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Felty's syndrome is characterized by three features: rheumatoid arthritis, splenomegaly (enlarged spleen), and decreased levels of platelets (cells important in blood clotting) or decreased numbers of neutrophils (white blood cells important in inflammation). This triad of conditions is present in one percent of patients with rheumatoid arthritis. Low levels of platelets and other complications can require splenectomy (removal of spleen), placing these patients at risk for severe sepsis (systemic infection). A case is described of a 32-year-old woman with Felty's syndrome who developed pneumococcal septic arthritis following splenectomy. Pneumococcal infections are caused by a group of 85 or more types of bacteria, and can result in pneumonia or other serious infections. Recovery occurs as the immune system develops antibodies against the specific type of infecting bacteria. The risk for developing severe pneumococcal sepsis after splenectomy is high among patients with Felty's syndrome. Most individuals, including this patient, are given pneumococcal vaccine prior to surgery to promote the formation of antibodies against the major types of pneumococcal bacteria. It is possible that this woman, like some other patients with rheumatoid arthritis, responded ineffectively to immunization. She developed septic arthritis of the knees and an unusual complication that was diagnosed as pneumococcal-associated kidney disease. She was treated with penicillin for six months, and arthritis and kidney function gradually improved. Blood tests showed that the patient had produced antibodies against only 2 of the 23 types of pneumococci molecules in the vaccine, but had vigorously responded to the infecting bacteria. The case indicates the potential risk of pneumococcal infection among patients with Felty's syndrome who undergo splenectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

The synthetic drug inosine pranobex is capable of modulating the immune system, and has been used to treat various viral diseases, including herpes simplex infections. Inosine pranobex has been shown to improve some symptoms of rheumatoid arthritis, such as morning stiffness, and is well-tolerated by patients, but may increase blood levels of urate. Rheumatoid arthritis (RA) is a joint disease characterized by inflammation of the joints, stiffness, swelling, overgrowth of cartilage tissue, and pain. The effectiveness of inosine pranobex in treating RA was assessed in 24 patients with RA who were given this drug for 24 weeks; 26 patients were given a placebo, a substance with no known therapeutic effect for the same time period. Various indicators of RA, such as morning stiffness, articular index, grip strength, pain score, erythrocyte sedimentation rate, C reactive protein, levels of immunoglobulins G and M, and blood urate levels were measured at the start of the study, and at 12 and 24 weeks thereafter. Before the study, all indicators of RA were similar for both the treated and untreated groups, with the exception of C reactive protein, which was greater in the placebo group than in patients treated with inosine pranobex. C reactive protein is an abnormal protein present in the blood during active disease activity. Inosine pranobex did not improve any of the symptoms of RA, but did increase blood levels of urate. The results show that inosine pranobex is ineffective in treating RA. (Consumer Summary produced by Reliance Medical Information, Inc.)