Felty Syndrome on the USMLE: A difficult topic

Many medical students are aware felty syndrome usmle questions, topics, and how the angle’s of this topic work. This is a tough topic and there are a lot to it, but before we get into what felty syndrome usmle is or how it presents in questions on the USMLE let’s first talk about what felty syndrome actually means. Felty Syndrome (FS) comes from an immune response that occurs with people who have rheumatoid arthritis (RA). The immune system creates antibodies called antinuclear antibodies that attack cells in the body. These antibodies can cause inflammation which then leads to tissue damage. Let’s get to the details of it!

felty syndrome usmle

Felty Syndrome Mnemonic

A well known mnemonic for this is SANTA.

S: Splenomegaly

A: Anemia

N: Neutropenia

T: Thrombocytopenia

A: Arthritis

Remember this, it will likely show up on the internal medicine shelf/comat and the USMLE!

Felty Syndrome Triad

The triad of felty syndrome is:

  • Rheumatoid arthritis
  • Anemia
  • Splenomegaly

If you see those three together in a question stem, then always think of felty syndrome and RA.

Felty Syndrome USMLE topic

This is a tricky topic because many medical students do not know what felty syndrome is. A lot of the times, this term is used as a way to describe a syndrome including rheumatoid arthritis (RA). If you are asked about FS on your exam then they may be asking about RA or anemia from decreased production of erythropoietin.

Felty syndrome is a complication of RA and involves three things: RA, Neutropenia, and splenomegaly.

Watch for these three things, and if they are present then start to think about felty syndrome.

What is Felty Syndrome

This is an immune response to Rheumatoid Arthritis that causes anemia (neutropenia), splenomegaly, and is associated with Rheumatoid Arthritis.

The important thing to know is what is associated with felty syndrome, and then how to diagnose it.

Occasionally the practice questions or the questions on the real deal will focus on those three things and then the tests you should order to formally diagnose it.

Rheumatoid Arthritis

Let’s first discuss what this means about rheumatoid arthritis (RA). In RA, there is inflammation of the synovial membrane which leads to destruction and loss of healthy tissue from the joints. As a result, RA can cause deformity as well as impaired function in terms of movement for those with this condition. The reason why this is important when it comes to the USMLE and felty syndrome usmle topics, questions, etc. is because you need to be aware of a condition that can cause severe damage in affected joints. This will not only affect your exam but also their day-to-day lives as well!

felty syndrome usmle

How to Diagnose this on the USMLE

To diagnose this on the USMLE you will have to get a complete blood count or CBC, a rheumatoid factor of (RF), and then understand the physical exam findings that support this diagnosis of early rheumatoid arthritis and its complication.

Here are some of the signs/symptoms that you should watch for in the question vignette:

  • Recurrent bacterial infections, or recurrent infections in general
  • Chronic rheumatoid arthritis symptoms
  • Chronic arthritis symptoms in general
  • Extra articular manifestations, like skin changes

RA can be a slow disease progression, so it is tough to notice it. It is key to realize who is at an increased risk.

What to do for treatment?

There are a few different ways to treat this, and you absolutely need to verify this with the latest treatment guidelines, and this is not the definitive way to treat this in the clinical setting, but it is what is typically the option on your exam.

You treat this with immunosuppressive therapy, as sometimes granulocyte colony stimulating factor and this helps to ramp up the immune response, so treating the RA with immune suppression will decrease the likelihood of felty syndrome developing.

The other way is with steroids, which can help control the inflammation.

The disease progression explained

What happens in this immune response?

The antinuclear antibodies or ANAs create blockages to erythropoietic production of red blood cells (RBCs) and result in anemia. The mechanism on how they do that is not completely understood but it is a blockage in the erythropoietic process of RBCs.

Here are some other things to remember:

Rheumatoid factor, or RF can be positive and will help diagnose this condition/complication on your tests! The ANA test may be negative initially which means it needs time before you see any positive results, so be aware of this. When you do see a positive result for the ANA test it is likely because there has been an increase in RBCs and therefore production or red blood cells (RBC).

This condition can also affect other organ systems like the spleen and liver, which means that if they are affected then we need to be aware of the complications from those organ systems being affected.

In terms of treatment, this condition can potentially affect your day-to-day life even more so than RA itself! If you have a problem with anemia it means that there is a decreased oxygen carrying capacity and therefore a lack of erythropoietic activity going on as well as a decrease in RBCs.

Is felty Syndrome Fatal?

This is a chronic condition and will last for a lifetime, but we don’t know the specific prognosis of this. It does significantly increase your risk for other organ damage, so it is important to be aware of that!

The good news about CHF or other organ damages in relation to felty syndrome usmle questions or topics is that if you are able to get treatment for this condition then you will reduce the likelihood of developing the chronic organ damage that is sometimes seen with it.

It’s tough, but if you’re well prepared than it won’t be as difficult when it comes to your exams! This is just one topic that can show up on your USMLE and we have a lot more resources here so check those out and good luck on your tests!


This one is a tough topic, but we have a lot of resources here to help you with it. If you remember those important points especially at the beginning of this post, then you will do just fine!

I hope this helps and if you have any other questions just post in the comment section below!

Similar Posts