Reader’s Digest Canada – September 2019

Stay Open

I always say, “Don’t make plans, make options.”

JENNIFER ANISTON, ACTOR

specialists who’d interacted with Sha-

ron over the preceding couple of weeks

had noted her slightly crooked hands,

or ulnar deviation. This type of deform-

ity is caused by a problem in the joints

and can make the fingers look like

they’re all bending toward the pinky. It’s

most often seen in people with rheuma-

toid arthritis (RA). Sharon’s high inflam-

matory markers would be consistent

with RA, but she’d never experienced

other classic signs, like joint swelling

and redness—only the mild aches.

Less than one per cent of people

with long-standing, uncontrolled RA

develop a condition called Felty syn-

drome, in which the spleen is enlarged

and white counts are abnormally low.

Because it’s so rare, especially now that

there are effective treatments for RA,

Sharon’s doctors had focused on inves-

tigating more common conditions.

But now they did a CT scan of her

abdomen, and there it was: a swollen

spleen. They tested Sharon for an anti-

body often found in the blood of peo-

ple with RA, and it was positive.

It’s highly unusual for doctors to

find Felty syndrome in someone who

doesn’t even know they have RA. “Felty

is normally seen after years and years

of destructive arthritis,” says Nimri. But

since Sharon never had checkups and

didn’t experience many symptoms, it

was missed.

Sharon’s RA has proven tough to con-

trol with medications, and she’s had

more infections, though none as serious

as the first one. Dr. Mohamed Abdallah,

who also treated Sharon, says a quarter

of patients with Felty syndrome require

removal of the spleen altogether, and

this may end up being the best solution

for her. In the meantime, Sharon is feel-

ing well enough to be back at work.

For her part, Nimri has a new appre-

ciation for subtle physical clues in a

patient. “Some of the physicians spot-

ted Sharon’s ulnar deviation, and we

initially didn’t think much of it,” she

says. “Lab tests are helpful, and they

save time, but I’ve learned not to

underestimate the role of the physical

exam in reaching a diagnosis.”

FOR HER PART,

DR. NIMRI HAS A NEW

APPRECIATION FOR

SUBTLE PHYSICAL

CLUES IN A PATIENT.

reader’s digest

26 september 2019