheumatoid arthritis are no longer able to work 10-20 years after their condition is diagnosed.
• On average, life expectancy is somewhat shorter for people with rheumatoid arthritis than for the general population. This does not mean that everyone with rheumatoid arthritis has a shortened life span. Rheumatoid arthritis itself is not a fatal disease. However, it can be associated with many complications and treatment-related side effects that can contribute to premature death.

Although rheumatoid arthritis most often affects the joints, it is a disease of the entire body. It can affect many organs and body systems besides the joints. Therefore, rheumatoid arthritis is referred to as a systemic disease.

• Musculoskeletal structures: Damage to muscles surrounding joints may cause atrophy (shrinking) that results in weakening. This is most common in the hands. Atrophy also may result from not using a muscle, usually because of pain or swelling. Damage to bones and tendons can cause deformities, especially of the hands and feet. Osteoporosis and carpal tunnel syndrome are other common complications of rheumatoid arthritis.
• Skin: Many people with rheumatoid arthritis develop small nodules on or near the joint that are visible under the skin. These rheumatoid nodules are most noticeable under the skin on the bony areas that stick out when a joint is flexed. Dark purplish areas on the skin (purpura) are caused by bleeding into the skin from blood vessels damaged by rheumatoid arthritis. Purpura is particularly common in those patients who have taken cortisone medication. This damage to the blood vessels is called vasculitis, and these vasculitic lesions also may cause skin ulcers.
• Heart: A collection of fluid around the heart (pericardial effusion) from inflammation is not uncommon in rheumatoid arthritis. This usually causes only mild symptoms, if any, but it can be very severe. Rheumatoid arthritis-related inflammation can affect the heart muscle, the heart valves, or the blood vessels of the heart (coronary arteries). Heart attacks are more frequent in patients with rheumatoid arthritis than those without it.
• Lungs: Rheumatoid arthritis' effects on the lungs may take several forms. Fluid may collect around one or both lungs and is referred to as a pleural effusion. Inflammation of the lining tissues of the lungs is known as pleuritis. Less frequently, lung tissues may become stiff or scarred, referred to as pulmonary fibrosis. Any of these effects can have a negative effect on breathing. Lung infections become more common.
• Digestive tract: The digestive tract is usually not affected directly by rheumatoid arthritis. Dry mouth, related to Sjögren's syndrome, is the most common symptom of gastrointestinal involvement. Digestive complications are much more likely to be caused by medications used to treat the condition, such as gastritis (stomach inflammation) or stomach ulcer caused by NSAID therapy. Any part of the digestive tract may become inflamed if the patient develops vasculitis, but this is uncommon. If the liver is involved, it may become enlarged and cause discomfort in the abdomen.
• Kidneys: The kidneys are not usually affected directly by rheumatoid arthritis. Kidney problems in rheumatoid arthritis are much more likely to be caused by medications used to treat the condition. Nevertheless, severe, long-standing disease can uncommonly lead to a form of protein deposition and damage to the kidney, referred to as amyloidosis.
• Blood vessels: Inflammation of the blood vessels can cause problems in any organ but is most common in the skin, where it appears as purple patches (purpura) or skin ulcers.
• Blood: Anemia or "low blood" is a common complication of rheumatoid arthritis. Anemia means that you have an abnormally low number of red blood cells and that these cells are low in hemoglobin, the substance that carries oxygen through the body. (Anemia has many different causes and is by no means unique to rheumatoid arthritis.) A low white blood cell count (leukopenia) can occur from Felty's syndrome, a complication of rheumatoid arthritis that is also characterized by enlargement of the spleen.
• Nervous system: The deformity and damage to joints in rheumatoid arthritis often lead to entrapment of nerves. Carpal tunnel syndrome is one example of this. Entrapment can damage nerves and may lead to serious consequences.
• Eyes: The eyes commonly become dry and/or inflamed in rheumatoid arthritis. This is a result of inflammation of the tear glands and is called Sjögren's syndrome. The severity of this condition depends on which parts of the eye are affected. There are many other eye complications of rheumatoid arthritis, including inflammation of the whites of the eyes (scleritis), that often require the attention of an ophthalmologist.

Like many autoimmune diseases, rheumatoid arthritis typically waxes and wanes. Most people with rheumatoid arthritis experience periods when their symptoms worsen (known as flares or active disease) separated by periods in which the symptoms improve. With successful treatment, symptoms may even go away completely (remission, or inactive disease).

About 1.3 million people in the United States are believed to have rheumatoid arthritis.

• About 75% of these are women. Women are two to three times more likely to develop rheumatoid arthritis than men.
• Rheumatoid arthritis affects all ages, races, and social and ethnic groups.
• It is most likely to strike people 35-50 years of age, but it can occur in children, teenagers, and elderly people. (A similar disease affecting young people is known as juvenile rheumatoid arthritis.)
• Worldwide, about 1% of people are believed to have rheumatoid arthritis, but the rate varies among different groups of people. For example, rheumatoid arthritis affects about 5%-6% of some Native-American groups, while the rate is very low in some Caribbean peoples of African descent.
• The rate is about 2%-3% in people who have a close relative with rheumatoid arthritis, such as a parent, brother or sister, or child.

Although there is no cure for rheumatoid arthritis, the disease can be controlled in most people. Early, aggressive therapy, soon after the initial diagnosis, is optimally targeted to stop or slow down inflammation in the joints can prevent or reduce symptoms, prevent or reduce joint destruction and deformity, and prevent or lessen disability and other complications.

I am male and have suffered from the symptoms of rheumatoid arthritis since I was less than 10 years old. fortunately It was never so much of a problem in those days as to have warranted a great deal of attention However at about age 40 I did end up having bouts of pain that at times were very intense. My mother had suffered from RA and had developed a philosophical point of view about it and just pressed on. So I did the same, which was a big mistake. My arthritis got progressively worse until when I was about 55 I reached a point where, at times, just getting out of the car had started to become a bit of a challenge. Occasionally I would see a doctor and he would prescribe some non steroidal anti inflammatory and this would settle it down again for a while. However one day one of the people at my work pointed out to me that one of my elbows was badly swollen. I took this to my doctor and as it turned out ended up seeing a different doctor from the usual. to cut a long story short he suspected RA and initiated tests to check this out. In the mean time He put me onto a fairly heavy dose of prednisone which brought the swelling in the elbow and some discomfort and minor swelling in other joints under control. When the results from blood tests and X ray came in they indicated that I had a high Rheumatoid factor accompanied with joint damage to a greater or lesser degree all over my body. (Mind you at this time I was still very active in the construction industry and was often engaged in a very physical capacity. As a result of the outcome of the tests I was referred to a Rheumatologist along with a folder full of joint x rays and test results. After an initial examination He informed me that we would start of by reducing the inflammation by using Prednisone ( Prednisone is a steroidal anti inflammatory that is widely used with inflammatory arthritis) prednisone is usually taken only every morning with food. Also a drug called Methotrexate once a week was prescribed. (Methotrexate is a disease modifying drug that interferes with the ability of the immune system to be able to produce the cells that cause the destructive inflammation that is at the root of RA). Methotrexate needs to be accompanied with folic acid taken daily, to protect you from liver damage. After about 6 month of this the amount of prednisone was reduced gradually until it was down to 5ml per day, ideally no prednisone is best. during the set ling down period I consulted my rheumatologist every 3 months and because I was taking Methotrexate I needed to have a blood test to keep an eye open for liver toxicity at first monthly which has now set led down to 3 monthly, these blood tests also check for inflammation, blood count sometimes RF and a couple of other things that I cant think of right now. In any case everything seemed to be under control except the elbow which was going from bad to worse, Another disease modifying drug was added by the name of Plaquenil to make further modifications to the immune system, however Alas I was too late to save the elbow so at a certain point I was referred to a orthopedic surgeon to have it replaced with a new metal one. That went well even though not quite as good as the real thing as it does have limits on what you can do with it. In any case I am 62 now and have been getting organized treatment for RA for about 6 years. I have to take a few different tablets in the mornings, one at night, and a blood test every 3 months, visit my rheumatologist every 6 months. Because of the drugs I take have to be more careful to stay out of the way of infectious diseases like flu. Believe me even if you did not have a problem with them before you will be far more susceptible to them wit a compromised immune system. Make flu shots part of the treatment. And keep an eye on your overall health as RA can affect many other organs in the body. Medicine can do great things to improve the quality of life However it is important also to maintain your own positive outlook as getting depressed about things that you can not change will cause stress, and emotional stress in my experience is one of the things that causes RA to flare. This is probably why more women suffer from it then men.