FS is a rare extra-articular manifestation of rheumatoid arthritis (RA) and is estimated to occur in <1% of RA patients.[5]Sibley JT, Haga M, Visram DA, et al. The clinical course of Felty's syndrome compared to matched controls. J Rheumatol. 1991;18:1163-1167.
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True FS prevalence is difficult to ascertain because many affected patients remain asymptomatic. In addition, with the advent of early and intensive suppression of RA disease activity with disease-modifying antirheumatic drugs (DMARDs) and biologic treatments, FS may now be occurring even less frequently and may be less severe.[6]Almoallim H, Klinkhoff A. Longterm outcome of treatment of Felty's syndrome with intramuscular gold: case reports and recommendations for management. J Rheumatol. 2005;32:20-26.
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FS tends to occur in the fifth to seventh decades of life, with a female-to-male ratio of 1.6:1.[2]Campion G, Maddison PJ, Goulding N, et al. The Felty syndrome: a case-matched study of clinical manifestations and outcome, serologic features, and immunogenetic associations. Medicine (Baltimore). 1990;69:69-80.
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It is uncommon in children and in people of black ancestry.[7]Rosenstein ED, Kramer N. Felty's and pseudo-Felty's syndromes. Semin Arthritis Rheum. 1991;21:129-142.
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The HLA-DR4 antigen is strongly associated with FS, so these patients tend to have a strong family history of RA.[3]Balint GP, Balint PV. Felty's syndrome. Best Pract Res Clin Rheumatol. 2004 Oct;18(5):631-45.
http://www.ncbi.nlm.nih.gov/pubmed/15454123?tool=bestpractice.com
In patients with FS, RA is typically present, on average, 10 to 20 years before neutropenia develops.[2]Campion G, Maddison PJ, Goulding N, et al. The Felty syndrome: a case-matched study of clinical manifestations and outcome, serologic features, and immunogenetic associations. Medicine (Baltimore). 1990;69:69-80.
http://www.ncbi.nlm.nih.gov/pubmed/1969604?tool=bestpractice.com