Felty's syndrome presenting without arthritis.

A patient with splenomegaly, severe granulocytopenia and a strongly positive rheumatoid factor test initially had no clinical evidence of rheumatoid arthritis. Leukopenia responded to splenectomy and did not recur during one year of follow up. Symmetrical metacarpophalangeal joint swelling developed after nine months. This case emphasizes that arthritis may occasionally be a late and minor manifestation of Felty's syndrome.