Felty’s syndrome and Cannabinoid Treatment for Symptoms

Felty’s syndrome

What is Felty's syndrome?
Felty's syndrome is a complication of long-standing rheumatoid arthritis.  Felty's syndrome is defined by the presence of three conditions:  rheumatoid arthritis, an enlarged spleen (splenomegaly),  and an abnormally low white blood count.  Felty's syndrome is uncommon.  It affects less than one percent  of patients with rheumatoid arthritis.

What causes Felty's syndrome?

The cause of Felty's syndrome is unknown.  Some patients with rheumatoid arthritis develop Felty's syndrome but most do not.  White blood cells are produced in the bone marrow.  There seems to be an active bone marrow function in patients with Felty's syndrome, producing white cells, despite the low numbers of circulating white blood cells.  White cells may be stored excessively in the spleen of a patient with Felty's syndrome.  This is especially true in patients with Felty's syndrome that have antibodies against the particular type of white blood cells usually affected (cells called granulocytes or neutrophils).

Symptoms

The symptoms of Felty's syndrome are similar to those of rheumatoid arthritis.  Patients suffer from painful, stiff, and swollen joints, most commonly in the joints of the hands, feet, and arms.  In some affected individuals, Felty's syndrome may develop during a period when the symptoms  and physical findings associated with rheumatoid arthritis have subsided or are not present.  In this case, Felty's syndrome may remain undiagnosed.  In more rare instances, the development of Felty's syndrome may precede the development of the symptoms and physical findings associated with rheumatoid arthritis.

Felty's syndrome is also characterized by an abnormally enlarged spleen (splenomegaly) and abnormally low levels of certain white blood cells (neutropenia).  As a result of neutropenia, affected individuals are increasingly susceptible to certain infections.

Individuals with Felty's syndrome may also experience fever, weight loss, and/or fatigue.  In some cases, affected individuals may have discoloration of the skin, particularly of the leg (abnormal brown pigmentation), sores (ulcers) on the lower leg, and/or an abnormally large liver (hepatomegaly).  In addition, affected individuals may have abnormally low levels of circulating red blood cells (anemia), a decrease in circulating blood platelets that assist in blood clotting functions (thrombocytopenia), and/or inflammation of the blood vessels (vasculitis).

Symptoms

  • 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

Treatment

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).

The best treatment for Felty's syndrome is to control the underlying RA.  Immunosuppressive therapy for RA often improves granulocytopenia and splenomegaly;  this finding reflects the fact that Felty's syndrome is an immune-mediated disease.  Most of the traditional medications used to treat RA have been used in the treatment of Felty's syndrome.  No well-conducted, randomized, controlled trials support the use of any single agent.  Use of rituximab and leflunomide have been proposed.

Use of gold therapy has also been described.There is no known prevention.

Complications

  • Recurrent Infection,
  • Hypersplenism causing anaemia and thrombocytopenia
  • Lymphadenopathy
  • Skin hyperpigmentation & cutaneous ulceration

Outlook (Prognosis)

Rheumatoid arthritis is likely to get worse.

How does Medical Marijuana (cannabinoids) help with Felty’s syndrome?

http://wn.com/Rheumatoid_Arthritis_and_Marijuana
http://www.youtube.com/watch?v=RLSpWtx4sFA&feature=player_embedded

The use of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. . . . Conclusions:  In the first ever controlled trial of a CBM in RA, a significant analgesic effect was observed and disease activity was significantly suppressed following Sativex treatment.

Cannabinoids help relieve symptoms  in Felty’s syndrome:

  • immuno suppressant properties
  • anti-inflammation properties  (joint swelling)
  • analgesic properties  (painful joints)
  • stimulate appetite
  • C. sativa is anti-fatigue
  • C. indica is anti-malaise

Inflammation is caused by a malfunction in the immune system.  When cannabidiol (CBD) is metabolized in the body, an acid with potent anti-inflammation properties is created.  These new metabolites fight pain and inflammation which relieve some of the symptoms of Felty’s syndrome.

Best  Strains:  Sativa x Indica hybrid (50%/50%)
New York Sour Diesel, White Berry, Kush (s), A-Train.
Tincture under the tongue, Canna Tea, Edibles, Vaporizer

References:



1. Online 'Mendelian Inheritance in Man' (OMIM) 134750
2. Balint GP, Balint PV (Oct 2004). "Felty's syndrome". Best Pract Res Clin Rheumatol 18 (5): 631–645. doi:10.1016/j.berh.2004.05.002.PMID 15454123.
3. Blendis, L. M.; Jones, K. L.; Hamilton, E. B.; Williams, R. (June 1976). "Familial Felty's syndrome" (Free full text). Annals of the Rheumatic Diseases35 (3): 279–281. doi:10.1136/ard.35.3.279. PMC 1006555. PMID 984910. edit
4. "CIGNA - Felty's Syndrome". Retrieved 2008-11-07.
5. "HowStuffWorks "Felty's Syndrome - Medical Dictionary"". Retrieved 2008-11-07.
6. "Felty's Syndrome Causes, Symptoms, Diagnosis and Treatment by MedicineNet.com". Retrieved 2008-11-07.
7. Keating, Richard M.. "eMedicine - Felty's Syndrome". Retrieved 2008-11-07.
8. Chandra PA, Margulis Y, Schiff C (2008). "Rituximab is useful in the treatment of Felty's syndrome". Am J Ther 15 (4): 321–2.doi:10.1097/MJT.0b013e318164bf32. PMID 18645332.
9. Talip F, Walker N, Khan W, Zimmermann B (April 2001). "Treatment of Felty's syndrome with leflunomide". J. Rheumatol. 28 (4): 868–70.PMID 11327265.
10. Michael S. Clement (1 June 2007). Blueprints Q & As for step 2. Lippincott Williams & Wilkins. pp. 71–. ISBN 9780781778206. Retrieved 14 November 2010.
11. Almoallim H, Klinkhoff A (January 2005). "Longterm outcome of treatment of Felty's syndrome with intramuscular gold: case reports and recommendations for management". J. Rheumatol. 32 (1): 20–6. PMID 15630719.
12. synd/1774 at Who Named It?
13. A. R. Felty. Chronic arthritis in the adult, associated with splenomegaly and leucopenia. A report of 5 cases of an unusual clinical syndrome. Bulletin of the Johns Hopkins Hospital, Baltimore, 1924, 35: 16.

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.