Association of Sjogren's and Felty's Syndromes
Authors: K. J. Gurling
Journal: Annals of the Rheumatic Diseases (1953)

Felty (1924) described five cases of chronic rheumatoid arthritis in which he had also noticed splenomegaly, a leucopenia with slight anaemia, pigmentation of the skin, and lymphadenopathy, features which have recently been reviewed by several authors, including Hutt and others (1951), Ytrehus (1946), and Hatch (1945).Sjogren (1933), Gougerot (1926), and Houwer (1927) have drawn attention to the association with rheumatoid arthritis of kerato-conjunctivitis sicca and xerostomia due to the impairment of both lacrimal and parotid gland function, a well-recognized syndrome variously named after these three authors though most frequently referred to as Sj6gren's syndrome.More widespread recognition in the past decade of the many and varied aspects of this syndrome had led to more frequent diagnosis, and full accounts have been published by Sjogren (1943), Bruce (1941), Gifford, Puntenney, and Bellows (1935), Weber (1945), Henderson (1950), and Morgan and Raven (1952).A report of the histology post mortem has recently been published by Ellman, Weber, and Goodier (1951).The two patients whose histories are reported in this paper were found to have features of both syndromes when they were examined in 1951 during the course of an investigation into the treatment of Sjogren's disease, the results of which are to be published elsewhere (Pearson, 1953).This asso- ciation does not seem to have been specifically described previously, though, as will be discussed later, similar cases have been mentioned in the literature. Case HistoriesCase 1, Female, aged 61.-Her present illness began in 1946 when she developed rheumatoid arthritis in the thumbs, and later the fingers and wrists.Because the hips, knees, and feet also became involved, she sought treatment, and a leucopenia was discovered when myocrisin injections were contemplated.The arthritis had persisted with a moderate degree of activity ever since though she was never greatly incapacitated.In September, 1951, the spleen and liver were found to be enlarged, and as the leucopenia persisted, a diagnosis of Felty's syndrome was suggested.Shortly before this time she first noticed irritation of the eyes and lids, though these symptoms were not severe.Her mouth also became dry and she had vague sore throats with frequent super- ficial buccal and gingival ulcers.She had also felt tired and in generally poor health during the previous year.Previous History.-Recurrentbronchitis with mucoid or muco-purulent sputum.Amenorrhoea since 1939.Family Histor*v.-None of arthritis or anaemia.General Examination.-InNovember, 1951, she appear- ed pale and anaemic, but otherwise reasonably fit.The skin was dry but not pigmented and there were a few petechiae on the lips, abdomen, and shins.The left parotid gland was slightly enlarged, firm, and painless; no pus could be massaged from the duct.Her tongue was large, red, and abnormally smooth, fissured, and dry, but no ulcers were present in the mouth.Weight 7 st. 5lb.(47 kg.).Respiratory System.-Afew rales were audible over both lower lobes.Cardiovascular System.-Normal.Blood pressure 140/90.Abdomen.-Liver smooth, firm, and considerably enlarged, spleen readily palpable.Joints.-Typical chronic rheumatoid arthritis affecting hands, elbows, hips, knees, and feet, with mild residual deformities.Some pain but little sign of disease activity.Lymphatic System.-Afew palpable glands in the neck and both groins which were not clearly pathological; moderate splenic enlargement the only indication of hyperplasia.Laboratory Investigations (November, 1951) Blood.Hb. 62 per cent.(9-2 g.) Haldane.Red blood cells, 3,600,000; Colour index, 0 86.Mean cell volume, 82 cu.V.; Mean cell haemoglobin concentration, 31 per cent.;Packed cell volume, 29*5 mm.Platelets, 95,000 c.mm. White blood cells, 1,100.Neutrophils, 4 per cent.;Eosinophils, 5 per cent.;Basophils, I per cent.;Lymphocytes, 75 percent.;Monocytes, 15 per cent.212