Rheumatoid Arthritis and Low White Blood Cell Count

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Neutropenia in people with rheumatoid arthritis (RA) is a rare condition. Typically, it affects those with Felty syndrome and enlarged /swollen spleen (an organ located in the upper part of the belly).


The exact cause of how RA triggers and cause low white blood cell count may be not fully understood yet. But in general, the chronic condition of overwhelming inflammation might be the answer.

Felty syndrome

Typically, it is triad of neutropenia, RA, and enlarged spleen. Though it was first found in 1924, but the cause is not known.

It is usually found in those with RA for more than one decade, particularly those who have poorly-controlled advanced RA with extra-articular manifestations. It is very rare – it affects not more than 1 percent of people with RA.

Since it typically involves low white blood cell count (especially low neutrophil count), people with it are at high risk of infection (recurrent infections). Other symptoms may include:

  1. Weight loss (not done on purpose).
  2. Changes in appetite, especially loss of appetite.
  3. Anorexia might also occur in people with this syndrome.
  4. General feeling of illness or discomfort (Malaise). This may be followed with fatigue, too.
  5. Eye problems, such as redness, dryness, irritation, or even painful eyes.
  6. Pale skin.
  7. Pain due to swollen spleen.
  8. And symptoms of RA.

People with Felty syndrome are usually already taking treatments for RA.

Methotrexate is a kind of disease-modifying antirheumatic drug. It is a common medication for RA that may also help improve and treat low white blood cell count.

Even if necessary, doctor may recommend the removal of the spleen, too.


Enlarged (swollen) spleen

Chronic inflammatory conditions such as RA could pose the risk of developing splenomegaly (enlarged or swollen spleen). In general, spleen is important to help filter blood, fight infections and germs.

The bad news, splenomegaly doesn’t cause any symptom in some cases. Even in fact, it is often found during a routine physical exam.


*Image credit to A.D.A.M health solution

If it does cause symptoms, these may include:

  1. Recurrent infections.
  2. Easy to bleed.
  3. Fatigue.
  4. Anemia.
  5. Easier for fullness, even it may occur without eating. Typically, it occurs when the enlarged spleen is large enough to press the stomach.
  6. Pain in the left upper abdomen. It may be felt in the left shoulder, too.

RA is not the only one. There are a number of different causes of splenomegaly. These include infections (either bacterial, viral, or parasitic infections such as malaria), problems that affect liver, some hemolytic anemia types (problems related to premature devastation of red blood cells), some metabolic disorders, and cancers of blood.

If underlying condition is identified, the treatment plan can be focused to treat the cause. Spleen removal with surgery may be suggested if the cause is not known and the problem gets worse.


Low white blood count in people with RA should be investigated clearly. In those who do have Felty syndrome, RA is more difficult to treat and they are more likely to have recurrent infections.

Fortunately, the incidence of Felty syndrome in RA is decreasing. It seems that the use and development of more effective treatment options for RA have an impact on this decline.

Citations /references:

  1. http://www.mayoclinic.org/symptoms/low-white-blood-cell-count/basics/causes/sym-20050615
  2. http://www.patient.co.uk/doctor/full-blood-count
  3. http://www.nlm.nih.gov/medlineplus/ency/article/000445.htm
  4. http://umm.edu/health/medical/ency/images/enlarged-spleen


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